Abstract
Background
The significance of periconceptional nutrition for optimizing offspring and maternal
health and reducing social inequalities warrants greater understanding of diet quality
among US women.
Objective
Our objective was to evaluate racial or ethnic and education inequalities in periconceptional
diet quality and sources of energy and micronutrients.
Design
Cross-sectional analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring
Mothers-to-Be cohort.
Participants and setting
Nulliparous women (N=7,511) were enrolled across eight US medical centers from 2010
to 2013.
Main outcome measures
A semiquantitative food frequency questionnaire assessing usual dietary intake during
the 3 months around conception was self-administered during the first trimester. Diet
quality, measured using the Healthy Eating Index-2010 (HEI-2010), and sources of energy
and micronutrients were the outcomes.
Statistical analyses
Differences in diet quality were tested across maternal racial or ethnic and education
groups using F tests associated with analysis of variance and χ2 tests.
Results
HEI-2010 score increased with higher education, but the increase among non-Hispanic
black women was smaller than among non-Hispanic whites and Hispanics (interaction
P value <0.0001). For all groups, average scores for HEI-2010 components were below
recommendations. Top sources of energy were sugar-sweetened beverages, pasta dishes,
and grain desserts, but sources varied by race or ethnicity and education. Approximately
34% of energy consumed was from empty calories (the sum of energy from added sugars,
solid fats, and alcohol beyond moderate levels). The primary sources of iron, folate,
and vitamin C were juices and enriched breads.
Conclusions
Diet quality is suboptimal around conception, particularly among women who are non-Hispanic
black, Hispanic, or who had less than a college degree. Diet quality could be improved
by substituting intakes of refined grains and foods empty in calories with vegetables,
peas and beans (legumes), seafood, and whole grains.
Keywords
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References
- Effect of in utero and early-life conditions on adult health and disease.N Engl J Med. 2008; 359: 61-73
- The nutritional basis of the fetal origins of adult disease.Int J Epidemiol. 2001; 30: 15-23
- A periconceptional nutritional origin for noninfectious preterm birth.Science. 2003; 300: 606
- The effects of maternal nutrition around the time of conception on the health of the offspring.Soc Reprod Fertil Suppl. 2007; 64: 397-410
- Modifications to the Healthy Eating Index and its ability to predict obesity: The Multi-Ethnic Study of Atherosclerosis.Am J Clin Nutr. 2008; 88: 64-69
- Long-term diet quality is associated with lower obesity risk in young African American women with normal BMI at baseline.J Nutr. 2013; 143: 1636-1641
- Unhealthy dietary patterns are associated with weight gain during pregnancy among Finnish women.Public Health Nutr. 2009; 12: 2392-2399
- Adherence of pregnant women to Nordic dietary guidelines in relation to postpartum weight retention: Results from the Norwegian Mother and Child Cohort Study.BMC Public Health. 2014; 14: 75
- Trends in dietary quality among adults in the United States, 1999 through 2010.JAMA Intern Med. 2014; 174: 1587-1595
- The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.J Nutr. 2014; 144: 399-407
- Women's compliance with nutrition and lifestyle recommendations before pregnancy: General population cohort study.BMJ. 2009; 338: b481
- Women's dietary patterns change little from before to during pregnancy.J Nutr. 2009; 139: 1956-1963
- Do women change their health behaviours in pregnancy? Findings from the Southampton Women's Survey.Paediatr Perinat Epidemiol. 2009; 23: 446-453
- Changes in dietary intake from the first to the second trimester of pregnancy.Paediatr Perinat Epidemiol. 2006; 20: 35-42
- Racial disparities in preterm birth: An overview of the potential role of nutrient deficiencies.Acta Obstet Gynecol Scand. 2011; 90: 1332-1341
- A description of the methods of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b).Am J Obstet Gynecol. 2015; 212 (539 e531-539 e524)
US Department of Health & Human Services. 2013 Poverty guidelines. https://aspe.hhs.gov/2013-poverty-guidelines. Published 2013. Accessed March 14, 2016.
US Department of Agriculture Food and Nutrition Service. Supplemental Nutrition Assistance Program (SNAP). https://aspe.hhs.gov/2013-poverty-guidelines. Published 2013. Accessed March 14, 2016.
- Obesity: Preventing and Managing the Global Epidemic.World Health Organization, Geneva, Switzerland2000
Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey. http://www.cdc.gov/nchs/nhanes.htm. Published 2016. Accessed January 15, 2017.
- A data-based approach to diet questionnaire design and testing.Am J Epidemiol. 1986; 124: 453-469
- Validation of a self-administered diet history questionnaire using multiple diet records.J Clin Epidemiol. 1990; 43: 1327-1335
- Structured measurement error in nutritional epidemiology: Applications in the Pregnancy, Infection, and Nutrition (PIN) Study.J Am Stat Assoc. 2007; 102: 856-866
- A diet history questionnaire ranks nutrient intakes in middle-aged and older men and women similarly to multiple food records.J Nutr. 1993; 123: 489-501
- Validity and reliability of the Block98 food-frequency questionnaire in a sample of Canadian women.Public Health Nutr. 2006; 9: 84-93
- Revision of dietary analysis software for the Health Habits and History Questionnaire.Am J Epidemiol. 1994; 139: 1190-1196
Diet*Calc Analysis Program, version 1.5.0. National Cancer Institute, Epidemiology and Genomics Research Program; 2012.
