Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women

Is Health Education among the Decisive Factors for the Diet Quality of Pregnant Women in Poland?

Health education (HE), an educational process that leads to increased nutritional awareness and improved health, is one of the factors influencing diet quality (DQ) during pregnancy. The aim was to evaluate the DQ of pregnant women and its determinants considering their HE. The study included 122 pregnant women aged 20-40 years. DQ was assessed using the Kom-PAN^® questionnaire and the Pro-Healthy Diet Index (pHDI). Data collected included dietary habits, socio-demographic data, education level, place of residence, and maternal lifestyle-related characteristics, namely, pre-pregnancy weight, trimester of pregnancy, and pre-pregnancy and pregnancy physical activity (PA). Weekly energy expenditure was determined using the Polish version of the PPAQ questionnaire. HE at school more than tripled the odds of a higher DQ. Women in their second trimester were 54% more likely to have a higher DQ than women in their third trimester of pregnancy. Undertaking pre-pregnancy PA increased the odds of a higher DQ 2.5 times. Comparative analyses performed in a group of women with HE (HEG, n = 33) and without HE (nHEG, n = 89) showed better DQ in the former, but this was still unsatisfactory in health-promoting properties. The results obtained showed that the HE and trimester of pregnancy and pre-pregnancy Pa influenced DQ in pregnant women.

Sources of Variation in Food-Related Metabolites during Pregnancy

The extent to which variation in food-related metabolites are attributable to non-dietary factors remains unclear, which may explain inconsistent food-metabolite associations observed in population studies. This study examined the association between non-dietary factors and the serum concentrations of food-related biomarkers and quantified the amount of variability in metabolite concentrations explained by non-dietary factors. Pregnant women (n = 600) from two Canadian birth cohorts completed a validated semi-quantitative food frequency questionnaire, and serum metabolites were measured by multisegment injection-capillary electrophoresis-mass spectrometry. Hierarchical linear modelling and principal component partial R-square (PC-PR2) were used for data analysis. For proline betaine and DHA (mainly exogenous), citrus foods and fish/fish oil intake, respectively, explained the highest proportion of variability relative to non-dietary factors. The unique contribution of dietary factors was similar (15:0, 17:0, hippuric acid, TMAO) or lower (14:0, tryptophan betaine, 3-methylhistidine, carnitine) compared to non-dietary factors (i.e., ethnicity, maternal age, gestational age, pre-pregnancy BMI, physical activity, and smoking) for metabolites that can either be produced endogenously, biotransformed by gut microbiota, and/or derived from multiple food sources. The results emphasize the importance of adjusting for non-dietary factors in future analyses to improve the accuracy and precision of the measures of food intake and their associations with health and disease.

Identifiable Dietary Patterns of Pregnant Women: A Canadian Sample

Purpose: To estimate the percentage of a sample of pregnant women in Canada following a vegetarian, vegan, low-carbohydrate, gluten-free, Mediterranean, or well-balanced diet, before and during pregnancy and to explore if pregnant women received and were satisfied with nutrition information received from health care providers (HCPs).Methods: Participants were conveniently sampled through Facebook and Twitter. An online survey collected data on sociodemographic characteristics, maternal diet, and whether women received and were satisfied with nutrition information from their HCPs. The McNemar test assessed changes in the proportion of diets followed before and during pregnancy.Results: Of 226 women, most followed a well-balanced diet before (76.9%) and during (72.9%) pregnancy (p = 0.26). Vegetarian, gluten-free, vegan, and low-carbohydrate diets were the least followed diets before and during pregnancy (vegetarian: 7.6% vs 5.3%; gluten-free: 4.9% vs 4.0%; vegan: 2.7% vs 2.2%; low-carbohydrate:4.0% vs 0.4%). Overall, the number of women following restrictive diets before pregnancy was significantly reduced throughout pregnancy (19.1% vs 12.0%, p < 0.001). Only 52.0% of women received nutrition information from their primary HCP, and 35.6% were satisfied with the nutrition information received.Conclusions: Most women followed a well-balanced diet before and during pregnancy and approximately one-third were satisfied with the information received from HCPs.

