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)

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Summary

Introduction

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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