Objectives: To investigate possible associations between maternal diet during pregnancy and fetal growth. Method: Factor analysis was used to explore dietary patterns among pregnant women. The association between maternal dietary patterns and fetal growth (in terms of small for gestational age, SGA) was investigated by logistic regression. Prospective cohort study, including information on 44 612 women in Denmark. Results: Two major dietary patterns were defined: the first pattern was characterized by red and processed meat, high-fat dairy, and the second pattern was characterized by intake of vegetables, fruits, poultry and fish. Women were classified into three classes according to their diet: the first class had high intake of foods of the first dietary pattern, and was classified as 'the Western diet', the second class preferred foods of the second pattern and was classified as the 'Health Conscious'; and the third one had eaten foods of both patterns, and was classified as the 'Intermediate'. The odds ratio of having a small for gestationalage infant (with a birth weight below the 2.5th percentile for gestational age and gender) was 0.74 (95% CI 0.64-0.86) for women in the Health Conscious class compared with women in the Western Diet class. The analyses were adjusted for parity, maternal smoking, age, height, pre-pregnancy weight and father's height. Conclusions: Our results indicated that a diet in pregnancy, based on red and processed meat and high-fat diary, was associated with increased risk for SGA. Further studies are warranted to identify specific macro-, or micronutrients that may be underlying these associations.

Shifting towards a MD during pregnancy may reduce the risk of early delivery in Danish women.

Studies on formula-fed infants indicate a beneficial effect of dietary DHA on visual acuity. Cross-sectional studies have shown an association between breast-milk DHA levels and visual acuity in breast-fed infants. The objective in this study was to evaluate the biochemical and functional effects of fish oil (FO) supplements in lactating mothers. In this double-blinded randomized trial, Danish mothers with habitual fish intake below the 50th percentile of the Danish National Birth Cohort were randomized to microencapsulated FO [1.3 g/d long-chain n-3 FA (n-3 LCPUFA)] or olive oil (OO). The intervention started within a week after delivery and lasted 4 mon. Mothers with habitual high fish intake and their infants were included as a reference group. Ninety-seven infants completed the trial (44 OO-group, 53 FO-group) and 47 reference infants were followed up. The primary outcome measures were: DHA content of milk samples (0, 2, and 4 mon postnatal) and of infant red blood cell (RBC) membranes (4 mon postnatal), and infant visual acuity (measured by swept visual evoked potential at 2 and 4 mon of age). FO supplementation gave rise to a threefold increase in the DHA content of the 4-mon milk samples (P < 0.001). DHA in infant RBC reflected milk contents (r = 0.564, P < 0.001) and was increased by almost 50% (P < 0.001). Infant visual acuity was not significantly different in the randomized groups but was positively associated at 4 mon with infant RBC-DHA (P = 0.004, multiple regression). We concluded that maternal FO supplementation during lactation did not enhance visual acuity of the infants who completed the intervention. However, the results showed that infants with higher RBC levels of n-3 LCPUFA had a better visual acuity at 4 mon of age, suggesting that n-3 LCPUFA may influence visual maturation.

The women who fulfilled the criteria of a MD did not have a reduced risk of preterm birth.

Objective: To validate intakes of protein, folic acid, retinol and n-3 fatty acids estimated from a food-frequency questionnaire in week 25 of pregnancy . Design: Validation was done against a 7-day weighed food diary (FD) and biomarkers of the nutrients in gestation week 32-38. Subjects and setting: The FFQ-25 to be validated was used in the Danish National Birth Cohort comprising 101 042 pregnant Danish women, of whom 88 participated in the present validation study. Results: Estimated intakes of protein, retinol and folic acid did not differ significantly between the two dietary methods, but intake of n-3 fatty acids was one third larger when estimated from the FFQ-25. The intakes estimated from the two dietary methods were all significantly correlated, ranging from 0.20 for retinol intake to 0.57 for folic acid intake. Sensitivities of being correctly classified into low and high quintiles were between 0.22 and 0.77, and specificities were between 0.62 and 0.89. Urinary protein content did not correlate significantly with protein estimated from the FFQ (r ¼ 0.17, P . 0.05), but did with intake estimated from the FD (r ¼ 0.56, P , 0.0001). Erythrocyte folate correlated significantly with the estimated total intake from the FFQ (r ¼ 0.55, P , 0.0001) and the FD (r ¼ 0.52, P , 0.0001). No correlations with plasma retinol were found. Erythrocyte eicosapentaenoic acid (C20:5n2 3) correlated significantly with n-3 fatty acids intake estimated from both the FFQ-25 (r ¼ 0.37, P , 0.001) and the FD (r ¼ 0.62, P , 0.0001). Conclusion: The FFQ-25 gives reasonable valid estimates of protein, retinol and folic acid intakes, but seems to overestimate intake of n-3 fatty acids. A number of hypotheses on the influence of maternal diet during pregnancy on health have been suggested during the last two decades. In Denmark, data on the dietary intake of pregnant women have been collected on a large scale in the Danish National Birth Cohort (DNBC), which is a prospective pregnancy cohort with national coverage 1 . In gestation week 25, a 360-item food-frequency questionnaire (FFQ-25) was mailed to all cohort members. To enable sensible use of these dietary data for aetiological analyses, however, we need information on the validity of the collected dietary information. The questionnaire is a modified version of the food-frequency questionnaire (FFQ) developed at the Danish Cancer Registry 2 , which was validated in a population of 40-64-year-old men and women 3 and young non-pregnant women 4 . Since diet during pregnancy could be different and since pregnant women might be more aware of their dietary habits, it is important to validate the questionnaire in this particular population and describe the degree of misclassification.Hypotheses initially motivating the set-up of the cohort included those regarding the potential influences of protein 5 -8 , vitamin A 9,10 , folic acid 11,12 and n-3 fatty acids 13,14 consumed in pregnancy on pregnancy outcomes and various measures of offspring health. In the current paper we p...

Recent research suggests that the diet consumed in, or shortly before, pregnancy can potentially lead to maldevelopment and diseases in the offspring, which may become apparent at any time from the embryonic stage until old age. For example, maternal diet may affect the chance of twinning (and associated complications), malformation risk, brain development, and the offspring's fecundity and risk of contracting cardiovascular diseases and cancer in adult life. Prospectively designed longitudinal studies with sufficient size and data quality are much needed to substantiate or refute these hypotheses. At present, the Danish National Birth Cohort is likely to be the largest epidemiological database containing extensive information on maternal dietary exposures. By October 2002, 100 000 women had been recruited in early pregnancy, for long-term follow-up of themselves and their offspring. The present paper details the information available in the database on early nutritional exposures with emphasis on maternal dietary intake. We also present distributions of selected nutritional exposures.

Fruit and vegetable consumption in pregnancy is positively associated with birth weight in well-nourished Danish women, especially among lean women.

Objective: As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 mg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey. Design: Cohort study on pregnant women in Denmark. Setting: The Danish National Birth Cohort (DNBC). Subjects: From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy. Results: An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance. Conclusions: Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.