Diet Quality and Weight Outcomes During Pregnancy and Postpartum: Relations with Dietary Restraint and Eating Competence

Abstract

Abstract Objectives Dietary restraint has been associated with greater gestational weight gain, but it is not known whether eating competence – a constellation of contextual skills, positive eating attitudes, food acceptance, and internal regulation – may mitigate this. This study examined associations of eating competence and restraint, and their interaction, with diet quality and weight during pregnancy and postpartum. Methods Participants (n = 292) completed the ecSatter Inventory (eating competence) and Dutch Eating Behavior Questionnaire (dietary restraint) in early pregnancy and 6-months postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI, and adequacy and moderation components) were calculated by pooling 24-hour diet recalls during each pregnancy trimester and during 2, 6, and 12 months postpartum. Linear and logistic regressions examined associations of eating behaviors with diet quality, excessive gestational weight gain, and postpartum weight retention, adjusted for sociodemographic covariates and parity. Multiplicative interaction terms tested the interaction of eating competence and restraint on diet quality and weight outcomes. Results During both pregnancy and postpartum, higher HEI was associated with greater eating competence (b = 0.33 ± 0.09, P < .001 and b = 0.26 ± 0.12, P = .03, respectively) and dietary restraint (b = 2.23 ± 1.00, P < .001 and b = 3.56 ± 1.27, P = .006, respectively). These associations were more consistently observed in adequacy versus moderation components. Eating competence was inversely associated with early pregnancy BMI (b = −0.15 ± 0.04, P = .001) but was not associated with gestational weight gain or postpartum weight retention. Restraint was not associated with weight outcomes. No interaction of eating competence with restraint on diet or weight outcomes was observed. Conclusions These findings suggest positive eating-related skills may be a promising intervention target. While some studies have linked dietary restraint with weight gain, we observed a positive association of restraint with diet quality and no association with weight outcomes. Consistency of these findings across the range of eating competence suggests dietary restraint may not promote obesogenic eating habits during pregnancy and postpartum. Funding Sources This research was supported by the NICHD Intramural Research Program.