American Journal of Obstetrics and Gynecology | 2019
Expansion of diagnostic criteria for hypertension identifies group at intermediate risk of adverse outcomes: 77
Abstract
disparities in diet quality exist. However, it is unknown whether individual diet quality is associated with obstetric outcomes. Our objective was to assess if there are differences in maternal and neonatal health according to maternal periconceptional diet quality. STUDY DESIGN: Secondary analysis of a large, multicenter prospective cohort study of 10,038 nulliparous women receiving obstetrical care at 8 US centers. Women underwent three antenatal study visits and had detailed maternal and neonatal data abstracted by trained research personnel. In the first trimester, women completed the modified Block 2005 food frequency questionnaire, a semiquantitative assessment of usual dietary intake for the 3 months around conception. Responses were scored using the Healthy Eating Index-2010 (HEI), which assesses adherence to the 2010 Dietary Guidelines for Americans. Higher scores represent better adherence. HEI scores were analyzed continuously and by quartile. Multivariable logistic regression was performed to assess associations between diet quality and outcomes. RESULTS: In this cohort of 8259 women with HEI data, the mean HEI score was 63 ( 13) of 100. Women with the lowest quartile HEI scores were more likely to be younger, non-Hispanic black and Hispanic, publicly insured, low income, and tobacco users. They were more likely to have comorbidities (obesity, chronic hypertension, pregestational diabetes, mental health disorders) and had less educational attainment. Women with lowest quartile scores experienced less frequent major perineal lacerations and more frequent postpartum hemorrhage (PPH), preeclampsia, and preterm birth, but only the odds of PPH persisted on multivariable analyses (Table). Although some differences in neonatal outcomes were noted on bivariable analyses, after controlling for potential confounders, only the odds of macrosomia (which were lower) differed for neonates born to mothers with the lowest HEI quartile (Table). Results did not differ when analyzing HEI as a continuous variable. CONCLUSION: Periconceptional diet quality is associated with sociodemographic and clinical differences but after accounting for these potential confounders, diet quality is associated with few differences in maternal or neonatal outcomes.