Pre-pregnancy Dietary Patterns Research Articles

Dietary patterns and their associations with postpartum weight retention: results of the MINA cohort study.

To examine the association of prepregnancy dietary patterns with postpartum weight retention at 6months (PPWR6) among Lebanese and Qatari women. Data for this study were derived from the Mother and Infant Nutrition Assessment (MINA) prospective cohort study conducted in Lebanon and Qatar. Pregnant women were recruited during their first trimester and were followed up for three years. For the purpose of this study, data belonging to sociodemographic characteristics of participants, prepregnancy dietary intake, prepregnancy BMI as well as weight retention at 6months were used. Dietary intake was examined using a 98-item food frequency questionnaire. Principal component analysis was used for the derivation of dietary patterns. The associations of dietary patterns with PPWR6 were examined using simple and multiple linear regressions. Data was available for 177 participants (Lebanon: 93; Qatar: 84). Mean PPWR6 was 4.05 ± 5.29kg. Significantly higher PPWR6 was observed among participants with pre-pregnancy overweight/obesity and among those with excessive gestational weight gain. Two dietary patterns were identified: the "Western" and the "Varied" patterns. After adjustment for confounders, a positive association was observed between the 'Western' pattern scores and PPWR6 (ß = 1.27; 95% CI 0.68-1.86; p value: < 0.0001). Higher adherence to the Western pattern was associated with higher PPWR6 amongst women, hence underscoring the importance of public health interventions aimed at fostering healthier dietary habits during this crucial stage of the lifecycle.

Effects of prepregnancy dietary patterns on infant birth weight: a prospective cohort study

Background Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns. Objectives This study aimed to explore the effects between prepregnancy dietary patterns on birth weight. Methods This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother–Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI). Results Four dietary patterns were identified based on 15 food groups. These patterns were named as “cereals–vegetables–fruits,” “vegetables–poultry–aquatic products,” “milk–meat–eggs,” and “nuts–aquatic products–snacks.” After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the “cereals–vegetables–fruits” pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the “nuts–aquatic products–snacks” pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, “cereals–vegetables–fruits” pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480). Conclusions An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy.

Pre-pregnancy dietary pattern is associated with newborn size: results from ProcriAr study.

Babies born small-for-gestational age (SGA) have an increased risk of mortality, morbidity and adverse functional consequences. Studies suggest that pre-pregnancy maternal diet may influence newborns' size. This study aimed to determine whether maternal pre-pregnancy dietary patterns (DP) are associated with delivering SGA newborns in the ProcriAr Cohort Study, Sao Paulo-Brazil. Pre-pregnancy DP of 299 women were investigated using factor analysis with principal component's estimation, based on intake reported on a validated 110-item FFQ. Newborns were classified as SGA if their weight and/or length, adjusted by gestational age and sex, were below the 10th percentile of the INTERGROWTH-21st standards. Multivariate Poisson regression modelling with robust error variance was performed to examine associations between the different DP (in quintiles) and SGA. In a model adjusted by maternal sociodemographic and health behaviours, women who scored in the highest quintile of the DP 'Snacks, sandwiches, sweets and soft drinks' (in relation to the women who scored in the lowest quintile) were significantly more likely to deliver SGA babies (relative risk 1·92; 95 % CI 1·08, 3·39). This study verified that women's pre-pregnancy dietary behaviour characterised by an energy-dense nutrient-poor food intake was a risk factor for delivering SGA newborns. Investments in education and improved access to healthful food and nutritional information before pregnancy should be prioritised due to their potential positive impact on child health. However, further studies are warranted to identify specific metabolic pathways that may be underlying these associations.