Dietary Quality and Sociodemographic and Health Behavior Characteristics Among Pregnant Women Participating in the New York University Children's Health and Environment Study

Maternal diet, prior to and during pregnancy, plays an important role in the immediate and long-term health of the mother and her offspring. Our objectives were to assess diet quality among a large, diverse, urban cohort of pregnant women, and examine associations with sociodemographic and health behavior characteristics. Data were from 1,325 pregnant women enrolled in New York University Children's Health and Environment Study (NYU CHES). Diet quality was assessed using the Healthy Eating Index (HEI)-2015. Mean total HEI-2015 score was 74.9 (SD = 8.5); 376 (28%), 612 (46%), 263 (20%), and 74 (6%) of women had scores that fell into the grade range of A/B, C, D, and F, respectively. Mean HEI-2015 component scores were high for fruit and whole grains and low for protein-related, sodium, and fat-related components. In multivariable linear regression models, Hispanic women scored 1.65 points higher on the total HEI-2015 (95% CI: 0.21, 3.10) compared to non-Hispanic White women, while younger age (<30 years), parity, single status, pre-pregnancy obesity, smoking, pre-existing hypertension, moderate/severe depressive symptoms, not meeting physical activity recommendations, and not taking a vitamin before pregnancy were associated with ~1.5–5-point lower mean total HEI-2015 scores. Diet is a modifiable behavior; our results suggest a continued need for pre-conceptional and prenatal nutritional counseling.

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study

Objective: Dietary pattern analysis has emerged as a balanced and realistic approach that reflects how the food is consumed in real life. However, previous studies have overlooked the two important phases in women's life, pregnancy, and lactation. We aimed to explore dietary patterns and their determinants among pregnant and lactating women from marginalized families in rural areas and urban slums of India. Methods: It was a community-based cross-sectional study conducted across four districts of India, one from each region (North, West, East, and South). We used a structured questionnaire to collect data on socio-demographic characteristics and access to nutrition services. The dietary data were collected using a qualitative food frequency questionnaire having 204 food items, which were clubbed into 16 major food groups. The principal component analysis method was employed to identify dietary patterns (prefixed at 4). We used multinomial logistic regression to explore associations of socio-demographic and access to nutrition services' variables with identified dietary patterns. Results: The data of 476 pregnant and 446 lactating women were assessed. Four patterns explained for 54% of the variation in their food intake. The patterns identified were low-mixed vegetarian (19%), non-vegetarian (15%), high-mixed vegetarian (11%), and calorie-rich (9%). The low-mixed diet was rich in rice, roots and tubers, green leafy vegetables, and other vegetables. The non-vegetarian diet was characterized by high loadings for nuts or seeds, chicken, meat or fish, eggs, beverages (milk-based), and snacks. The high-mixed vegetarian diet was rich in cereals other than rice and wheat, pulses, and fruits. The calorie-rich diet had high factor loadings for wheat, butter and oil, sweets, and milk and milk products. Hindus and women who lived in rural areas had higher odds of consuming a low-mixed vegetarian diet and lower odds of a high-mixed vegetarian diet. Working women and those who received nutrition advice during pregnancy or lactation had 2-3 times higher odds of consuming a high-mixed vegetarian diet. Conclusions: A high prevalence of a low-mixed vegetarian diet among women can have adverse pregnancy and birth outcomes. Healthy dietary patterns during pregnancy and lactation are required to meet the increased micro- and macronutrient requirements for improved maternal and child health.

Fruit and vegetable consumption before and during pregnancy and birth weight of new-borns in Japan: the Tohoku medical megabank project birth and three-generation cohort study

BACKGROUND

Associations of fruit and vegetable consumption before and during pregnancy with birth weight of new-borns and the risk of low birth weight (LBW) remain unclear.

