Micronutrient Intake Is Inadequate for a Sample of Pregnant African-American Women

Published:January 05, 2017DOI:



      Micronutrient intake is critical for fetal development and positive pregnancy outcomes. Little is known about the adequacy of micronutrient intake in pregnant African-American women.


      To describe nutrient sufficiency and top food groups contributing to dietary intake of select micronutrients in low-income pregnant African-American women and determine whether micronutrient intake varies with early pregnancy body mass index (BMI) and/or gestational weight gain.


      Secondary analysis of data collected in a cohort study of pregnant African-American women.


      A total of 93 women aged 18 to 36 years, <20 weeks pregnant, with early pregnancy BMIs ≥18.5 and <40.0. The study was conducted during 2008 to 2012 with participants from university-affiliated obstetrics clinics in an urban setting in the northeastern United States.

      Main outcome measures

      Proportion of women with dietary intakes below Estimated Average Requirement (EAR) or Adequate Intake (AI) for vitamin D, folate, iron, calcium, and choline throughout pregnancy. Top food groups from which women derived these micronutrients was also determined.

      Statistical analyses performed

      Descriptive statistics included means, standard deviations, and percentages. Percent of women reaching EAR or AI was calculated. The χ2 test was used to assess micronutrient intake differences based on early pregnancy BMI and gestational weight gain.


      A large percentage of pregnant women did not achieve the EAR or AI from dietary sources alone; EAR for folate (66%), vitamin D (100%), iron (89%), and AI for choline (100%). Mean micronutrient intake varied throughout pregnancy. Top food sources included reduced-fat milk, eggs, and mixed egg dishes, pasta dishes, and ready-to-eat cereal.


      The majority of study participants had dietary micronutrient intake levels below EAR/AI throughout pregnancy. Findings suggest that practitioners should evaluate dietary adequacy in women to avoid deficits in micronutrient intake during pregnancy. Top food sources of these micronutrients can be considered when assisting women in improving dietary intake.


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      1. Linus Pauling Institute. Micronutrient needs during pregnancy and lactation. Accessed December 13, 2014.

        • Radlowski E.
        • Johnson R.
        Perinatal iron deficiency and neurocognitive development.
        Front Hum Neurosci. 2013; 7: 1-11
        • Kovacs C.
        The role of vitamin D in pregnancy and lactation: Insights from animal models and clinical studies.
        Annu Rev Nutr. 2012; 32: 97-123
        • Hofmeyr G.
        • Beliz J.
        • von Dadelszen P.
        • on behalf of the Calcium and Pre-eclampsia (CAP) Study Group
        Low-dose calcium supplementation for preventing pre-eclampsia: A systematic review and commentary.
        BJOG. 2014; 121: 951-957
        • Zeisel S.
        The supply of choline is important for fetal progenitor cells.
        Semin Cell Dev Biol. 2011; 22: 624-628
        • Tessema J.
        • Jefferds M.
        • Cogswell M.
        • Carlton E.
        Motivators and barriers to prenatal supplement use among minority women in the United States.
        J Am Diet Assoc. 2009; 109: 102-108
        • Ladipo O.
        Nutrition in pregnancy: Mineral and vitamin supplements.
        Am J Clin Nutr. 2000; 72: 280S-290S
        • Haugen M.
        • Brantsæter A.
        • Alexander J.
        • Meltzer H.
        Dietary supplements contribute substantially to the total nutrient intake in pregnant Norwegian women.
        Ann Nutr Metab. 2008; 52: 272-280
        • Brough L.
        Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low income, multi-ethnic population.
        Br J Nutr. 2010; 104: 437-445
      2. Nutrition and Your Health: Dietary Guidelines for Americans. 8th ed. National Academies Press, Washington, DC2015
      3. Rasmussen K.M. Yaktine A.L. Weight Gain During Pregnancy: Reexamining the Guidelines. The National Academies Press, Washington, DC2009
        • Dietz P.M.
        • Callaghan W.M.
        • Sharma A.J.
        High pregnancy weight gain and risk of excessive fetal growth.
        Am J Obstet Gynecol. 2009; 201: e1-e6
        • Fraser A.
        • Tilling K.
        • Macdonald-Wallis C.
        • et al.
        Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood.
        Circulation. 2010; 121: 2557-2564
        • Groth S.
        • Holland M.
        • Meng Y.
        • Kitzman H.
        Gestational weight gain of pregnant African American adolescents affects body mass index 18 years later.
        J Obstet Gynecol Neonatal Nurs. 2013; 42: 541-550
        • Kirkegaard H.
        • Stovring H.
        • Rasmussen K.
        • Abrams B.
        • Sørensen T.
        • Nohr E.
        How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis.
        Am J Clin Nutr. 2014; 99: 312-319
        • Nehring I.
        • Schmoll S.
        • Beyerlein A.
        • Hauner H.
        • von Kries R.
        Gestational weight gain and long-term postpartum weight retention: A meta-analysis.
        Am J Clin Nutr. 2011; 94: 1225-1231
        • Rooney B.L.
        • Schauberger C.W.
        • Mathiason M.A.
        Impact of perinatal weight change on long-term obesity and obesity-related illnesses.
        Obstet Gynecol. 2005; 106: 1349-1356
        • Sridhar S.B.
        • Darbinian J.
        • Ehrlich S.F.
        • et al.
        Maternal gestational weight gain and offspring risk for childhood overweight or obesity.
        Am J Obstet Gynecol. 2014; 211: 259.e251-259.e258
        • Walter J.
        • Perng W.
        • Kleinman K.
        • Rifas-Shiman S.
        • Rich-Edwards J.
        • Oken E.
        Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum.
        Am J Obstet Gynecol. 2014; 212 (20): e1-e12
        • Margerison Zilko C.
        • Rehkopf D.
        • Abrams B.
        Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes.
        Am J Obstet Gynecol. 2010; 202: e1-e8
        • Deputy N.
        • Sharma A.
        • Kim S.
        Gestational weight gain—United States, 2012 and 2013.
        MMWR Morbid Mortal Wkly Rep. 2015; 64: 1215-1220
        • Laraia B.
        • Bodnar L.
        • Siega-Riz A.
        Pregravid body mass index is negatively associated with diet quality during pregnancy.
        Public Health Nutr. 2007; 10: 920-926
        • Groth S.
        • Morrison-Beedy D.
        GNB3 and FTO polymorphisms and pregnancy weight gain in black women.
        Biol Res Nurs. 2015; 17: 405-412
      4. Centers for Disease Control and Prevention. Overweight and obesity. Accessed December 1, 2014.

