Maternal dietary patterns during pregnancy and birth weight: a prospective cohort study

Abstract

Background: Existing data on maternal dietary patterns and birth weight remains limited and inconsistent, especially in non-Western populations. We aimed to examine the relationship between maternal dietary patterns and birth weight among a cohort of Chinese.

Methods: In this study, 4,184 mother-child pairs were included from the Iodine Status in Pregnancy and Offspring Health Cohort. Maternal diet during pregnancy was evaluated using a self-administered food frequency questionnaire with 69 food items. Principal component analysis was used to identify dietary patterns. Information on birth weight and gestational age was obtained through medical records. Adverse outcomes of birth weight were defined according to standard clinical cutoffs, including low birth weight, macrosomia, small for gestational age, and large for gestational age.

Results: Three maternal dietary patterns were identified: plant-based, animal-based, and processed food and beverage dietary patterns, which explained 23.7% variance in the diet. In the multivariate-adjusted model, women with higher adherence to the plant-based dietary patten had a significantly higher risk of macrosomia (middle tertile vs. low tertile: odds ratio (OR) 1.45, 95% CI 1.00-2.10; high tertile vs. low tertile: OR 1.55, 95% CI 1.03-2.34; P-trend = 0.039). For individual food groups, potato intake showed positive association with macrosomia (high tertile vs. low tertile: OR 1.72, 95% CI 1.20-2.47; P-trend = 0.002). Excluding potatoes from the plant-based dietary pattern attenuated its association with macrosomia risk. No significant associations was observed for the animal-based or processed food and beverage dietary pattern with birth weight outcomes.

Conclusions: Adherence to a plant-based diet high in carbohydrate intake was associated with higher macrosomia risk among Chinese women. Future studies are required to replicate these findings and explore the potential mechanisms involved.

Keywords: Birth weight; Chinese; Macrosomia; Plant-based dietary pattern.

Fig. 1

Subgroup analyses for the association between three dietary pattern scores (continuous, per 1-unit increase) and birth weight (continuous, in grams), stratified by maternal age, gestational periods, passive smoking, physical activity, and infant sex. Beta and 95% CI were calculated in linear model adjusted for maternal age (continuous variables, in years), and infant sex (male or female), maternal domicile place (south China, north China, or Shanghai surrounding area), pre-pregnancy BMI (< 18.5, 18.5–23.9, or ≥ 24.0 kg/m²), household income (< 100,000, 100,000-350,000, or ≥ 350,000 yuan/year), education (< 13 or ≥ 13 years), baseline season (spring/winter, summer, or autumn), parity (primiparous or multiparous), gestational periods at recruitment (first, second, or third trimester), passive smoking (yes or no), alcohol drinking (yes or no), multivitamin (yes or no), calcium tablets (yes or no), folic acid (yes or no), total energy (continuous variables, in kcal/day), gestational week at birth (continuous variables, in weeks), and the other two dietary scores. The corresponding stratification variable was excluded in the corresponding subgroup analysis, for example, infant sex was not adjusted in the analyses stratified by infant sex. N Total = number of total participants in the study. CI = confidence interval

Fig. 2

Associations between plant-based dietary pattern with and without potatoes and macrosomia. ORs and 95% CIs were calculated in logistic model adjusted for maternal age (continuous variables, in years), infant sex (male or female), maternal domicile place (south China, north China, or Shanghai surrounding area), pre-pregnancy BMI (< 18.5, 18.5–23.9, or ≥ 24.0 kg/m²), household income (< 100,000, 100,000-350,000, or ≥ 350,000 yuan/year), education (< 13 or ≥ 13 years), baseline season (spring/winter, summer, or autumn), parity (primiparous or multiparous), gestational periods at recruitment (first, second, or third trimester), passive smoking (yes or no), alcohol drinking (yes or no), physical activity (active or inactive), multivitamin (yes or no), calcium tablets (yes or no), folic acid (yes or no), total energy (continuous variables, in kcal/day), and gestational week at birth (continuous variables, in weeks) P for trend was obtained by modelling the median value of the tertiles into the logistic regression models OR = odds ratio. CI = confidence interval. Ref = reference