METHODS

Between July 2013 and March 2017, we recruited 23,406 pregnant women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study (TMM BirThree Cohort Study). Fruit and vegetable consumption before and during pregnancy was calculated using food frequency questionnaires. Information regarding birth weight was obtained from medical records, and LBW was defined as < 2500 g. We used a multivariable linear regression model and a multivariate logistic regression model to assess associations between fruit and vegetable consumption and birth weight/risk of LBW.

RESULTS

In total, 17,610 women were included in the analysis. Mean birth weight was 3061.8 ± 354.1 g, and 5.4% of the new-borns had LBW. Compared to women in the lowest quartile of fruit consumption between pre- and early pregnancy, women in the highest quartile had heavier new-borns (β = 49.4; 95% CI: 34.1-64.7) and lower risk of LBW (OR: 0.79; 95% CI: 0.65-0.95). Women in the highest quartile of fruit consumption from early to mid-pregnancy also had heavier new-borns (β = 32.3; 95% CI: 17.1-47.6), and they tended to have lower risk of LBW (OR: 0.83; 95% CI: 0.69-1.01). Results of analysing the association between changes in fruit consumption from pre- to mid-pregnancy and birth outcomes revealed that women with continuous high fruit consumption from pre- to mid-pregnancy had heavier new-borns (β = 37.6; 95% CI: 25.0-50.3), but they did not have lower risk of LBW (OR: 0.90; 95% CI: 0.77-1.06). Associations involving vegetable consumption and birth weight/risk of LBW were not observed.

CONCLUSIONS

Fruit consumption before and during pregnancy was positively associated with birth weight of new-borns and negatively associated with risk of LBW.

Food and nutrient intake and adherence to dietary recommendations during pregnancy: a Nordic mother-child population-based cohort

Background

A woman's food intake during pregnancy has important implications not only for herself but also for the future health and well-being of her child. Suboptimal dietary quality has been consistently reported in many high-income countries, reflecting poor adherence to dietary guidelines.

Objective

This study aimed to explore the intake of food and nutrients in a cohort of pregnant women in Norway and their adherence to Nordic Nutrition Recommendations (NNR) and Norwegian food-based guidelines (NFG).

Design

We investigated the dietary intake in 1,674 pregnant women from the mother-child birth cohort, PreventADALL, recruited at approximately 18-week gestational age. Dietary intake was assessed by an electronic validated food frequency questionnaire (PrevFFQ) in the first half of pregnancy.

Results

Total fat intake was within the recommended intake (RI) range in most women; however, the contribution of saturated fatty acids to the total energy intake was above RI in the majority (85.2%) of women. Carbohydrate intake was below RI in 43.9% of the women, and 69.5% exceeded the RI of salt. Intakes of fiber, vegetables, and fish were high in a large part of the population. Many women had a high probability of inadequate intakes of the following key micronutrients during pregnancy: folate (54.4%), iron (49.6%), calcium (36.2%), vitamin D (28.7%), iodine (24.4%), and selenium (41.3%). A total of 22.8% women reported an alcohol intake of >1 g/day, and 4.4% reported an alcohol intake of >10 g/day. Women with higher educational levels showed a tendency towards healthier eating habits, except for higher intakes of alcohol and coffee, compared to women with lower educational level.

Discussion

Excessive saturated fat intake and limited intake of many important micronutrients during pregnancy were common, potentially increasing the risk for adverse pregnancy and birth outcomes.

Conclusions

This study highlights the need for improved nutritional guidance to pregnant women across all educational levels.

Maternal vegetable intake during and after pregnancy

Background

Improved understanding of vegetable intake changes between pregnancy and postpartum may inform future intervention targets to establish healthy home food environments. Therefore, the goal of this study was to explore the changes in vegetable intake between pregnancy and the postnatal period and explore maternal and sociodemographic factors that are associated with these changes.

