Assessment of pregnancy dietary intake and association with maternal and neonatal outcomes

Abstract

Background: Maternal dietary habits are contributors of maternal and fetal health; however, available data are heterogeneous and not conclusive.

Methods: Nutrient intake during pregnancy was assessed in 503 women with uncomplicated pregnancies, using the validated Food Frequency Questionnaire developed by the European Prospective Investigation into Cancer and Nutrition (EPIC-FFQ).

Results: In all, 68% of women had a normal body mass index at the beginning of pregnancy, and 83% of newborns had an appropriate weight for gestational age. Maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and placental weight were independently correlated with birth weight. GWG was not related to the pre-pregnancy BMI. EPIC-FFQ evaluation showed that 30% of women adhered to the European Food Safety Authority (EFSA) ranges for macronutrient intake. In most pregnant women (98.1%), consumption of water was below recommendations. Comparing women with intakes within EFSA ranges for macronutrients with those who did not, no differences were found in BMI, GWG, and neonatal or placental weight. Neither maternal nor neonatal parameters were associated with the maternal dietary profiles.

Conclusions: In our population, maternal pre-pregnancy BMI, GWG, and placental weight are determinants of birth weight percentile, while no association was found with maternal nutrition. Future studies should explore associations through all infancy.

Impact: Maternal anthropometrics and nutrition status may affect offspring birth weight. In 503 healthy women, maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and placental weight were independently correlated to neonatal birth weight. GWG was not related to the pre-pregnancy BMI. In all, 30% of women respected the EFSA ranges for macronutrients. Neither maternal nor neonatal parameters were associated with maternal dietary profiles considered in this study. Maternal pre-pregnancy BMI, GWG, and placental weight are determinants of neonatal birth weight percentile, while a connection with maternal nutrition profiles was not found.

Fig. 1. Maternal anthropometric parameters distributions based on birth weight percentile.

Pre-pregnancy maternal BMI (a) and gestational weight gain (GWG) (b) boxplot distributions in small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) neonatal groups. c Pair-wise t test results analyzing differences in pre-pregnancy BMI and GWG between SGA, AGA, and LGA birth weight categories.

Fig. 2. K-means clustering (k = 4) of four different dietary profiles based on macronutrient intake ratios.

In red (group 1) high carbohydrate (45–55%) and normal fat (30–40%); in orange (group 2) very high carbohydrate (55–65%) and low fat (22–35%); in light green (group 3) low carbohydrate (30–40%) and very high fat (40–53%); in dark green (group 4) high carbohydrate (40–48%) and high fat (35–45%). Neonatal and maternal parameters are reported on lateral bar: birth weight percentile (BW percentile), maternal pre-pregnancy BMI, gestational weight gain (GWG), energy intake. K-means groups are also reported. Top-right legend reports neonatal, maternal, and nutritional categories: for birth weight percentile, infants are categorized into large for gestational age (LGA), appropriate for gestational age (AGA), small for gestational age (SGA); for maternal pre-pregnancy BMI, women are divided into underweight (BMI < 18.5 kg/m²), normal weight (18.5 ≤ BMI < 25 kg/m²), overweight (25 ≤ BMI < 30 kg/m²), and obese (BMI ≥ 30 kg/m²); for gestational weight gain (GWG), women are divided into low GWG (GWG < 7 kg), high GWG (GWG > 13 kg), and normal GWG (7 ≤ GWG ≤ 13 kg); energy intakes are divided into three categories: low energy (energy < 1200 kcal/day), normal energy (1200 ≤ energy < 2500 kcal/day), and high energy (energy > 2500 kcal/day).