Association Between Diet Quality & Rate of Gestational Weight Gain Among Pregnant Women in Dhulikhel, Nepal

Abstract

Abstract Objectives The National Academy of Medicine (NAM) guidelines recommend linear gestational weight gain (GWG) in the 2nd and 3rd trimester with appropriate rate defined based on pre-pregnancy BMI. Here we prospectively examined the association between diet quality and GWG rate from 2nd to 3rd trimester among women receiving prenatal care in a periurban hospital in Nepal. Methods A pilot cohort of singleton pregnant women (N = 101; age 25.9 ± 4.1 years) was recruited from a tertiary, periurban hospital in Nepal. In the 1st trimester, diet quality was assessed from the adapted Nepali version of the PrimeScreen questionnaire, which assigned diet quality scores (range 0–42; higher scores for better quality) based on consumption frequency of 12 healthy and 9 unhealthy food groups. The GWG rate was calculated as the measured weight at the early-to-mid 3rd trimester (28–35 wks) minus the weight at 2nd trimester (13–25 wks), divided by the number of weeks in between. Linear regression estimated the association between diet quality and GWG rate, adjusting for a priori covariates including age, education, ethnicity, pre-pregnancy BMI, and nausea/vomiting. The adequacy of GWG rate was also categorized as inadequate, adequate, or excessive using NAM guidelines. Results Most women were of normal (55.4%) or overweight (33.7%) BMI status pre-pregnancy. The mean GWG rate in mid-to-late pregnancy was 0.46 ± 0.2 kg/wk and the mean diet quality score was 23.6 ± 2.5. Based on pre-pregnancy BMI, 49.4% of women had excessive GWG rate, while nearly equal numbers had either adequate GWG or inadequate GWG rate. Pre-pregnancy BMI and GWG rate were inversely correlated (r = −0.21, P = 0.049). Education level was positively associated with both GWG rate (P = 0.01) and adequacy of GWG (P = 0.02). There was no significant association between diet quality and the GWG rate [adjusted β (95% CI) = −0.02 (−0.05, 0.01); P = 0.14]. The mean GWG rate was marginally lower (0.44 vs. 0.57 kg/wk; P = 0.06) among those with high versus low (2 + servings vs. 0–1 serving/wk) intake of red meat; similar findings were seen when comparing red meat intake between women with excessive versus adequate GWG (Cramer's V = 0.2; P = 0.06). Conclusions While overall diet quality is not related to GWG among Nepali women, a high intake of red meat may be a potential risk factor for excessive GWG in this population. Funding Sources Rutgers Global Health Institute.