Maternal Dietary Patterns During Pregnancy And Pregnancy Outcomes: A Population-based Cohort Study

Backbround Maternal nutritional status during pregnancy is important for the growth and development of the fetus. However, there is little information about the effect of maternal diet patterns during pregnancy on the fetus growth in China.Objectives To describe dietary patterns of a cohort of women during pregnancy, investigate whether the dietary patterns are associated with sociodemographic factors, and assess the effect of these dietary patterns on the pregnancy outcomes, especially the risk of delivering a small-for-gestational-age (SGA) infant.Methods This study drew on resources from the Anhui Birth Defects and Child Development Cohort Study (ABC cohort study), which is an ongoing, population-based, long-term prospective cohort study that aims to recruit 20 000 pregnant women by the end of 2010. Subjects were women seeking routine antenatal health care for the first time with gestational age of no more than 28 weeks and booking into the Maternal and Child Healthcare Centers in two areas: Hefei city (including three centers) and Ma'anshan city (including four centers) of Anhui province. Pregnant women entering the cohort from October 2008 to September 2009 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy by the trained researcher. A total of 7 122 women were recruited and 6 905 completed questionaires were obtained. Finally 2 387 women delivered live babies. Principal-components analysis was used to derive dietary patterns from 19 food groups. Then dietary patterns were related to social and demographic characteristics and lifestyle factors. The association between maternal dietary patterns and fetal growth (in terms of SGA) was investigated by logistic regression analysis.Results Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The"animal protein"component loaded highly on poultry, mutton and fish. The"healthy"component described a diet based on milk, egg and nuts. The"traditional"component loaded highly on rice, fruit and vegetables. The"caffeine"component was characterized by coffee, tea and cola and the final"processed"component was associated with pickled food and fried food. There were strong associations between various socio-demographic variables and all dietary components; in particular, a"healthy"diet was positively associated with increasing education and age, and planned pregnancy. There was a negative association with depressive women and those who vomited in the first trimester of pregnancy. A"caffeine"diet was negatively associated with increasing age, planned pregnancy and living in urban place. There was a positive association with depressive symptom. A"processed"diet was negatively associated with education and positively associated with anxious symptom.The"caffeinee"dietary pattern was associated with a higher risk of a SGA baby (OR=2.24; 95%CI: 1.26～3.98). This risk remained significant after adjustment for potential confounders, such as maternal age and height, and gender of the babies. The odds ratio of having a SGA infant was 2.23 (95%CI: 1.25～3.95) for women in the high"traditional"class compared with women in the moderate"traditional"class. The analyses were adjusted for age and height of the women, and gender of the babies.Conclusions Principal components analysis produced five dietary patterns. There were strong associations between various socio-demographic variables and various dietary patterns. Our results indicated that a diet in pregnancy, based on"caffeinee"and"traditional"diet, was associated with increased risk for SGA. Further studies are required to identify potential macro-, or micronutrients that may be underlying these associations. Therefore, dietary and lifestyle profiles should be included in periconception screening programs.