- Update of the Healthy Eating Index: HEI-2010.J Acad Nutr Diet. 2013; 113: 569-580
- Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction.Am J Clin Nutr. 2005; 82: 163-173
- Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.Arch Intern Med. 2008; 168: 713-720
- A population's distribution of Healthy Eating Index-2005 component scores can be estimated when more than one 24-hour recall is available.J Nutr. 2010; 140: 1529-1534
Basiotis PP, Guenther PM, Lino M, Britten P. Americans consume too many calories from solid fat, alcohol, and added sugar. http://www.cnpp.usda.gov/sites/default/files/nutrition_insights_uploads/Insight33.pdf. Accessed November 19, 2015.
- Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States.J Am Diet Assoc. 2010; 110: 1477-1484
- Sources of food group intakes among the US population, 2001-2002.J Am Diet Assoc. 2008; 108: 804-814
- Dietary sources of nutrients among US adults, 1994 to 1996.J Am Diet Assoc. 2004; 104: 921-930
- The growing socioeconomic disparity in dietary quality: Mind the gap.JAMA Intern Med. 2014; 174: 1595-1596
- The Supplemental Nutrition Assistance Program, food insecurity, dietary quality, and obesity among U.S. adults.Am J Public Health. 2015; 105: 1453-1459
- Dietary quality of Americans by Supplemental Nutrition Assistance Program participation status: A systematic review.Am J Prev Med. 2015; 49: 594-604
Food Research and Action Center. Impact of the revised WIC food packages on nutrition outcomes and the retail food environment. http://frac.org/pdf/frac_brief_revised_wic_food_package_impact_nutrition_retail.pdf. Published 2014. Accessed December 3, 2015.
- Maternal dietary patterns during the second trimester are associated with preterm birth.J Nutr. 2015; 145: 1857-1864
- Diet quality in early pregnancy and its effects on fetal growth outcomes: The Infancia y Medio Ambiente (Childhood and Environment) Mother and Child Cohort Study in Spain.Am J Clin Nutr. 2010; 91: 1659-1666
- A dietary pattern characterized by high intake of vegetables, fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women.J Nutr. 2009; 139: 1162-1168
- Structure of dietary measurement error: Results of the OPEN biomarker study.Am J Epidemiol. 2003; 158 (discussion 22-16): 14-21
- Addressing current criticism regarding the value of self-report dietary data.J Nutr. 2015; 145: 2639-2645
- Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: The OPEN study.Am J Epidemiol. 2003; 158: 1-13
- Personal responsibility and obesity: A constructive approach to a controversial issue.Health Aff (Millwood). 2010; 29: 379-387
Biography
L. M. Bodnar is vice-chair of research and associate professor, Department of Epidemiology, Graduate School of Public Health, and associate professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Biography
H. N. Simhan is a professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Biography
C. B. Parker is a senior biostatistician, RTI International, Research Triangle Park, NC.
Biography
H. Meier is a research statistician II, RTI International, Research Triangle Park, NC.
Biography
B. M. Mercer is chair, Department of Obstetrics and Gynecology, and director, Division of Obstetrics, Case Western Reserve University School of Medicine, Cleveland, OH.
Biography
W. A. Grobman is the Arthur Hale Curtis, MD, Professor of Obstetrics and Gynecology and professor, Obstetrics and Gynecology (Maternal Fetal Medicine) and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Biography
A. M. Peaceman is chief, Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and professor, Obstetrics and Gynecology (Maternal Fetal Medicine), Northwestern University Feinberg School of Medicine, Chicago, IL.
Biography
D. M. Haas is professor of Obstetrics & Gynecology, professor of Medicine, and adjunct professor, School of Public Health, Indiana University School of Medicine, Indianapolis.
Biography
S. Barnes is research study coordinator, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis.
Biography
D. A. Wing is associate clinical professor, Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Irvine.
Biography
P. D. Wadhwa is professor of Psychiatry & Human Behavior, Obstetrics & Gynecology, Pediatrics, and Epidemiology, School of Medicine, University of California, Irvine, School of Medicine, Irvine.
Biography
M. K. Hoffman is the Marie E. Pinizzotto, MD, Endowed Chair of Obstetrics and Gynecology, Departments of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE.
Biography
S. Parry is the Franklin Payne Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia.
Biography
M. Elovitz is director, Maternal and Child Health Research Program, director, Prematurity Prevention Program, and professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia.
Biography
R. M. Silver is a professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City.
Biography
S. Esplin is an associate professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City.
Biography
G. R. Saade is a professor, Women's & Children's Services, Department of Obstetrics and Gynecology, University of Texas Medical Branch-Galveston, Galveston.
Biography
R. Wapner is a professor of Obstetrics & Gynecology, Department of Maternal Fetal Medicine, Columbia University, New York, NY.
Biography
J. D. Iams is vice chair, Department of Obstetrics and Gynecology, and director, Prematurity Clinic, The Ohio State University College of Medicine, Columbus.
Biography
U. M. Reddy is extramural program staff, Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Article info
Publication history
Published online: March 17, 2017
Accepted:
January 19,
2017
Received:
August 8,
2016
Footnotes
Supplementary materials: Figure 1 and Table 6 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study is supported by funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development grants to RTI International (grant no. U10 HD063036), Case Western Reserve University (grant no. U10 HD063072), Columbia University (grant no. U10 HD063047), Indiana University (grant no. U10 HD063037), University of Pittsburgh (grant no. U10 HD063041), Northwestern University (grant no. U10 HD063020), University of California Irvine (grant no. U10 HD063046), University of Pennsylvania (grant no. U10 HD063048), and University of Utah (grant no. U10 HD063053). The study sponsors had no role in the study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication.
ClinicalTrials.gov identifier NCT01322529.
Identification
Copyright
© 2017 by the Academy of Nutrition and Dietetics.