Prepregnancy dietary patterns and risk of preterm birth and low birth weight: findings from the Australian Longitudinal Study on Women’s Health

Findings from previous studies on associations between prepregnancy dietary patterns and preterm birth and low birth weight (LBW) are limited and inconsistent. To examine the association between prepregnancy dietary patterns and the risk of preterm birth and LBW. This study included 3422 and 3508 singleton live births from the Australian Longitudinal Study on Women's Health (ALSWH) for the analyses of preterm birth and LBW, respectively. We included women who were nulliparous and nonpregnant at baseline surveys. We used factor analyses and the Healthy Eating Index-2015 (HEI-2015) score to derive maternal dietary patterns. Four dietary patterns were identified with factor analyses: meats and high-fats; prudent diets; sugar, refined grains, and processed foods; and traditional vegetables. Preterm birth and LBW were assessed using maternal reports from ALSWH data between 2003 and 2015. Multivariable logistic regression analyses were used. Greater adherence to the traditional vegetables pattern before pregnancy was associated with a lower risk of preterm birth and spontaneous preterm birth after adjustments for lifestyle factors and pregnancy complications, highest compared with lowest tertile (adjusted OR=0.72, 95% CI: 0.53, 0.99) and (RR ratio=0.62, 95% CI: 0.39, 1.00), respectively. However, these associations were attenuated by the prepregnancy BMI. No significant associations were observed between prepregnancy dietary patterns and LBW. This study suggests that better adherence to the traditional vegetables pattern before pregnancy is associated with a lower risk of preterm birth, particularly spontaneous preterm birth among nulliparous women. This finding warrants further examination.

Risk factors for congenital heart disease: The Baby Hearts Study, a population-based case-control study.

We investigated the role of maternal environmental factors in the aetiology of congenital heart disease (CHD). A population-based case-control study (242 CHD cases, 966 controls) was conducted using an iPad questionnaire for mother with linkage to maternity and first trimester prescription records. Risk of CHD was associated with low maternal education (OR adjusted for confounders 1.59; 95% confidence interval [CI], 1.02–2.49), pregestational diabetes (OR 4.04; 95% CI 1.00–16.28), self-reported maternal clotting disorders (adjOR 8.55, 95%CI 1.51–48.44), prescriptions for the anticlotting medication enoxaparin (adjOR 3.22, 95%CI 1.01–10.22) and self-reported vaginal infections (adjOR 1.69, 95%CI 1.01–2.80). There was no strong support for the hypothesis that periconceptional folic acid supplements have a protective effect, but there was a protective effect of frequent consumption of folate rich fruits (adjOR 0.64, 95%CI 0.47–0.89). Compared to the most common pre-pregnancy dietary pattern, CHD risk was associated with a poor diet low in fruit and vegetables (adjOR 1.56, 95%CI 1.05–2.34). Mothers of cases reported more pregnancy related stress (adjOR 1.69; 95% CI 1.22–2.34) and multiple stressors (adjOR 1.94, 95%CI 0.83–4.53). We found no supportive evidence for CHD risk being associated with obesity, smoking, depression or antidepressant use in this population. Our findings add to the previous evidence base to show potential for public health approaches to help prevent CHD in future by modifying environmental factors. Independent confirmation should be sought regarding elevated CHD risk associated with maternal blood clotting disorders and their treatment, since we are the first to report this.

Association between pre-pregnancy body weight and dietary pattern with large-for-gestational-age infants in gestational diabetes

