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

BACKGROUND: Dietary intake may be associated with neonatal outcomes, yet little is known about the influence of prepregnancy dietary pattern (DP). OBJECTIVES: To evaluate the association between prepregnancy DPs and perinatal outcomes. DESIGN: Prospective 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/SETTING: Two 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 MEASURES: Type of delivery, large for gestational age (LGA), birth length (BL)>90th percentile, Apgar score<7 at 1 minute, and preterm birth. STATISTICAL ANALYSES: Reduced 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. RESULTS: The 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. CONCLUSIONS: Higher 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.

Dietary patterns and their association with adiponectin and leptin concentrations throughout pregnancy: a prospective cohort.

The aim of this study was to evaluate the association of dietary patterns (DP) with maternal adiposity indicators, leptin, adiponectin and insulin concentrations during pregnancy. A prospective cohort of pregnant women followed up at the 5th-13th, 20th -26th and 30th-36th gestational weeks and 30-40 d postpartum was conducted in Rio de Janeiro. A FFQ was administered in the third trimester (30th-36th gestational weeks). The reduced rank regression procedure was used to identify DP that explain response variables (dietary fibre and total fat) related to indicators of maternal adiposity (postpartum weight retention and gestational weight gain (GWG) adequacy), and plasma leptin, adiponectin and insulin concentrations. The associations between tertiles of DP and the outcomes were determined using logistic regression or longitudinal linear mixed-effect regression models. The mean daily energy intake during pregnancy was 10 104 (sd 3234) kJ (2415 (sd 773) kcal), and GWG was 11·9 (sd 4·2) kg. In all, 40 % of women presented pre-gestational overweight/obesity. Excessive GWG occurred in 34·7 % of pregnant women and 56·6 % were overweight/obese at postpartum. The 'common-Brazilian' DP (characterised by higher intake of beans, rice and lower intake of fast food/snacks, candies/table sugar and processed meats/bacon) was positively associated with adiponectin (ß=1·07; 95 % CI 0·17, 1·98). The 'Western' DP (characterised by higher intake of fast food/snacks and processed meat/bacon and lower intake of noodles/pasta/roots/tubers and sodas) was negatively associated with adiponectin (ß=-1·11; 95 % CI -2·00, -0·22) and positively associated with leptin concentrations (ß=64·9; 95 % CI 22·8, 107·0) throughout pregnancy. It may be suggested that the 'common-Brazilian' is a healthy DP and beneficial for serum concentrations of adiponectin and leptin.

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

BACKGROUND: Physiologic adaptations lead to an increase in blood lipid levels during pregnancy, yet little is known about the influence of prepregnancy dietary patterns. AIM: To identify whether prepregnancy dietary patterns that explain the consumption of fiber, energy, and saturated fat are associated with blood lipid levels throughout pregnancy. DESIGN: Prospective 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/SETTING: Women 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 MEASURES: Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglyceride levels, measured at all trimesters. STATISTICAL ANALYSES PERFORMED: Dietary 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. RESULTS: Fast 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 (ß=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 (ß=-.053, 95% CI -0.101 to -0.004; P=0.035 and ß=.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. CONCLUSIONS: Prepregnancy 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.

Dietary patterns by cluster analysis in pregnant women: relationship with nutrient intakes and dietary patterns in 7-year-old offspring.

Little is known about how dietary patterns of mothers and their children track over time. The objectives of this study are to obtain dietary patterns in pregnancy using cluster analysis, to examine women's mean nutrient intakes in each cluster and to compare the dietary patterns of mothers to those of their children. Pregnant women (n = 12 195) from the Avon Longitudinal Study of Parents and Children reported their frequency of consumption of 47 foods and food groups. These data were used to obtain dietary patterns during pregnancy by cluster analysis. The absolute and energy-adjusted nutrient intakes were compared between clusters. Women's dietary patterns were compared with previously derived clusters of their children at 7 years of age. Multinomial logistic regression was performed to evaluate relationships comparing maternal and offspring clusters. Three maternal clusters were identified: 'fruit and vegetables', 'meat and potatoes' and 'white bread and coffee'. After energy adjustment women in the 'fruit and vegetables' cluster had the highest mean nutrient intakes. Mothers in the 'fruit and vegetables' cluster were more likely than mothers in 'meat and potatoes' (adjusted odds ratio [OR]: 2.00; 95% Confidence Interval [CI]: 1.69-2.36) or 'white bread and coffee' (OR: 2.18; 95% CI: 1.87-2.53) clusters to have children in a 'plant-based' cluster. However the majority of children were in clusters unrelated to their mother dietary pattern. Three distinct dietary patterns were obtained in pregnancy; the 'fruit and vegetables' pattern being the most nutrient dense. Mothers' dietary patterns were associated with but did not dominate offspring dietary patterns.