Abstract
Interventions to promote healthy pregnancy in women with obesity by improving diet quality have been widely unsuccessful. We hypothesized that diet quality is determined by eating behaviors, but evidence in women with obesity is lacking. We evaluated diet quality and eating behavior in 56 women with obesity (mean ± SEM, 36.7 ± 0.7 kg/m2, 46% White, 50% nulliparous) early in pregnancy (14.9 ± 0.1 weeks). Diet quality was objectively assessed with food photography over six days and defined by Healthy Eating Index. Eating behaviors were assessed by validated questionnaires. Women reported consuming diets high in fat (38 ± 1% of energy) and the HEI was considered “poor” on average (46.7 ± 1.3), and for 71% of women. Diet quality was independently associated with education level (p = 0.01), food cravings (p < 0.01), and awareness towards eating (p = 0.01). Cravings for sweets and fast foods were positively correlated with respective intakes of these foods (p < 0.01 and p = 0.04, respectively), whereas cravings for fruits and vegetables did not relate to diet intake. We provide evidence of the determinants of poor diet quality in pregnant women with obesity. Based on this observational study, strategies to improve diet quality and pregnancy outcomes are to satisfy cravings for healthy snacks and foods, and to promote awareness towards eating behaviors.
Highlights
Poor quality of maternal diet is considered one of the most significant predictors of adverse pregnancy outcomes [1,2,3,4,5] and poor infant health [5,6,7,8,9]
Among women with normal weight or who are overweight, improvements in maternal diet quality reduced the prevalence of adverse outcomes including excess gestational weight gain [12,13], gestational diabetes, and hypertensive disorders in mothers [2] and macrosomia in infants [14]
To develop more successful behavioral interventions for women with obesity requires an understanding of determinants of poor diet quality, i.e., consumption of specific food groups, mindful eating, or food cravings
Summary
Poor quality of maternal diet is considered one of the most significant predictors of adverse pregnancy outcomes [1,2,3,4,5] and poor infant health [5,6,7,8,9]. In women with obesity, successful dietary interventions are seldom reported, likely due to small effects on diet quality [14,15,16,17]. To develop more successful behavioral interventions for women with obesity requires an understanding of determinants of poor diet quality, i.e., consumption of specific food groups, mindful eating, or food cravings. Others have shown in 24 h recalls, that poor diet quality of women with
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