BackgroundBoth obesity and gestational diabetes (GDM) are associated with adverse outcomes. Diet during pregnancy impacts weight gain and fetal growth. Therefore, we aimed to explore non-pharmacological treatment success depending on pre-pregnancy body weight and its association with large for gestational age (LGA) infants in women with GDM.MethodsIn our observational study we investigated 57 singleton pregnant women with GDM. All women received standard treatment, including healthy diet education and regular medical checkups. Data were collected through blood analysis, medical records and questionnaires assessing diet before conception and during pregnancy. Differences in dietary patterns were compared in normal weight and overweight/obese group using Mann–Whitney U, Wilcoxon Signed Rank Test or Kruskal–Wallis test, as appropriate. Logistic regression was used for prediction of LGA. p-value less than 0.05 was used for statistical significance.ResultsPreconceptionally, the Mann–Whitney U test showed that the normal-weight group (n = 41) more frequently consumed fruits (U = 116.5, p < 0.001), eggs (U = 189.5, p = 0.02), cheese (U = 148.0, p = 0.003) compared to the overweight/obese group (n = 16), that consumed more beef (U = 407.0, p = 0.03) and low-calorie beverages (U = 397.0, p = 0.05). During pregnancy both groups improved their diet, with no differences detected. Personality types differed only preconceptionally with regard to healthy diet. Excessive gestational weight gain did not significantly differ between body-weight groups (16.6% vs. 23.1%), neither did the incidence of LGA infants (46.2% vs. 43.8%). Significant predictors of LGA were paternal height (OR = 1.12, 95% CI 1.01–1.23), 3rd trimester HbA1c (OR = 0.50, 95% CI 0.26–0.97), unemployment (OR = 4.80, 95% CI 1.12–20.61) and diet improvement during pregnancy (OR = 1.19, 95% CI 1.02–1.39). After adjustment improvement in diet was no longer a significant predictor for LGA.ConclusionEven though dietary patterns of the participants significantly improved during pregnancy, LGA infants were born independently of pre-pregnancy weight or diet and despite good glycemic control. Further research is needed to explore social determinants of health and whether solutions outside the health sector could provide efficient means in preventing adverse pregnancy outcomes as well as improving metabolic health.

Robust Clustering With Subpopulation-Specific Deviations

The National Birth Defects Prevention Study (NBDPS) is a case-control study of birth defects conducted across 10 U.S. states. Researchers are interested in characterizing the etiologic role of maternal diet, collected using a food frequency questionnaire. Because diet is multidimensional, dimension reduction methods such as cluster analysis are often used to summarize dietary patterns. In a large, heterogeneous population, traditional clustering methods, such as latent class analysis, used to estimate dietary patterns can produce a large number of clusters due to a variety of factors, including study size and regional diversity. These factors result in a loss of interpretability of patterns that may differ due to minor consumption changes. Based on adaptation of the local partition process, we propose a new method, robust profile clustering, to handle these data complexities. Here, participants may be clustered at two levels: (1) globally, where women are assigned to an overall population-level cluster via an overfitted finite mixture model, and (2) locally, where regional variations in diet are accommodated via a beta-Bernoulli process dependent on subpopulation differences. We use our method to analyze the NBDPS data, deriving prepregnancy dietary patterns for women in the NBDPS while accounting for regional variability. Supplementary materials for this article, including a standardized description of the materials available for reproducing the work, are available as an online supplement.

Prepregnancy Dietary Patterns and Their Association with Perinatal Outcomes: A Prospective Cohort Study

