Racial or Ethnic and Socioeconomic Inequalities in Adherence to National Dietary Guidance in a Large Cohort of US Pregnant Women

Abstract

Background The significance of periconceptional nutrition for optimizing offspring and maternal health and reducing social inequalities warrants greater understanding of diet quality among U.S. women. Objective The objective was to evaluate racial/ethnic and education inequalities in periconceptional diet quality and sources of energy and micronutrients. Design Cross-sectional analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b) cohort. Participants and setting Nulliparous women (n=7511) were enrolled across 8 U.S. medical centers from 2010 to 2013. Main outcome measures A semi-quantitative food frequency questionnaire assessing usual dietary intake in the 3 months around conception was self-administered in the first trimester. Diet quality, measured using the Healthy Eating Index-2010 (HEI-2010), and sources of energy and micronutrients were the outcomes. Statistical analyses Differences in diet quality were tested across maternal racial/ethnic and education groups using F-tests associated with analysis of variance and Chi-squared tests. Results HEI-2010 score increased with higher education, but the increase among non-Hispanic Black women was smaller than among non-Hispanic whites and Hispanics (interaction p<0.0001). For all groups, average scores for HEI-2010 components were below recommendations. Top sources of energy were sugar-sweetened beverages, pasta dishes, and grain desserts, but sources varied by race/ethnicity and education. Approximately 34% of energy consumed was from empty calories (the sum of energy from added sugars, solid fats, and alcohol beyond moderate levels). The primary sources of iron, folate, and vitamin C were juices and enriched breads. Conclusions Diet quality is suboptimal around conception, particularly among women who are non-Hispanic Black, Hispanic, or who had less than a college degree. Diet quality could be improved by substituting intakes of refined grains and foods empty in calories with vegetables, peas and beans (legumes), seafood, and whole grains.

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study

“…In 1996, the Australian Longitudinal study on Women's Health (ALSWH) recruited 40 000 women in three age cohorts of 'young' (18-23 years), 'mid-aged' (45-50 years) and 'older' (70-75 years) women (31) . In 1996, the Australian Longitudinal study on Women's Health (ALSWH) recruited 40 000 women in three age cohorts of 'young' (18-23 years), 'mid-aged' (45-50 years) and 'older' (70-75 years) women (31) .…”

“…Higher scores are assigned to each subscale if there are frequent, diverse or optimal intakes of food, nutrients or both (30) . Diet quality scores have been used to assess diet adequacy in pregnant women (23,31) . The Australian Recommended Food Score (ARFS) has been used to evaluate overall diet quality and demonstrates comparative validity in Australian women (28) and adults (30) .…”

“…In Australia, there are two cohort studies investigating the dietary pattern of pregnant women. In 1996, the Australian Longitudinal study on Women's Health (ALSWH) recruited 40 000 women in three age cohorts of 'young' (18-23 years), 'mid-aged' (45-50 years) and 'older' (70-75 years) women (31) . This is the first cohort study to obtain comprehensive dietary intake data in a nationally representative sample of Australian women, across the various age ranges (28) .…”

Maternal nutrient intake and fetal gastroschisis: A case‐control study

“…Higher calorie intake was observed in the GG than in the CG, but the intake of essential nutrients, such as amino acids, that are exclusively obtained from the diet was lower. Suboptimal nutrition may have a critical influence during the preconception period, when the fetal growth trajectory, the placental capacity to supply nutrients to the fetus, fetoplacental immunology, and maternal hormonal and metabolic regulatory systems are established (Bodnar et al, ; Oliver, Jaquiery, Bloomfield, & Harding, ). According to the study by Bodnar et al () in the United States of America, the preconception diet quality of women in their first pregnancy is suboptimal.…”

“…Suboptimal nutrition may have a critical influence during the preconception period, when the fetal growth trajectory, the placental capacity to supply nutrients to the fetus, fetoplacental immunology, and maternal hormonal and metabolic regulatory systems are established (Bodnar et al, ; Oliver, Jaquiery, Bloomfield, & Harding, ). According to the study by Bodnar et al () in the United States of America, the preconception diet quality of women in their first pregnancy is suboptimal. The consumption of whole grains, dairy products, and fatty acids was particularly low, whereas the intake of empty calories and sodium was excessively high.…”