The Institute of Medicine (IOM) and National Research Council (NRC) established guidelines for weight gain during pregnancy to maximize positive health outcomes for mothers and their offspring. However, in the US, about half of all pregnant women exceed these recommendations. Excessive weight gain during pregnancy is associated with various negative outcome for mothers and their children. Research in recent years has begun to explore the relationship between both diet quality and ultra-processed food (UPF) intake during pregnancy with gestational weight gain (GWG). However, research is scarce, especially pertaining to UPF intake and GWG. Additionally, there is no research which explores these relationships among Latina women living within the US. The purpose of this study is to explore the relationships between prenatal diet quality, measured with the Healthy Eating Index-2020 (HEI), and intake of UPF, based on the Nova classification system, with the adequacy of GWG among a predominantly Latina sample of adult pregnant women living within the US. Additionally, the association between social determinants of health with diet quality and with UPF intake were also explored.
The study is a secondary-data analysis of data from a longitudinal study. The sample analyzed includes 118 pregnant women between the ages of 18-45 years old (mean = 29.9, SD = 6.1). Mean pre-pregnancy body mass index (pBMI) for the total sample was 25.8 kg/m2 (overweight). 67% of the sample identified as Hispanic/Latina. Overall, 22% of the sample were classified with inadequate GWG; 17% with adequate GWG; and 61% with excessive GWG.
The mean total HEI score for the sample was 54.1 out of 100, where higher scores reflect higher diet quality and adherence to the Dietary Guidelines for Americans. There was a statistically significant difference across GWG groups (inadequate/adequate/excessive) in mean total HEI scores (p < .05). The adequate GWG group had the highest total HEI scores and the excessive GWG group had the lowest total HEI scores.
Variables that were found to be univariately associated with excessive gestational weight gain included: average total HEI score, pBMI, ethnicity; education; and income (p < .05). A 1-point increase in mean total HEI scores was associated with a 5% lower chance of excessive GWG (p = .02). However, after adjustment for covariates (maternal age; pBMI; income; education; race and ethnicity), the association between average total HEI score and excessive gestational weight gain was attenuated and no longer statistically significant.
There was a statistically significant difference across GWG groups (inadequate, adequate, or excessive) in their scores of two HEI components: Greens and Beans (p < .01); and Seafood and Plant Proteins (p < .01). The adequate GWG group had the highest scores and the excessive GWG group had the lowest scores in these HEI components.
In simple logistic regressions of excessive GWG versus adequate GWG on HEI components, the Greens and Beans scores and the Seafood and Plant Protein scores were significantly associated with excessive GWG. After adjustment, the Greens and Beans scores and Seafood and Plant Proteins scores indicated strong estimated negative associations with excessive GWG, OR = 0.61, 〖 χ〗_1^2= 8.07, p < 0.01 and OR = 0.60, 〖 χ〗_1^2= 7.84, p < 0.01, respectively. A higher score on these components was associated with a lower risk of excessive GWG.
The mean percentage of energy intake from ultra-processed foods (PEI-UPF) was 51.2%. There was no statistically significant difference in the PEI-UPF across GWG groups (inadequate, adequate, or excessive) and the PEI-UPF was not associated with odds of excessive GWG. However, the adequate GWG group had the lowest intake of PEI-UPF (49.2%) and the excessive GWG group had the highest intake of PEI-UPF (52.1%).
Social determinants of health were not associated with the mean PEI-UPF, but results suggested a positive relationship between social support and total HEI scores (p = .08). Deeper analysis of the social support measure revealed a statistically significant relationship between the appraisal subscale of social support and HEI scores, Β = 0.13, F(1, 102) = 7.11 (p = 0.009).
Overall, dietary intake during pregnancy may influence the adequacy of gestational weight gain. Achieving recommended intake of greens and beans, as well as seafood and plant proteins, may play a particularly important role in reducing the risk for excessive gestational weight gain. In addition, greater levels of social support, particularly access to another person who can offer advice and guidance with personal problems, may enhance diet quality during pregnancy.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/yx1k-wa28 |
| Date | January 2024 |
| Creators | Haramati, Eden |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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