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Racial or Ethnic and Socioeconomic Inequalities in Adherence to National Dietary Guidance in a Large Cohort of US Pregnant Women

Published:March 17, 2017DOI:https://doi.org/10.1016/j.jand.2017.01.016

      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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      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.

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      H. N. Simhan is a professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA.

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      C. B. Parker is a senior biostatistician, RTI International, Research Triangle Park, NC.

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      H. Meier is a research statistician II, RTI International, Research Triangle Park, NC.

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      B. M. Mercer is chair, Department of Obstetrics and Gynecology, and director, Division of Obstetrics, Case Western Reserve University School of Medicine, Cleveland, OH.

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      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.

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      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.

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      D. M. Haas is professor of Obstetrics & Gynecology, professor of Medicine, and adjunct professor, School of Public Health, Indiana University School of Medicine, Indianapolis.

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      S. Barnes is research study coordinator, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis.

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      D. A. Wing is associate clinical professor, Obstetrics & Gynecology, University of California, Irvine, School of Medicine, Irvine.

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      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.

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      S. Parry is the Franklin Payne Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia.

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      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.

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      R. M. Silver is a professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City.

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      S. Esplin is an associate professor, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City.

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      G. R. Saade is a professor, Women's & Children's Services, Department of Obstetrics and Gynecology, University of Texas Medical Branch-Galveston, Galveston.

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      R. Wapner is a professor of Obstetrics & Gynecology, Department of Maternal Fetal Medicine, Columbia University, New York, NY.

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      J. D. Iams is vice chair, Department of Obstetrics and Gynecology, and director, Prematurity Clinic, The Ohio State University College of Medicine, Columbus.

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      U. M. Reddy is extramural program staff, Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.