BackgroundDietary intake may be associated with neonatal outcomes, yet little is known about the influence of prepregnancy dietary pattern (DP). ObjectivesTo evaluate the association between prepregnancy DPs and perinatal outcomes. DesignProspective cohort study during pregnancy (baseline between 5 and 13 gestational week and three follow-up visits: 20 to 26 gestational weeks, 30 to 36 gestational weeks, and 30 to 40 days postpartum, respectively). Diet was assessed in the first trimester using a food frequency questionnaire and having prepregnancy as the time frame. Participants/settingTwo hundred fifty-three pregnant women met the following eligibility criteria (20 to 40 years of age, 5 to 13 weeks of gestation at baseline, free of chronic [except obesity] or infectious diseases, and with a singleton pregnancy). The final sample was composed of 193 pregnant women attending a public health care center in Rio de Janeiro, Brazil, from 2009 to 2012. Main outcome measuresType of delivery, large for gestational age (LGA), birth length (BL)>90th percentile, Apgar score<7 at 1 minute, and preterm birth. Statistical analysesReduced rank regression was used to identify prepregnancy DPs that explain the following response variables: fiber density (daily dietary fiber intake in grams, divided by total daily energy intake in kilocalories), dietary energy density, and percent energy from saturated fat. Statistical analyses included multiple logistic regression models. The following covariates were defined as confounders based on a unique Direct Acyclic Graph for each outcome: maternal age, current smoker, alcohol consumption, years of education, and first-trimester leisure physical activity. ResultsThe prevalence of normal delivery was 56.7%. LGA occurred in 16%, BL>90th percentile in 24.3%, Apgar score<7 at 1 minute in 14.2%, and preterm birth in 9.5% of the study population. Three DPs were identified: “fast food and candies” was associated with higher odds of LGA (odds ratio [OR]=4.38, 95% CI: 1.32 to 14.48) and BL>90th percentile (OR=4.81, 95% CI: 1.77 to 13.07); “beans, bread, and fat” was inversely associated with Apgar score<7 at 1 minute (OR=0.14, 95% CI: 0.03 to 0.70); and “vegetables and dairy” was inversely associated with preterm birth (OR=0.24, 95% CI: 0.06 to 0.97). There was no association between adherence to DPs and type of delivery. ConclusionsHigher adherence to fast food and candies prepregnancy DP increased the odds of LGA birth, while a higher adherence to vegetables and dairy DP decreased the odds of preterm birth.

The relationship between pre-pregnancy dietary patterns adherence and risk of gestational diabetes mellitus in Iran: A case-control study.

The present study aimed to investigate major dietary patterns and their association with risk of gestational diabetes mellitus (GDM) in Yazd city located in Iran. This case-control designed study was conducted at six healthcare centres. Two hundred and seventy-eight pregnant women who referred for GDM screening participated. Dietary assessment was carried out by using a 67-item validated food frequency questionnaire to evaluate dietary history of participants during the last year. Principal component analysis was used to identify major food patterns. Multivariable logistic regression model was employed to identify the association between dietary patterns and risk of GDM. Two major dietary patterns were detected. The Western dietary pattern was associated with higher intakes of sugar-sweetened beverages, refined grain products, fast foods, salty snacks, sweets and biscuit, mayonnaise and saturated oils, while the prudent dietary pattern was associated with higher intakes of fruits, low-fat dairy, potato, egg, fish, poultry, nuts, organs meat and red meat. Furthermore, prudent dietary pattern was negatively associated with GDM risk (OR = 0.88, 95% CI: 0.44-0.99). However, there was no significant association between adherence of the Western dietary pattern and risk of GDM. Pre-pregnancy adherence of the prudent dietary pattern was significantly associated with reduced risk of GDM.

Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications.

Few studies have explored pre-pregnancy diet and its relationship with pregnancy outcomes. The objectives of this study were to: (1) derive pre-pregnancy dietary patterns for women enrolled in a prospective cohort in the province of Alberta, Canada; (2) describe associations between dietary patterns and socio-demographic characteristics; and (3) describe associations between dietary patterns and pregnancy complications. Upon enrolment into the Alberta Pregnancy Outcomes and Nutrition (APrON) study (median age of gestation, 17 weeks), women (n = 1545) completed a validated 142-item food frequency questionnaire recording food and beverages consumed “in the 12 months prior to pregnancy”. Other assessments included pre-pregnancy body mass index (BMI), gestational weight gain, gestational hypertension, gestational diabetes, and socio-demographic characteristics. Dietary patterns were derived using principal components analysis. Scores were calculated to represent adherence with each dietary pattern retained. Four dietary patterns were retained, accounting for 22.9% of the variation in the overall diet. Dietary patterns were named the “healthy”, “meat and refined carbohydrate”, “beans, cheese and salad” or “tea and coffee” patterns. Higher “healthy” pattern scores prior to pregnancy were associated with lower odds of developing gestational hypertension during pregnancy (adjusted Odds Ratio (OR): 0.6, 95% Confidence Intervals (CI): 0.4, 0.9). Diet prior to pregnancy is an important target for interventions and may reduce the likelihood of developing complications such as gestational hypertension during pregnancy.

