Comparison of Preconception Diet Scores Across Studies: The PrePARED Consortium

Abstract

Background: Preconception diet and nutritional status are important determinants of reproductive and pregnancy health. As a comprehensive evaluation, this paper describes harmonization of diet data across multiple cohorts including over 50,000 participants and the differences between them. This information may be useful for developing targeted strategies to improve women's diet prior to pregnancy for optimal prenatal health outcomes.

Methods: The Preconception Period Analysis of Risks and Exposures influencing health and Development (PrePARED) consortium incorporates studies covering the preconception period and includes both couples planning pregnancy and studies covering the reproductive period but not focused on pregnancy. We harmonized data on 56,520 participants from seven cohort studies that collected data during the preconception period. We generated data on diet quality according to the International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist to examine diet quality measures across the cohorts and compare estimates of diet quality across studies. Four studies used food frequency questionnaires; one used a study-specific diet history; one used two 24 h dietary recalls; and one used a short series of general diet questions. Positive responses on the six FIGO questions were tallied to calculate a total diet quality score.

Results: Cohort samples varied in terms of age; socioeconomic status; race; ethnicity; and geographic region. Across the cohorts, participants met a median of three or four of the FIGO criteria for diet quality; those most commonly met were recommendations for consumption of meat and protein, while those least commonly met were recommendations for limiting consumption of processed foods and snacks. There was greater variation in meeting recommendations for the consumption of fruits and vegetables; dairy; fish; and whole grains. The percentage meeting ≤ 2 criteria ranged from 6.4% (Coronary Artery Risk Development in Young Adults) to 40.4% (Bogalusa Heart Study).

Discussion: There was wide variability across preconception cohort studies in the extent to which participants met FIGO dietary guidelines. Although studies were conducted in populations that were not likely to be malnourished, it was rare for women to meet all the preconception dietary recommendations. These findings illustrate a need for strategies to promote meeting dietary guidelines prior to conception to improve health outcomes.

Keywords: data harmonization; diet; dietary guidelines; nutrition; preconception.

Figure 1

FIGO scores by study, percent meeting recommendation, all participants. Missing data on n = ALSWH, 1; BHS, 11; CARDIA, 2; Recommendation: meat/chicken 2–3 times/week, fruits/vegetables 2–3 times/day; fish 1–2 times/week; dairy every day; whole grains daily; packaged snacks, cakes, pastries, or sugar-sweetened drinks < 5 times/week. ALSWH, Australian Longitudinal Study of Women’s Health; BHS, Bogalusa Heart Study; CARDIA, Coronary Artery Risk Development in Young Adults; CePAWHS, Central Pennsylvania Women’s Health Study; CTS, California Teachers’ Study; FIGO, Federation Internationale de Gynecologie et d’Obstetrique (International Federation of Gynecology and Obstetrics); HCHS/SOL, Hispanic Community Health Study/Study of Latinos; PRESTO, Pregnancy Study Online.

Figure 2

FIGO scores by study, percent meeting recommendation, participants with a pregnancy. BHS, missing data on n = 2.