Perspective: Organic food consumption during pregnancy and the potential effects on maternal and offspring health.

Pregnancy represents a critical window for both maternal and child health. Previous studies have shown that the consumption of an organic diet during pregnancy can reduce pesticide exposure compared with the consumption of a conventional diet. It is possible that this could, in turn, improve pregnancy outcomes, because maternal pesticide exposure during pregnancy has been associated with increased risk of pregnancy complications. Organic foods are produced by methods that comply with organic standards, generally restricting the use of agrochemicals, such as synthetic pesticides. In the past few decades, the global demand for organic foods has increased drastically, driven in large part by consumer beliefs that organic foods provide benefits to human health. However, the effects of organic food consumption during pregnancy on maternal and child health have not been established. This narrative review aims to summarize current evidence regarding the consumption of organic foods during pregnancy and the potential effects on short- and long-term health outcomes in mothers and offspring. We performed a comprehensive literature search and identified studies investigating the association between organic food consumption during pregnancy and health outcomes in mothers and their offspring. The outcomes identified from the literature search included pre-eclampsia, gestational diabetes mellitus, hypospadias, cryptorchidism, and otitis media. Although existing studies suggest that consumption of organic foods (overall or a specific kind) during pregnancy may have health benefits, further investigation to replicate the findings in other populations is needed. Moreover, because these previous studies have all been observational and thus may be limited by the potential for residual confounding and reverse causation, causal inference cannot be established. We argue that the next necessary step in this research is a randomized trial to test the efficacy of organic diet intervention in pregnancy on maternal and offspring health.

Organic Food Consumption during Pregnancy and Hypospadias and Cryptorchidism at Birth: The Norwegian Mother and Child Cohort Study (MoBa).

BACKGROUND: The etiologies of the male urogenital anomalies hypospadias and cryptorchidism remain unclear. It has been suggested that maternal diet and environmental contaminants may affect the risk of these anomalies via placental or hormonal disturbances. OBJECTIVES: We examined associations between organic food consumption during pregnancy and prevalence of hypospadias and cryptorchidism at birth. METHODS: Our study includes 35,107 women participating in the Norwegian Mother and Child Cohort Study (MoBa) who delivered a singleton male infant. Information about use of six groups of organically produced food (vegetables, fruit, bread/cereal, milk/dairy products, eggs, and meat) during pregnancy was collected by a food frequency questionnaire. Women who indicated that they sometimes, often, or mostly consumed organic foods in at least one of the six food groups were classified as organic food consumers in analyses. Hypospadias and cryptorchidism diagnoses were retrieved from the Medical Birth Registry of Norway. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression. RESULTS: Seventy-four male newborns were diagnosed with hypospadias (0.2%), and 151 with cryptorchidism (0.4%). Women who consumed any organic food during pregnancy were less likely to give birth to a boy with hypospadias (OR = 0.42; 95% CI: 0.25, 0.70, based on 21 exposed cases) than women who reported they never or seldom consumed organic food. Associations with specific organic foods were strongest for vegetable (OR = 0.36; 95% CI: 0.15, 0.85; 10 exposed cases) and milk/dairy (OR = 0.43; 95% CI: 0.17, 1.07; 7 exposed cases) consumption. No substantial association was observed for consumption of organic food and cryptorchidism. CONCLUSIONS: Consumption of organically produced foods during pregnancy was associated with a lower prevalence of hypospadias in our study population. These findings were based on small numbers of cases and require replication in other study populations.

Reduced risk of pre-eclampsia with organic vegetable consumption: results from the prospective Norwegian Mother and Child Cohort Study.

OBJECTIVE: Little is known about the potential health effects of eating organic food either in the general population or during pregnancy. The aim of this study was to examine associations between organic food consumption during pregnancy and the risk of pre-eclampsia among nulliparous Norwegian women. DESIGN: Prospective cohort study. SETTING: Norway, years 2002-2008. PARTICIPANTS: 28 192 pregnant women (nulliparous, answered food frequency questionnaire and general health questionnaire in mid-pregnancy and no missing information on height, body weight or gestational weight gain). MAIN OUTCOME MEASURE: Relative risk was estimated as ORs by performing binary logistic regression with pre-eclampsia as the outcome and organic food consumption as the exposure. RESULTS: The prevalence of pre-eclampsia in the study sample was 5.3% (n=1491). Women who reported to have eaten organic vegetables 'often' or 'mostly' (n=2493, 8.8%) had lower risk of pre-eclampsia than those who reported 'never/rarely' or 'sometimes' (crude OR=0.76, 95% CI 0.61 to 0.96; adjusted OR=0.79, 95% CI 0.62 to 0.99). The lower risk associated with high organic vegetable consumption was evident also when adjusting for overall dietary quality, assessed as scores on a healthy food pattern derived by principal component analysis. No associations with pre-eclampsia were found for high intake of organic fruit, cereals, eggs or milk, or a combined index reflecting organic consumption. CONCLUSIONS: These results show that choosing organically grown vegetables during pregnancy was associated with reduced risk of pre-eclampsia. Possible explanations for an association between pre-eclampsia and use of organic vegetables could be that organic vegetables may change the exposure to pesticides, secondary plant metabolites and/or influence the composition of the gut microbiota.

Possibilities and considerations when merging dietary data from the world's two largest pregnancy cohorts: the Danish National Birth Cohort and the Norwegian Mother and Child Cohort Study.