      5. University of Minnesota Nutrition Coordinating Center. Nutrition Data System for Research software and methodology version 2009. Accessed April 19, 2016.

      6. US Department of Agriculture, Agricultural Research Service. AMPM - USDA automated multiple-pass method. Accessed June 14, 2016.

        • Tooze J.A.
        • Midthune D.
        • Dodd K.W.
        • et al.
        A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution.
        J Am Diet Assoc. 2006; 106: 1575-1587
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intake: Applications in Dietary Practice.
        The National Academies Press, Washington, DC2000
        • Vanhees K.
        • Vonhögen I.
        • van Schooten F.
        • Godschalk R.
        You are what you eat, and so are your children: The impact of micronutrients on the epigenetic programming of offspring.
        Cell Mol Life Sci. 2014; 71: 271-285
        • Wu G.
        • Imhoff-Kunsch B.
        • Girard A.
        Biological mechanisms for nutritional regulation of maternal health and fetal development.
        Paediatr Perinat Epidemiol. 2012; 26: 4-26
        • Baker A.M.
        • Haeri S.
        • Camargo Jr., C.A.
        • Espinola J.A.
        • Stuebe A.M.
        A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia.
        J Clin Endocrinol Metab. 2010; 95: 5105-5109
        • Beaudin A.E.
        • Stover P.J.
        Folate-mediated one-carbon metabolism and neural tube defects: Balancing genome synthesis and gene expression.
        Birth Defects Res C Embryo Today. 2007; 81: 183-203
        • Berti C.
        • Bartesaghi L.
        • Ghidinelli M.
        • et al.
        Non-redundant function of dystroglycan and beta1 integrins in radial sorting of axons.
        Development. 2011; 138: 4025-4037
        • Lao T.T.
        • Tam K.F.
        • Chan L.Y.
        Third trimester iron status and pregnancy outcome in non-anaemic women; pregnancy unfavourably affected by maternal iron excess.
        Hum Reprod. 2000; 15: 1843-1848
        • Milman N.
        Iron and pregnancy—A delicate balance.
        Ann Hematol. 2006; 85: 559-565
        • Scholl T.
        Iron status during pregnancy: Setting the stage for mother and infant.
        Am J Clin Nutr. 2005; 81: 1218S-1222S
        • Institute of Medicine, Food and Nutrtion Board
        Dietary Reference Intakes: The Essential Guide to Nutrient Requirements.
        The National Academies Press, Washington, DC2006
      7. IBM-SPSS Statistics for Windows, version 20.0. Armonk, NY: IBM Corporation; 2011.

