Abstract
Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003–2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and 30 kg/m2 (obese) were used to categorize pregnant women’s weight status. Diet quality during pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2–11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2–11.7, AOR 5.4; 95% CI 2.0–14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p < 0.05). Serum iron concentration (ng/dL) was significantly higher in normal weight women compared to overweight women (86.2 ± 5.0 vs. 68.9 ± 3.0, p < 0.05). An inverse association was found between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those women entering pregnancy as overweight and obese.
Highlights
Maternal diet before and during pregnancy may play an important role in maternal, neonatal, and child health outcomes [1,2]
Overweight and obesity status before pregnancy has been found to be associated with excessive gestational weight gain [7], which in turn is associated with postpartum weight retention [8]
Fifty-nine percent had more than a college level education, 39% were in their third trimester of pregnancy, 9% were smokers during pregnancy, and 35% engaged in light leisure-time physical activities during pregnancy (Table 2)
Summary
Maternal diet before and during pregnancy may play an important role in maternal, neonatal, and child health outcomes [1,2]. Pregnant women require additional folate and iron before and during pregnancy to meet their own needs and optimize birth outcomes [3]. Nutrients 2016, 8, 162 birth and low birth weight have been associated with inadequate folate intake [4] and iron deficiency during pregnancy [5]. In the United States, women of childbearing age who are overweight or obese had lower serum concentrations of folate compared to those women with underweight and normal weight [6]. Adverse birth outcomes have been associated with pre-pregnancy overweight and obesity and inadequate maternal nutrition during pregnancy. Overweight and obesity status before pregnancy has been found to be associated with excessive gestational weight gain [7], which in turn is associated with postpartum weight retention [8]
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