A Priori and a Posteriori Dietary Patterns during Pregnancy and Gestational Weight Gain: The Generation R Study

Abstract

Abnormal gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We examined whether dietary patterns are associated with GWG. Participants included 3374 pregnant women from a population-based cohort in the Netherlands. Dietary intake during pregnancy was assessed with food-frequency questionnaires. Three a posteriori-derived dietary patterns were identified using principal component analysis: a “Vegetable, oil and fish”, a “Nuts, high-fiber cereals and soy”, and a “Margarine, sugar and snacks” pattern. The a priori-defined dietary pattern was based on national dietary recommendations. Weight was repeatedly measured around 13, 20 and 30 weeks of pregnancy; pre-pregnancy and maximum weight were self-reported. Normal weight women with high adherence to the “Vegetable, oil and fish” pattern had higher early-pregnancy GWG than those with low adherence (43 g/week (95% CI 16; 69) for highest vs. lowest quartile (Q)). Adherence to the “Margarine, sugar and snacks” pattern was associated with a higher prevalence of excessive GWG (OR 1.45 (95% CI 1.06; 1.99) Q4 vs. Q1). Normal weight women with higher scores on the “Nuts, high-fiber cereals and soy” pattern had more moderate GWG than women with lower scores (−0.01 (95% CI −0.02; −0.00) per SD). The a priori-defined pattern was not associated with GWG. To conclude, specific dietary patterns may play a role in early pregnancy but are not consistently associated with GWG.

A maternal “mixed, high sugar” dietary pattern is associated with fetal growth

“…Further to the data from our setting, dietary patterns high in processed foods and/or sugar have been associated with maternal adiposity, GDM risk, and birth size in high‐income and low‐ and middle‐income countries (LMICs; Coelho et al, ; Englund‐Ögge et al, ; Guilloty et al, ; Sedaghat et al, ; Tielemans et al, ). It has also been suggested that the influence of maternal dietary practices on infant adiposity may persist into childhood.…”

“…In addition, both a higher maternal BMI and greater GWG were positively associated with newborn weight‐to‐length ratio but not with fat mass index (Wrottesley et al, ). Differences in the associations between dietary patterns during pregnancy and GWG in normal weight and overweight/obese women have been documented elsewhere (Hillesund, Bere, Haugen, & Øverby, ; Tielemans et al, ). Additionally, both positive and negative associations between energy dense, processed dietary patterns and birth weight have been shown in previous studies (Coelho, Cunha, Esteves, Lacerda, & Filha, ; Colón‐Ramos et al, ; Knudsen, Orozova‐Bekkevold, Mikkelsen, Wolff, & Olsen, ).…”

“…The Kaiser-Meyer-Olkin measure of sampling adequacy (0.69) andBartlett's test of sphericity (p < .001) were used to confirm PCA as an appropriate dimension reduction technique for use in this sample.Dietary patterns were retained based on eigenvalues and their visual inflections on a scree plot as well as the percentage of total variance explained. As previously described by Tielemans et al, foods or food groups with factor loadings ≤−0.2 or ≥0.2 reflected strong associations with dietary patterns(Tielemans et al, 2015) and were therefore used to name the patterns. Dietary pattern scores were calculated for each pattern by multiplying factor loadings by the standardised intake frequency of each food/food group and then summing these.…”

Development of a dietary screening questionnaire to predict excessive weight gain in pregnancy

“…Results from numerous observational studies have shown that a healthy dietary pattern during pregnancy is associated with a decrease in the odds of excessive GWG and various pregnancy complications (Brantsaeter et al, 2009;Chen et al, 2016;Englund-Ogge et al, 2014;Hillesund et al, 2014;Knudsen et al, 2008;Martin et al, 2015;Renault et al, 2015;Shin et al, 2016;Tielemans et al, 2015;Tryggvadottir et al, 2016;Uusitalo et al, 2009). However, these results have not been mirrored in nutritional intervention studies (Rogozinska et al, 2017).…”

“…Results from observational studies have repeatedly shown that dietary habits characterized by high consumption of fruits and vegetables, wholegrain, fish, healthy fat, and low consumption of food with little nutritional value are associated with lower risk of excessive GWG and pregnancy complications (Brantsaeter et al, ; Chen et al, ; Englund‐Ogge et al, ; Hillesund, Bere, Haugen, & Overby, ; Knudsen, Orozova‐Bekkevold, Mikkelsen, Wolff, & Olsen, ; Martin, Sotres‐Alvarez, & Siega‐Riz, ; Renault et al, ; Shin, Lee, & Song, ; Tielemans et al, ; Tryggvadottir, Medek, Birgisdottir, Geirsson, & Gunnarsdottir, ; Uusitalo et al, ). Results from intervention studies, aiming at improving diet, physical activity, or both, have shown that reduction in GWG can be achieved.…”