        • Siega-Riz A.M.
        • Bodnar L.
        • Savitz D.
        What are pregnant women eating? Nutrient and food group differences by race.
        Am J Obstet Gynecol. 2002; 186: 480-486
        • Gennaro S.
        • Biesecker B.
        • Fantasia H.
        • Nguyen M.
        • Garry D.
        Nutrition profiles of African American women in the third trimester.
        MCN Am J Matern Child Nurs. 2011; 36: 120-126
        • Snook Parrott M.
        • Bodnar L.
        • Simhan H.
        • Harger G.
        • Morkovic N.
        • Roberts J.
        Maternal cereal consumption and adequacy of micronutrient intake in the periconceptional period.
        Public Health Nutr. 2009; 12: 1276-1283
        • Harville E.
        • Schramm M.
        • Watt-Morse M.
        • K C
        • Anderson J.
        • Hertz-Picciotto I.
        Calcium intake during pregnancy among white and African-American pregnant women in the U.S.
        J Am Coll Nutr. 2004; 23: 43-50
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes: Applications in Dietary Assessment.
        National Academies Press, Washington, DC2000
        • Brunst K.
        • Wright R.
        • DiGioia K.
        • et al.
        Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population.
        Public Health Nutr. 2014; 17: 1960-1970
      8. Current Eating Patterns in the United States. Accessed November 10, 2016.

        • Derbyshire E.
        • Davies J.
        • Costarelli V.
        • Dettmar P.
        Prepregnancy body mass index and dietary intake inthe first trimester of pregnancy.
        J Hum Nutr Diet. 2006; 19: 267-273
        • Scholl T.
        • Chen X.
        Vitamin D intake during pregnancy: Association with maternal characteristics and infant birth weight.
        Early Hum Dev. 2009; 85: 231-234
      9. Groth S, Simpson A, Fernandez I. The dietary choices of women who are low-income, pregnant, and African American [published online ahead of print July 22, 2016]. J Midwifery Womens Health.

        • Dollahite J.
        • Pijai E.
        • Scott-Pierce M.
        • Parker C.
        • Trochim W.
        A randomized controlled trial of a community-based nutrition education program for low-income parents.
        J Nutr Educ Behav. 2014; 46: 102-109
        • Fulkerson J.
        • Rydell S.
        • Kubik M.
        • et al.
        Healthy home offerings via the mealtime environment (HOME): Feasibility, acceptability, and outcomes of a pilot study.
        Obesiy. 2010; 18: S69-S74
        • Jancey J.
        • Dos Remedios Monteiro S.
        • Dhaliwal S.
        • et al.
        Dietary outcomes of a community based intervention for mothers of young children: A randomised controlled trial.
        Int J Behav Nutr Phys Act. 2014; 11: 120
      10. Choose My Plate. Accessed October 3, 2016.

      11. Share Our Strength's Cooking Matters: No kid hungry. Cooking Matters: A long-term impact evaluation. Accessed March 25, 2016.

      12. Centers for Disease Control and Prevention. Three simple steps to eating more fruits and vegetables. Accessed September 30, 2016.

        • Whaley S.
        • Ritchie L.
        • Spector P.
        • Gomez J.
        Revised WIC food package improves diets of WIC families.
        J Nutr Educ Behav. 2012; 44: 204-209
        • Andreyeva T.
        • Luedicke J.
        Incentivizing fruit and vegetable purchases among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children.
        Public Health Nutr. 2015; 18: 33-41
        • Thompson F.
        • Byers T.
        Dietary assessment resource manual.
        J Nutr. 1994; 124: 2245S-2317S
        • Krebs-Smith S.
        • Graubard B.
        • Kahle L.
        • Subar A.
        • Cleveland L.
        • Ballard-Barbash R.
        Low energy reporters vs others: A comparison of reported food intakes.
        Eur J Clin Nutr. 2000; 54: 281-287


      S. W. Groth is an associate professor, University of Rochester School of Nursing, Rochester, NY.


      P. A. Stewart is an assistant professor of pediatrics, University of Rochester Medical Center, Rochester, NY.


      D. J. Ossip is a professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.


      I. D. Fernandez is an associate professor, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.


      R. C. Block is an associate professor, Department of Public Health Sciences, Cardiology Department, and Department of Medicine, University of Rochester Medical Center, Rochester, NY.


      N. Wixom is a registered dietitian nutritionist, Rochester, NY.