Methods

We examined sociodemographic, dietary, and health characteristics of healthy mothers 18-43y from the prospective Infant Feeding Practices II cohort (n = 847) (2005–2012). Mothers completed a modified version of the diet history questionnaire, a food-frequency measure, developed by the National Cancer Institute. We created four categories of mothers, those that were: meeting vegetable recommendations post- but not prenatally (n = 121; improved intake), not meeting vegetable recommendations during pregnancy and postnatally (n = 370; stable inadequate), meeting recommendations pre- but not postnatally (n = 123; reduced intake), and meeting recommendations at both time points (n = 233; stable adequate). To make our results more relevant to public health recommendations, we were interested in comparing the improved vegetable intake group vs. stable inadequate vegetable intake group, as well as those that reduced their vegetable intake compared to the stable adequate vegetable intake group. Separate multivariable-adjusted logistic regression were used to examine sociodemographic predictors of improved vs. stable inadequate and reduced vs. stable adequate vegetable intake.

Results

Women with improved vegetable intake vs. stable inadequate smoked fewer cigarettes while women with reduced vegetable intake vs. stable adequate were more likely to experience less pregnancy weight gain. In adjusted models, employed women had greater odds of reduced vegetable intake (OR = 1.64 95% CI 1.14–2.36). In exploratory analyses, employment was associated with greater odds of reduced vegetable intake among low-income (OR = 1.79; 95% CI 1.03–3.1), but not higher income women (OR = 1.31; 95% CI 0.94–1.84). After further adjustment for paid maternity leave, employment was no longer associated with vegetable intake among lower income women (OR: 1.53; 95% CI: 0.76–3.05).

Conclusions

More women with reduced vs. stable adequate vegetable intake were lower income and worked full time. Improved access to paid maternity leave may help reduce disparities in vegetable quality between lower and higher income women.

Effects of consuming date fruits (Phoenix dactylifera Linn) on gestation, labor, and delivery: An updated systematic review and meta-analysis of clinical trials

BACKGROUND

Recent studies have shown that consumption of date fruits during pregnancy and also postpartum period might affect some pregnancy outcomes. We performed an updated systematic review and meta-analysis about the effects of consuming date fruits on gestation, labor, and delivery.

METHODS

Two researchers independently searched the online databases of PubMed, Scopus, Web of Science, Embase, Google Scholar, and EBSCO up to January 2019 for clinical trials examining the effects of date fruits consumption on any types of gestation, labor, and delivery outcomes. A fixed-effects model or random-effects models were applied to pool data, where appropriate. Quality assessment was done by Jadad scale.

RESULTS

In total, 11 and 8 studies were included in the systematic review and meta-analysis. Meta-analysis revealed that date fruit consumption significantly reduced gestation duration (pooled effect size: -0.30, 95% CI: -0.45, -0.15; P < 0.001), increased cervical dilation on admission (pooled effect size: 0.94, 95% CI: 0.88, 1.00; P < 0.001), and shorten duration of first stage of labor (pooled effect size: -50.09, 95% CI: -72.25, -27.93; P < 0.001). Also, it was revealed that date fruit consumption significantly reduced duration of second stage of labor in fixed-effects model (pooled effect size: -9.85, 95% CI: -14.00, -5.70; P < 0.001); however, this effect was not significant in random-effects analysis (pooled effect size: -11.27, 95% CI: -28.23, -5.68; P = 0.193).

CONCLUSIONS

Date fruits intake seems to reduce gestation duration and duration of the first stage of labor, and also increase cervical dilation on admission.

Maternal BMI and weight gain in singleton pregnancies: has something changed in the last decade?

