A Vegetable, Oil, and Fruit Dietary Pattern in Late Pregnancy is Linked to Reduced Risks of Adverse Birth Outcomes in a Predominantly Low-Income Hispanic and Latina Pregnancy Cohort

Abstract

Background: Studies examining diet and its links to birth outcomes among socioeconomically disadvantaged populations in the United States are scarce.

Objectives: We aimed to identify prenatal dietary patterns, examine their relationships with birth outcomes, and evaluate the variation of these associations by maternal diabetes status [no diabetes, gestational diabetes mellitus (GDM), preexisting diabetes].

Methods: Women in the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study (n = 465)-an ongoing, prospective pregnancy cohort of predominantly low-income Hispanic/Latina women in Los Angeles-completed up to two 24-hour dietary recalls in the third trimester of pregnancy. We identified prenatal dietary patterns via factor analysis and evaluated their associations with infant birth weight and gestational age at birth (GA) z-scores, separately, using linear regression, as well as the associations of the dietary patterns with premature births, having an infant that was small for gestational age (SGA), and having an infant that was large for gestational age, using logistic regression and adjusting for relevant covariates. We additionally tested interaction terms between prenatal dietary patterns and maternal diabetes status in separate models. We adjusted for multiple comparisons using the false discovery rate.

Results: We identified 2 dietary patterns: 1) a dietary pattern of solid fats, refined grains, and cheese (SRC); and 2) a dietary pattern of vegetables, oils, and fruit (VOF). Comparing the highest to lowest quartiles, the VOF was significantly associated with a greater infant birth weight (β = 0.40; 95% CIs: 0.10, 0.70; Ptrend = 0.011), a greater GA (β = 0.32; 95% CIs: 0.03, 0.61; Ptrend = 0.036), lower odds of a premature birth (OR = 0.31; 95% CIs: 0.10, 0.95; Ptrend = 0.049), and lower odds of having an infant that was SGA (OR = 0.18; 95% CIs: 0.06, 0.58; Ptrend = 0.028). Only among women with GDM, a 1-SD score increase in the prenatal SRC was significantly associated with a lower infant birth weight (β = -0.20; 95% CIs -0.39, -0.02; Pinteraction = 0.040).

Conclusions: Among low-income Hispanic/Latina pregnant women, greater adherence to the prenatal VOF may lower the risk of a premature birth and having an infant that is SGA. Greater adherence to the SRC, however, may adversely affect newborn birth weight among mothers with GDM, but future research is needed to verify our findings.

Keywords: 24-hour dietary recalls; Hispanics; Latinas; MADRES; birth outcomes; birth weight; dietary patterns; health disparities; pregnancy; preterm.

FIGURE 1

Adjusted mean differences in birth weight (z-score) per 1-SD score increases in prenatal dietary patterns during the third trimester of pregnancy, stratified by maternal diabetes status in MADRES (n = 465). Estimates are mean differences (95% CIs) in newborn sex-standardized birth weights (z-score) per 1-SD score increases in prenatal dietary patterns from multivariable linear regression, stratified by maternal diabetes status, adjusting for maternal age (years), maternal education (less than HS, HS degree or equivalent, more than HS), gestational age at consent (weeks), prepregnancy BMI (continuous), birth order (number), and total energy intake (kcals/d). VOF, P_interaction = 0.731; SRC, P_interaction = 0.040. Abbreviations: HS, high school; MADRES, Maternal and Developmental Risks from Environmental and Social Stressors; SRC, dietary pattern of solid fat, refined grain, and cheese; VOF, dietary pattern of vegetables, oils, and fruit.