Maternal Dietary Patterns and Birth Outcomes: A Systematic Review and Meta-Analysis

Abstract

Findings on the relations of maternal dietary patterns during pregnancy and risk of preterm birth and offspring birth size remain inconclusive. We aimed to systematically review and quantify these associations. We searched MEDLINE, Embase, CENTRAL, and CINAHL up to December 2017. Three authors independently conducted a literature search, study selection, data extraction, and quality assessment. Summary effect sizes were calculated with random effects models and studies were summarized narratively if results could not be pooled. We included 36 studies and pooled results from 25 observational studies (167,507 participants). Two common dietary patterns-"healthy" and "unhealthy"-were identified. Healthy dietary patterns-characterized by high intakes of vegetables, fruits, wholegrains, low-fat dairy, and lean protein foods-were associated with lower risk of preterm birth (OR for top compared with bottom tertile: 0.79; 95% CI: 0.68, 0.91; I2 = 32%) and a weak trend towards a lower risk of small-for-gestational-age (OR: 0.86; 95% CI: 0.73, 1.01; I2 = 34%). Only statistically data-driven healthy dietary patterns, and not dietary index-based patterns, were associated with higher birth weight (mean difference: 67 g; 95% CI: 37, 96 g; I2 = 75%). Unhealthy dietary patterns-characterized by high intakes of refined grains, processed meat, and foods high in saturated fat or sugar-were associated with lower birth weight (mean difference: -40 g; 95% CI: -61, -20 g; I2 = 0%) and a trend towards a higher risk of preterm birth (OR: 1.17; 95% CI: 0.99, 1.39; I2 = 76%). Data from observational studies indicate that greater adherence to healthy dietary patterns during pregnancy is significantly related to lower risk of preterm birth. No consistent associations with birth weight and small- or large-for-gestational-age were observed.

Keywords: birth weight; diet quality; dietary pattern; maternal diet; preterm birth.

FIGURE 1

Flowchart of study selection.

FIGURE 2

Associations between maternal dietary patterns and the risk of preterm birth. Black dots denote study-specific effect estimates comparing the lowest and highest tertiles of dietary patterns, horizontal lines denote 95% CI, diamonds indicate the pooled effect estimates with their corresponding 95% CI, and asterisks indicate index-based dietary patterns. Descriptions of dietary patterns are detailed in Supplemental Table 2.

FIGURE 3

Associations between maternal dietary patterns and birth weights of offspring. Black dots denote study-specific effect estimates comparing the lowest and highest tertiles of dietary patterns, horizontal lines denote 95% CI, diamonds indicate the pooled effect estimates with their corresponding 95% CI, and asterisks indicate index-based dietary patterns. Descriptions of dietary patterns are detailed in Supplemental Table 2.

FIGURE 4

Associations between maternal healthy dietary patterns and the risk of small-for-gestational-age/fetal growth restriction/low birth weight. Black dots denote study-specific effect estimates comparing the lowest and highest tertiles of dietary patterns, horizontal lines denote 95% CI, diamonds indicate the pooled effect estimates with their corresponding 95% CI, and asterisks indicate index-based dietary patterns. Descriptions of dietary patterns are detailed in Supplemental Table 2.

FIGURE 5

Associations between maternal healthy dietary patterns and the risk of large-for-gestational-age. Black dots denote study-specific effect estimates comparing the lowest and highest tertiles of dietary patterns, horizontal lines denote 95% CI, diamonds indicate the pooled effect estimates with their corresponding 95% CI, and asterisks indicate index-based dietary patterns. Descriptions of dietary patterns are detailed in Supplemental Table 2.