Dietary patterns are influenced by socio-demographic conditions of women in childbearing age: a cohort study of pregnant women.

BackgroundWomen’s health during their reproductive years and whilst pregnant has implications for their children’s health, both in utero and during childhood. Associations of women’s pre-pregnancy dietary patterns (DP) with maternal socio-demographic characteristics and nutrient intake were investigated in ProcriAr cohort study in São Paulo/Brazil, 2012.MethodsThe DPs of 454 women were investigated by principal component factor analysis, using dietary information from a validated 110-item food frequency questionnaire. Multiple linear regression models identified independent associations between DPs and maternal socio-demographic characteristics and Spearman’s correlation determined associations between DPs and nutrients intake.ResultsParticipants’ mean age was 26.1 years (standard deviation = 6.3), 10.3% had more than 8 years of formal education, 30% were migrants from outside of the Southeast of Brazil, 48% were employed, 13% were smokers, and 51% were overweight/obese. Four DPs were derived: ‘Lentils, whole grains and soups,’ ‘Snacks, sandwiches, sweets and soft drinks,’ ‘Seasoned vegetables and lean meats,’ and ‘Sweetened juices, bread and butter, rice and beans’. The ‘Lentils, whole grains and soups’ score was positively related to maternal age, being non-smoker and born in the South, North or Midwest of Brazil. The ‘Snacks, sandwiches, sweets and soft drinks’ score was positively related to higher maternal education, and negatively related to age, lack of formal work and being born in the Northeast region. The ‘Seasoned vegetables and lean meats’ score was positively related to higher maternal education. The ‘Sweetened juices, bread and butter, rice and beans’ score was positively related to unemployment and to no family history of hypertension, and negatively related to maternal overweight and obesity. Dietary intake of fruits and vegetables, foods that require preparation, nutrients from one-carbon metabolism, protein, iron, calcium and vitamin D were correlated with the ‘Seasoned vegetables and lean meats’. Dietary intake of sugar-sweetened and alcoholic beverages, industrialized and takeaway foods, and foods rich in sugar, energy, fat, and synthetic folate were correlated with the ‘Snacks, sandwiches, sweets and soft drinks’.ConclusionsFindings from this study add perspectives to be considered in the implementation of health interventions, which could improve women’s nutritional status and provide an adequate environment for the developing fetus.

Early pregnancy body mass index modifies the association of pre‐pregnancy dietary patterns with serum polyunsaturated fatty acid concentrations throughout pregnancy in Brazilian women

Dietary patterns (DPs) have been described as an important factor that may influence polyunsaturated fatty acid (PUFA) concentrations and body mass index (BMI) during pregnancy. We aim to evaluate the association between pre-pregnancy DPs and serum PUFA percentages throughout pregnancy considering early pregnancy BMI as a possible effect modifier. A prospective cohort of 154 pregnant women was followed (5th-13th, 20th-26th, and 30th-36th gestational weeks). Serum PUFA concentrations (total n-3 and total n-6, eicosapentaenoic+docosahexaenoic acids) were measured in each trimester and expressed as percentages. The n-6/n-3 ratio was calculated. Longitudinal linear mixed-effects models including interaction terms between DPs and early pregnancy BMI were employed. Serum PUFA percentages declined, whereas the n-6/n-3 ratio, monounsaturated, and saturated percentages increased throughout pregnancy for all BMI categories. Three pre-pregnancy DPs were identified by principal component analysis (common Brazilian, healthy, and processed). Overweight women with higher adherence to the common-Brazilian and to the healthy DPs presented reduced n-3 PUFA percentage and increased n-6 percentages and n-6/n-3 ratio compared to under or normal weight women. Obese women with higher adherence to the processed DP presented a more pronounced decrease of total n-3 percentage compared to under or normal weight women. Early pregnancy BMI modified the effect of pre-pregnancy DPs on PUFA profile throughout gestation. Higher adherence to the healthy pattern was associated with increased n-3 percentage, except for overweight women. Only for processed DP was the behaviour of PUFA the same for all BMI categories, showing a worse evolution profile, that is, increased n-6 and reduced n-3 fractions.

