Abstract
Linkages between diet and other lifestyle factors may confound observational studies. We used cluster analysis to analyze how the intake of food and nutrients during pregnancy co-varies with lifestyle, clinical and demographic factors in 567 women who participated in the NICE (nutritional impact on immunological maturation during childhood in relation to the environment) birth-cohort in northern Sweden. A food frequency questionnaire, Meal-Q, was administered in pregnancy Week 34, and the reported food and nutrient intakes were related to maternal characteristics such as age, education, rural/town residence, parity, pre-pregnancy smoking, first-trimester BMI, allergy and hyperemesis. Two lifestyle-diet clusters were identified: (1) High level of education and higher age were related to one another, and associated with a diet rich in fruits, vegetables, whole grains and fish, and (2) smoking before pregnancy and higher BMI in early pregnancy were related to one another and associated with a diet that contained white bread, French fries, pizza, meat, soft drinks, candy and snacks. More than half of the women had lower-than-recommended daily intake levels of vitamin D, folate, selenium, and iodine. Complex lifestyle-diet interactions should be considered in observational studies that link diet and pregnancy outcome.
Highlights
While several observational studies have suggested that an adequate intake of micronutrients prevent several adverse pregnancy outcomes, apart from the preventive effect of folic acid supplementation on neural tube defects, randomized controlled studies of such factors are largely lacking [1]
Of the 655 women included in the NICE cohort, 633 received the Meal-Q (Figure 1)
The aims of this study were to give a detailed overview of the dietary intake of specific food items and nutrients in the third trimester of pregnancy in these women, and to correlate the dietary intakes with the different maternal characteristics that have been suggested in the literature to be associated with food intake, i.e., age, education level, residential address, parity, pre-pregnancy smoking, first-trimester body mass index (BMI), allergy, and hyperemesis
Summary
While several observational studies have suggested that an adequate intake of micronutrients prevent several adverse pregnancy outcomes, apart from the preventive effect of folic acid supplementation on neural tube defects, randomized controlled studies of such factors are largely lacking [1]. From studies of populations of persons who suffer from nutrient deficiency, it is known that nutrients such as proteins, iron, zinc, selenium, iodine, folate, vitamin A, choline, and long-chain polyunsaturated fatty acids are important for fetal brain development and cognitive function [2,3]. In the ongoing Nutritional impact on Immunological maturation during Childhood in relation to the Environment (NICE) birth-cohort, the ways in which exposure to different agents during pregnancy and in early life affects the subsequent health status of the infants are being explored. The primary aim of the NICE study is to investigate the effects of exposures to key environmental factors, such as nutrition, microbes, environmental toxins, and lifestyle, during both pregnancy and early childhood on the maturation of the infant’s immune system, as well as on the development of sensitization and allergy, infant growth, neurological development, and oral health [9]. A detailed examination of the maternal diet during pregnancy is an important and an essential component of the NICE cohort, as the maternal diet during pregnancy is associated with many different outcomes, both during pregnancy and during childhood
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