Aim: To assess the trend of the pregravid body mass index (BMI), pregnancy weight gain, and BMI gain in singleton pregnancies delivered at ≥38 completed weeks during the last decade.Materials and methods: We used data from a population-based dataset for the period of 2006-2015. Linear regression was used to assess the relationship between BMI, pregnancy weight gain, and BMI change over time.Results: A total of 70,866 women were included and stratified as primiparous and multiparous. The average BMI in the primiparous women increased 0.52 kg/m² in the past decade, increasing for 0.05 kg/m² every year. The average pregnancy weight gain in this group decreased in this period by 0.7 kg, consequently lowering for 0.07 kg per year, the average BMI change during pregnancy decreased overall by 0.26 kg/m² (0.026 kg/m²/year). However, in multiparous women, the average pregravid BMI did not change over time, but the average pregnancy weight gain decreased by 0.21 kg (0.021 kg/year), and the average BMI change decreased for 0.10 kg/m².Conclusions: Our study showed that the pregravid BMI is increasing in the pregnant primiparous women, but the BMI gain, as well as the pregnancy weight gain, decreased irrespective of parity. Given that the range of differences is not clinically significant, we conclude that pregravid BMI, pregnancy weight gain, and BMI change during pregnancy did not change in the last decade.

Trimester-Specific Assessment of Diet Quality in a Sample of Canadian Pregnant Women

The present study aimed to (1) examine changes in diet quality throughout pregnancy and (2) identify maternal characteristics associated with trimester-specific diet quality. Pregnant women (n = 79) were recruited in their 1st trimester of pregnancy and completed, at each trimester, three web-based 24-hour dietary recalls, from which the Canadian Healthy Eating Index (HEI) was calculated. Physical activity, nutrition knowledge, and socio-demographic web-questionnaires were also completed. Although no variation in total HEI scores was observed across trimesters, we found an overall decrease in the following subscores: adequacy, total fruits and vegetables, unsaturated fats and saturated fats (p < 0.05). In the 1st trimester, overweight and obese pregnant women had a lower diet quality in comparison with normal-weight and underweight women (HEI scores: 63.1 ± 11.9 vs. 68.0 ± 9.3; p = 0.04). In the 3rd trimester, women younger than 28 years old, with no university degree, poorer nutrition knowledge and who reside in an urban setting, had a lower diet quality (p < 0.05). In conclusion, less educated, younger women who reside in an urban setting may be at a higher risk of poor diet quality in late pregnancy and could benefit from public health programs.

Pre-pregnancy and early pregnancy dietary behavior in relation to maternal and newborn health in the Norwegian Fit for Delivery study - a post hoc observational analysis

Background

Randomized controlled trials targeting maternal dietary and physical activity behaviors during pregnancy have generally failed to accomplish reductions in the prevalence of adverse maternal and neonatal outcomes. Interventions carried out during pregnancy could thus be missing the mark in maximizing intervention health benefit.

Objective

To investigate whether pre-pregnancy and early pregnancy dietary behavior as reported at inclusion into the Norwegian Fit for Delivery (NFFD) trial was associated with maternal and neonatal outcomes irrespective of subsequent randomization assignment.

Design

The study is a post-hoc observational analysis of data from a randomized controlled lifestyle intervention. We constructed two diet scores from participant responses to a 43-item questionnaire that addressed dietary behavior in retrospect (pre-pregnancy diet score) and dietary behavior at inclusion (early pregnancy diet score), respectively. The diet scores ranged from 0 to 10, with higher score reflecting healthier dietary behavior. Associations between diet scores and maternal and neonatal health outcomes were estimated in multivariate logistic regression models.

Results

A total of 591 women were eligible for analysis. A one-point increase in pre-pregnancy diet score was associated with lower odds of excessive gestational weight gain (GWG) (odds ratio [OR]_adj: 0.92; 95% confidence interval [CI]: 0.84-1.00, p = 0.050), preterm delivery (OR_adj: 0.81; 95% CI: 0.68-0.97, p = 0.019), and birthweight ≥ 4,000 g (OR_adj: 0.88; 95% CI: 0.78-0.99, p = 0.038). A one-point increase in early pregnancy diet score was associated with lower odds of excessive GWG (OR_adj: 0.88; 95% CI: 0.79-0.97, p = 0.009), preterm delivery (OR_adj: 0.82; 95% CI: 0.67-0.99, p = 0.038), and preeclampsia (OR_adj: 0.78; 95% CI: 0.62-0.99, p = 0.038).