OBJECTIVES: To elucidate the research possibilities when merging data on maternal diet from the Danish National Birth Cohort (DNBC) and the Norwegian Mother and Child Cohort Study (MoBa), through comparison of (i) the methodology used for dietary assessment and (ii) the estimated intake of selected food groups in the two cohorts. DESIGN: Qualitative and quantitative comparison of the two dietary databases. SETTING: Two national prospective pregnancy cohorts. POPULATION: Denmark, Norway. METHODS: Comparison of food intake using food frequency questionnaires (FFQs). RESULTS: The FFQs had overlapping time windows and a majority of the questions in the two FFQs were comparable. Calculation principles shared similar features, including the software used and use of global questions to calibrate intakes of different food groups. A total of 63 food groups were defined that could be compared across the two cohorts; these were further aggregated down to 31 broader groups. A comparison of food intakes (grams/d) showed 39, 74 and 141% lower daily intakes of fish, potatoes and rice, respectively, in DNBC vs. MoBa and 39, 54 and 65% higher daily intakes of milk, butter and potatoes in DNBC vs. MoBa. For most other food groups, differences in consumption data were below 20%. CONCLUSIONS: The two FFQs are to a large extent compatible and substantial differences in dietary habits were observed between the two cohorts. This may strengthen studies using pooled analysis to examine diet-disease relations. This is a conclusion of great importance given the colossal and costly task involved to establish each of these two cohorts.

Food patterns and dietary quality associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway.

BACKGROUND: Little is known about the consumption of organic food during pregnancy. The aim of this study was to describe dietary characteristics associated with frequent consumption of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa). METHODS: The present study includes 63 808 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational weeks 15 and a food frequency questionnaire at weeks 17-22. The exploration of food patterns by Principal component analyses (PCA) was followed by ANOVA analyses investigating how these food patterns as well as intake of selected food groups were associated with consumption of organic food. RESULTS: The first principal component (PC1) identified by PCA, accounting for 12% of the variation, was interpreted as a 'health and sustainability component', with high positive loadings for vegetables, fruit and berries, cooking oil, whole grain bread and cereal products and negative loadings for meat, including processed meat, white bread, and cakes and sweets. Frequent consumption of organic food, which was reported among 9.1% of participants (n = 5786), was associated with increased scores on the 'health and sustainability component' (p < 0.001). The increase in score represented approximately 1/10 of the total variation and was independent of sociodemographic and lifestyle characteristics. Participants with frequent consumption of organic food had a diet with higher density of fiber and most nutrients such as folate, beta-carotene and vitamin C, and lower density of sodium compared to participants with no or low organic consumption. CONCLUSION: The present study showed that pregnant Norwegian women reporting frequent consumption of organically produced food had dietary pattern and quality more in line with public advice for healthy and sustainable diets. A methodological implication is that the overall diet needs to be included in future studies of potential health outcomes related to consumption of organic food during pregnancy.

Characteristics associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway.

BACKGROUND: Little is known about the use of organic food during pregnancy. The aim of this study was to describe characteristics associated with the use of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa). METHODS: The present study includes 63,561 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational week 15 and a food frequency questionnaire at weeks 17-22. We used linear binomial regression with frequent versus rare use of organic food as outcome variable and characteristics of the respondent as independent variables. The outcome variable was derived from self-reported frequency of organic food use in six main food groups (milk/dairy, bread/cereal, eggs, vegetables, fruit and meat). RESULTS: Organic eggs and vegetables were the food items which were most frequently reported to be used "often" or "mostly". The proportion of women reporting frequent intake of organic food was 9.1% (n = 5754). This group included more women in the lower (<25 years) and higher (>40 years) age-groups, with normal or low body mass index, who were vegetarians, exercised regularly (3+times weekly), consumed alcohol and smoked cigarettes during pregnancy (p < 0.001 for all, except alcohol: p=0.044). Further, participants with frequent organic consumption included more women in the lower (≤ 12 years) or higher (17 years +) category of educational attainment, women who were students or had a partner being a student, who belonged to the lowest household income group (both respondent and her partner earned <300,000 NOK), who entered the study 2005-2007, and who lived in an urban area (p < 0.001 for all). CONCLUSIONS: The socio-economic characteristics of pregnant Norwegian women with frequent organic consumption did not unambiguously follow those typically associated with better health, such as higher levels of education and income. Rather, lower household income, and both lowest and highest levels of education were associated with a higher prevalence of frequent organic consumption. The results indicate that personal and socio-economic characteristics are important covariates and need to be included in future studies of potential health outcomes related to organic food consumption during pregnancy.

A dietary pattern characterized by high intake of vegetables, fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women.

Several dietary substances have been hypothesized to influence the risk of preeclampsia. Our aim in this study was to estimate the association between dietary patterns during pregnancy and the risk of preeclampsia in 23,423 nulliparous pregnant women taking part in the Norwegian Mother and Child Cohort Study (MoBa). Women participating in MoBa answered questionnaires at gestational wk 15 (a general health questionnaire) and 17-22 (a FFQ). The pregnancy outcomes were obtained from the Medical Birth Registry of Norway. Exploratory factor analysis was used to assess the associations among food variables. Principal component factor analysis identified 4 primary dietary patterns that were labeled: vegetable, processed food, potato and fish, and cakes and sweets. Relative risks of preeclampsia were estimated as odds ratios (OR) and confounder control was performed with multiple logistic regression. Women with high scores on a pattern characterized by vegetables, plant foods, and vegetable oils were at decreased risk [relative risk (OR) for tertile 3 vs. tertile 1: 0.72; 95% CI: 0.62, 0.85]. Women with high scores on a pattern characterized by processed meat, salty snacks, and sweet drinks were at increased risk [OR for tertile 3 vs. tertile 1: 1.21; 95% CI: 1.03, 1.42]. These findings suggest that a dietary pattern characterized by high intake of vegetables, plant foods, and vegetable oils decreases the risk of preeclampsia, whereas a dietary pattern characterized by high consumption of processed meat, sweet drinks, and salty snacks increases the risk.