Maternal dietary patterns during pregnancy and preterm delivery: a large prospective cohort study in China

Abstract

BackgroundEvidence about the associations between maternal dietary patterns and preterm delivery is scarce in Eastern countries. The purpose of this study was to examine the associations between maternal dietary patterns during pregnancy and preterm delivery in a Chinese population.MethodsA total of 7352 mothers were included in the Born in Guangzhou Cohort Study, a prospective study in China. A validated self-administered food frequency questionnaire (FFQ) was used to assess maternal diet at 24–27 weeks of gestation. Dietary patterns were identified by cluster analysis. Gestational age was obtained from routine medical records. Preterm delivery was defined as delivery before 37 completed weeks of gestation, and was further classified into spontaneous and iatrogenic preterm delivery, and also early/moderate and late preterm delivery. Associations between dietary patterns and preterm delivery outcomes were assessed using logistic regression analyses.ResultsSix dietary patterns were identified, including ‘Milk’, ‘Cereals, eggs, and Cantonese soups’, ‘Meats’, ‘Fruits, nuts, and Cantonese desserts’, ‘Vegetables’, and ‘Varied’. There were 351 (4.8%) preterm deliveries in this study population. Among those of preterm delivery, 16.2 and 83.8% were early/moderate and late preterm delivery, respectively. Compared with women of ‘Vegetables’ pattern, those of ‘Milk’ pattern had greater odds of overall preterm delivery (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.11, 2.29, p < 0.05), spontaneous preterm delivery (adjusted OR 1.73, 95% CI 1.14, 2.62, p < 0.05) and late preterm delivery (adjusted OR 1.73, 95% CI 1.08, 2.62, p < 0.05); those of ‘Cereals, eggs, and Cantonese soups’ and ‘Fruits, nuts, and Cantonese desserts’ patterns had greater odds of late preterm delivery (adjusted OR 1.54, 95% CI 1.01, 2.35 for ‘Cereals, eggs, and Cantonese soups’, adjusted OR 1.61, 95% CI 1.04, 2.50 for ‘Fruits, nuts, and Cantonese desserts’, respectively).ConclusionMaternal diet with frequent consumption of milk and less frequent consumption of vegetables during pregnancy might be associated with increased odds of preterm delivery. Future interventions should investigate whether increasing vegetable intake reduces preterm deliveries.Electronic supplementary materialThe online version of this article (10.1186/s12937-018-0377-3) contains supplementary material, which is available to authorized users.

Modeling Differential Effects of Maternal Dietary Patterns across Severity Levels of Preterm Birth Using a Partial Proportional Odds Model

“…Our findings are also consistent with the outcomes of a study of dietary pattern and its association with preterm birth in Singapore, that showed a dietary pattern high in vegetables, fruits, and white rice, is associated with a lower risk of preterm birth 44 . Our findings are further consistent with a study in China, which showed that maternal diet with frequent consumption of vegetables, might contribute significantly to lowering odds of experiencing a preterm birth outcome 30 . A study in Singapore found that the consumption of the 'vegetable, fruit and rice' pattern, which includes 'nut and rice foods' , was found to be associated with a reduced risk of preterm birth outcome 45 .…”

“…The complexity of preterm birth suggests that a simple binary logistic regression approach fails to identify exposure effects at different severity levels of preterm birth 24,[29][30][31] . Many researchers have applied newer statistical and scientific methods to identify the effect of dietary patterns on the incidence of preterm birth.…”

Effects of maternal diets on preterm birth and low birth weight: a systematic review

“…Maize and soyabean flour that is fortified with a vitamin and mineral Khoury et al (62) CLD ↓ RR 0•10 0•01, 0•77 Intake of fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables and legumes Lu et al (45) Milk pattern…”

Nutrition in Pregnancy and Growth in Southwest China (NPGSC) cohort: Design, implementation, and characteristics

“…Environmental exposures in fetal and infant life may have long-term programming effects on health. 1 Previous evidence has indicated that poor nutrition before and during pregnancy, including low dietary quality, low fibre intake, and a high glycaemic index, increases the risk of adverse pregnancy outcomes in mothers (eg anaemia, gestational hypertensive, and diabetic disorders) 2,3 and infants (eg fetal death, preterm birth, and macrosomia), [4][5][6] as well as increasing a child's risks of chronic diseases in later life. 7,8 Furthermore, higher maternal pre-pregnant body mass index and inappropriate gestational weight gain also yielded persistent effects on children's growth.…”