Prepregnancy Dietary Patterns Are Associated with Blood Lipid Level Changes During Pregnancy: A Prospective Cohort Study in Rio de Janeiro, Brazil

BackgroundPhysiologic adaptations lead to an increase in blood lipid levels during pregnancy, yet little is known about the influence of prepregnancy dietary patterns. AimTo identify whether prepregnancy dietary patterns that explain the consumption of fiber, energy, and saturated fat are associated with blood lipid levels throughout pregnancy. DesignProspective cohort study, with data collection at gestational weeks 5 to 13, 20 to 26, and 30 to 36. A food frequency questionnaire was administered at baseline (gestational week 5 to 13). Participants/settingWomen with singleton pregnancy (N=299) aged 20 to 40 years, without infectious/chronic disease (except obesity) were enrolled in the study. One hundred ninety-nine women were included in the final analysis. The study took place at a prenatal service of a public health care center in Rio de Janeiro, Brazil, during the period from 2009 to 2012. Main outcome measuresTotal cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglyceride levels, measured at all trimesters. Statistical analyses performedDietary patterns were derived by reduced rank regression. Fiber density, dietary energy density, and percent energy from saturated fat were response variables. Crude and adjusted longitudinal linear mixed-effects regression models were performed to account for confounders and mediators. Interaction terms between dietary pattern and gestational week were tested. ResultsFast Food and Candies; Vegetables and Dairy; and Beans, Bread, and Fat patterns were derived. Our Fast Food and Candies pattern was positively associated with triglyceride level (β=4.961, 95% CI 0.945 to 8.977; P=0.015). In the HDL-C rate of change prediction, significant interactions were observed between both the Fast Food and Candies and Vegetables and Dairy patterns and gestational week (β=–.053, 95% CI –0.101 to –0.004; P=0.035 and β=.055, 95% CI –0.002 to 0.112; P=0.060, respectively). The Beans, Bread, and Fat pattern was not associated with blood lipid levels. ConclusionsPrepregnancy dietary patterns were associated with gestational blood lipid levels; that is, higher scores for the Fast Food and Candies pattern were associated with higher triglyceride and slower HDL-C rates of change during pregnancy, whereas higher scores for the Vegetables and Dairy dietary patterns were associated with faster HDL-C rates of change over gestational weeks.

Pre-pregnancy dietary patterns and risk of gestational diabetes mellitus: results from an Australian population-based prospective cohort study.

We examined the associations between pre-pregnancy dietary patterns and the incidence of gestational diabetes mellitus (GDM) in a population-based cohort study of women of reproductive age. The Australian Longitudinal Study on Women's Health included 3,853 women without pre-existing diabetes who were followed-up between 2003 and 2012. Pre-pregnancy dietary patterns were derived using factor analysis based on 101 food items from a validated food frequency questionnaire. GDM was self-reported and validated in a subsample. Multivariable regression models with generalised estimating equations were used to estimate RR and 95% CI. During 9 years follow-up, 292 GDM cases (4.4%) were documented in 6,626 pregnancies. No associations were found for the 'Fruit and low-fat dairy' and 'Cooked vegetables' patterns. The 'Meats, snacks and sweets' pattern was associated with higher GDM risk after adjustment for socioeconomic, reproductive and lifestyle factors (RR [95% CI] per SD increase in score: 1.38 [1.02, 1.86]). Further adjustment for BMI attenuated the results (1.35 [0.98, 1.81]). In stratified analysis, the 'Meats, snacks and sweets' pattern was associated with significantly higher GDM risk in parous and obese women, and in women with lower educational qualifications. The 'Mediterranean-style' pattern was associated with lower GDM risk in the fully adjusted model (0.85 [0.76, 0.98]). These findings support general dietary recommendations for women of reproductive age to consume a diet rich in vegetables, whole grains, nuts and fish, and low in red and processed meats and snacks. Further prospective studies are needed to confirm these findings.

Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women’s Health

Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk. We investigated associations between prepregnancy dietary patterns and risk of HDPs. We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors. During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar; Mediterranean-style; fruit and low-fat dairy; and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58; 95% CI, 0.42, 0.81). In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs.

Asthma control in pregnancy is associated with pre-conception dietary patterns.

To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy. Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern (Z-score), with values presented as odds ratio and 95 % confidence interval. Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009-July 2013. One hundred and fifty-eight asthmatic pregnant women. Three dietary patterns were identified: (i) 'high protein/fruit' (strong food group loadings for fish, meat, chicken, fruit); (ii) 'high fat/sugar/takeaway' (takeaway foods, crisps, refined grains); and (iii) 'vegetarian-type' (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54; 95 % CI 1·07, 2·23; P=0·022). Women with uncontrolled asthma (n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma (n 43, all P≤0·05). Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond.

Association of Prepregnancy Dietary Patterns and Anxiety Symptoms from Midpregnancy to Early Postpartum in a Prospective Cohort of Brazilian Women

BackgroundAdherence to unhealthy dietary patterns may alter the risk of mental disorders during pregnancy and the postpartum period. ObjectiveTo analyze the association between prepregnancy dietary patterns and prospective variations on anxiety symptoms from midpregnancy to early postpartum. MethodsA prospective cohort of 207 healthy pregnant women was followed at 5 to 13, 20 to 26, and 30 to 36 gestational weeks, and once at 30 to 45 days postpartum. The State-Trait Anxiety Inventory was used to evaluate anxiety symptoms at the second and third gestational trimesters and during the postpartum period. Dietary intake was assessed using a food frequency questionnaire administered during the first trimester of pregnancy that referred to the 6 months before pregnancy. Principal components analysis was used to identify dietary patterns and three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Three longitudinal mixed-effect models were estimated to verify the association between dietary patterns and anxiety symptoms, adjusted for confounding variables. ResultsThe mean anxiety symptom scores were 40.4, 40.5, and 37.2 for the second trimester, third trimester, and postpartum, respectively. The rate of variation of the State-Trait Anxiety Inventory score was 0.535 (95% CI –0.035 to 1.107; P=0.066) and –0.010 (95% CI –0.018 to –0.002; P=0.019) when accounting for gestational age and quadratic gestational age, respectively. The common-Brazilian pattern, comprised mainly of rice and beans (β=–1.200, 95% CI –2.220 to –0.181; P=0.021), and the healthy pattern comprised mostly of vegetables, fruits, fish, and tea (β=–1.290, 95% CI –2.438 to –0.134; P=0.029), were negatively associated with prospective changes in anxiety symptoms. ConclusionsHigh adherence to the common-Brazilian or healthy patterns was negatively associated with higher anxiety symptom scores from mid-pregnancy to early postpartum in this group of Brazilian women.

Prepregnancy dietary patterns and risk of pregnancy loss

Two previous case-control studies observed associations between specific food groups and risk of miscarriage; however, to our knowledge, no previous studies have investigated dietary patterns and risk of pregnancy loss. We aimed to assess prepregnancy adherence to the alternate Healthy Eating Index 2010 (aHEI-2010), alternate Mediterranean diet (aMED), and Fertility Diet (FD) and risk of pregnancy loss. Our prospective cohort study included 15,950 pregnancies reported by 11,072 women in the Nurses' Health Study II between 1992 and 2009. Diet was assessed every 4 y starting in 1991 by using a validated food-frequency questionnaire. Prepregnancy dietary pattern scores were computed as the sum of a woman's score on each pattern's predefined components. Multivariable log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. Incident spontaneous abortions and stillbirths were reported in 2756 (17.3%) and 120 (0.8%) pregnancies, respectively. None of the 3 dietary patterns were associated with risk of pregnancy loss. In the multivariable model, RR of pregnancy loss for a 1-SD increase in score was 1.02 (95% CI: 0.98, 1.05) for the aMED pattern, 1.01 (95% CI: 0.98, 1.05) for the aHEI-2010 pattern, and 0.98 (95% CI: 0.95, 1.01) for the FD pattern. Results were consistent when pregnancy loss was classified as either a spontaneous abortion (loss at <20 wk) or a stillbirth (loss at ≥20 wk). Prepregnancy adherence to several dietary patterns was not associated with risk of pregnancy loss.