Discussion

Higher diet score either pre-pregnancy or in early pregnancy was protectively associated with excessive GWG and preterm delivery, whereas the protective association with high birthweight was confined to pre-pregnancy diet and with preeclampsia to early pregnancy diet.

Conclusions

Both pre-pregnancy and early pregnancy dietary behavior was associated with important maternal and neonatal health outcomes in the NFFD dataset.

Pilot evaluation of HEAL - A natural experiment to promote obesity prevention behaviors among low-income pregnant women

Instituting interventions during the prenatal period is optimal for early obesity prevention in the child. Healthy Eating Active Living (HEAL) is a six-week, multi-component program to promote breastfeeding, healthy dietary habits, cooking skills and physical activity among Medicaid-eligible pregnant-women in Texas. HEAL is integrated into the healthcare system and offered as a standard-of-care for eligible patients.

METHODS

Preliminary evaluation of this natural experiment conducted from March 2015 through October 2016 informs the initial feasibility, acceptability and effects of the program on participant diet, home nutrition environment, physical activity, and breastfeeding self-efficacy and intentions measured using self-report surveys. Analysis of covariance (ANCOVA) was conducted to evaluate pre- and post-intervention changes, controlling for participants' ethnicity, age, and income level. Interaction effects of session attendance on the outcomes were further assessed.

RESULTS

Of the 329 women who enrolled in HEAL, 210 women completed the pre-post assessment (64% retention rate). Pre-to-post intervention, there were significant increases in availability and intake of fruits and vegetables, self-efficacy towards consuming more fruits and vegetables, and cooking frequency and skills (p < 0.05), and decreased frequency of eating heat and serve foods (p < 0.05). Significant improvements in physical activity, duration of breastfeeding, perceived benefits and intentions to breastfeed were also observed (p < 0.05). Higher attendance of HEAL sessions was associated with better outcomes. Process evaluation demonstrated 95% fidelity of program implementation.

CONCLUSION

HEAL operationalizes clinic-community linkages and shows promise in improving behaviors during pregnancy. Future research warrants the use of a stringent study design with a control group to determine program efficacy.

Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway

OBJECTIVES

To investigate whether the timing of probiotic milk intake before, during early or late pregnancy influences associations with preeclampsia and preterm delivery.

DESIGN

Population based prospective cohort study.

SETTING

Norway, between 1999 and 2008.

PARTICIPANTS

70 149 singleton pregnancies resulting in live-born babies from the Norwegian Mother and Child Cohort Study (no chronic disease, answered questionnaires, no placenta previa/cerclage/serious malformation of fetus, first enrolment pregnancy). Only nulliparous women (n=37 050) were included in the preeclampsia analysis. Both iatrogenic and spontaneous preterm delivery (between gestational weeks 22+0 and 36+6) with spontaneous term controls (between gestational weeks 39+0 and 40+6) were included in the preterm delivery analysis resulting in 34 458 cases.

MAIN OUTCOME MEASURES

Adjusted OR for preeclampsia and preterm delivery according to consumption of probiotic milk at three different time periods (before pregnancy, during early and late pregnancy).

RESULTS

Probiotic milk intake in late pregnancy (but not before or in early pregnancy) was significantly associated with lower preeclampsia risk (adjusted OR: 0.80 (95% CI 0.68 to 0.94) p-value: 0.007). Probiotic intake during early (but not before or during late pregnancy) was significantly associated with lower risk of preterm delivery (adjusted OR: 0.79 (0.64 to 0.97) p-value: 0.03).

CONCLUSIONS

In this observational study, we found an association between timing of probiotic milk consumption during pregnancy and the incidence of the adverse pregnancy outcomes preeclampsia and preterm delivery. If future randomised controlled trials could establish a causal association between probiotics consumption and reduced risk of preeclampsia and preterm delivery, recommending probiotics would be a promising public health measure to reduce these adverse pregnancy outcomes.