Prepregnancy Healthy Dietary Pattern Is Inversely Associated with Depressive Symptoms among Pregnant Brazilian Women

Dietary patterns before pregnancy may be associated with depressive symptomatology during pregnancy. The aim of this study was to identify dietary patterns before pregnancy and to examine the association between these dietary patterns and depressive symptoms during pregnancy. A prospective cohort of 248 healthy pregnant women were followed at 5–13, 20–26, and 30–36 gestational weeks. Dietary intake was obtained by using a food-frequency questionnaire administered between 5 and 13 gestational weeks, which referred to the 6 mo preceding gestation, and factor analysis (principal components) was applied to identify dietary patterns. The Edinburgh Postnatal Depressive Scale (EPDS) was used to evaluate depressive symptoms during 3 follow-up pregnancy points. A multiple linear mixed-effects model was applied to verify the association between dietary patterns and depressive symptoms adjusted for obstetric factors, socioeconomic status, and energy intake. Three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Together, these patterns explained 36.1% of the total percentage of variance; the eigenvalues were 2.88, 2.12, and 1.86, respectively. Mean depressive symptom scores were 9.0 (95% CI: 8.4, 9.6), 7.2 (95% CI: 6.5, 7.8), and 7.0 (95% CI: 6.4, 7.7) for trimesters 1, 2, and 3, respectively. The rate of decrease in depressive symptoms was −0.088/wk (95% CI: −0.115, −0.061; P < 0.001). In the multiple longitudinal linear regression model, the healthy dietary pattern before pregnancy was inversely associated with depressive symptoms (β:−0.723; 95% CI: −1.277, −0.169; P = 0.011). High adherence to the healthy pattern before pregnancy was associated with lower EPDS scores during pregnancy in women from Rio de Janeiro, Brazil.

Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus

Previous studies observed inverse associations of adherence to the alternate Mediterranean (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary patterns with risk of type 2 diabetes; however, their associations with gestational diabetes mellitus (GDM) risk are unknown. This study aimed to assess usual prepregnancy adherence to well-known dietary patterns and GDM risk. Our study included 21,376 singleton live births reported from 15,254 participants of the Nurses' Health Study II cohort between 1991 and 2001. Pregnancies were free of prepregnancy chronic disease or previous GDM. Prepregnancy dietary pattern adherence scores were computed based on participants' usual intake of the patterns' components, assessed with a validated food-frequency questionnaire. Multivariable logistic regressions with generalized estimating equations were used to estimate the RRs and 95% CIs. Incident first-time GDM was reported in 872 pregnancies. All 3 scores were inversely associated with GDM risk after adjustment for several covariables. In a comparison of the multivariable risk of GDM in participants in the fourth and first quartiles of dietary pattern adherence scores, aMED was associated with a 24% lower risk (RR: 0.76; 95% CI: 0.60, 0.95; P-trend = 0.004), DASH with a 34% lower risk (RR: 0.66; 95% CI: 0.53, 0.82; P-trend = 0.0005), and aHEI with a 46% lower risk (RR: 0.54; 95% CI: 0.43, 0.68; P-trend < 0.0001). Prepregnancy adherence to healthful dietary patterns is significantly associated with a lower risk of GDM.