Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
Am J Obstet Gynecol. 2020 Jul;223(1):121.e1-121.e8. doi: 10.1016/j.ajog.2020.01.042. Epub 2020 Jan 23.
Periconceptional diet quality is commonly suboptimal and sociodemographic disparities in diet quality exist. However, it is unknown whether individual periconceptional diet quality is associated with obstetric outcomes.
Our objective was to assess differences in maternal and neonatal outcomes according to maternal periconceptional diet quality.
This is a secondary analysis of a large, multicenter prospective cohort study of 10,038 nulliparous women receiving obstetrical care at 8 United States centers. Women underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted by trained research personnel. In the first trimester (between 6 and 13 weeks), 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, which assesses adherence to the 2010 Dietary Guidelines for Americans. Higher scores on the Healthy Eating Index represent better adherence. Healthy Eating Index scores were analyzed by quartile; quartile 4 represents the highest dietary quality. Bivariable and multivariable analyses were performed to assess associations between diet quality and outcomes. A sensitivity analysis in which markers of socioeconomic status were included in the multivariable Poisson regression models was performed.
In the cohort of 8259 women with Healthy Eating Index data, the mean Healthy Eating Index score was 63 (±13) of 100. Women with the lowest quartile Healthy Eating Index 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), a higher prepregnancy body mass index, and less education. Women with lowest quartile scores experienced less frequent major perineal lacerations and more frequent postpartum hemorrhage requiring transfusion and hypertensive disorders of pregnancy, which persisted on multivariable analyses (controlling for age, body mass index, tobacco use, chronic hypertension, pregestational diabetes mellitus, and mental health disorders) comparing women in each quartile with quartile 4. Additionally, women in quartiles 1 and 2 experienced greater adjusted relative risk of cesarean delivery compared with women in quartile 4. Neonatal outcomes also differed by dietary quartile, with women in the lowest Healthy Eating Index quartile experiencing greater adjusted relative risk of preterm birth, neonatal intensive care unit admission, small for gestational age infant, and low birthweight, and lower risk of macrosomia; all neonatal findings also persisted in multivariable analyses. The sensitivity analysis with inclusion of markers of socioeconomic status (race/ethnicity, insurance status, marital status) in the multivariable models supported these findings.
Periconceptional diet quality among women in the United States is poor. Poorer periconceptional dietary quality is associated with adverse maternal and neonatal outcomes, even after controlling for potential comorbidities and body mass index, suggesting periconceptional diet may be an important social or biological determinant of health underlying existing health disparities.
围孕期饮食质量通常不理想，并且存在社会人口统计学方面的饮食质量差异。然而，尚不清楚个体围孕期饮食质量是否与产科结局有关。
我们的目的是评估根据孕产妇围孕期饮食质量的差异与产妇和新生儿结局的关系。
这是对在美国 8 个中心接受产科护理的 10038 名初产妇进行的一项大型、多中心前瞻性队列研究的二次分析。女性在 3 次产前研究访视期间进行了详细的母婴数据采集，并由经过培训的研究人员进行了分析。在孕早期（6-13 周），女性完成了改良的 Block 2005 食物频率问卷，这是对受孕前后 3 个月内日常饮食摄入的半定量评估。通过使用 2010 年美国饮食指南的健康饮食指数-2010 对这些回答进行评分。健康饮食指数得分越高表示依从性越好。通过四分位数分析健康饮食指数得分；四分位数 4 代表最高的饮食质量。进行了单变量和多变量分析，以评估饮食质量与结局之间的关系。进行了一项敏感性分析，在多变量泊松回归模型中纳入了社会经济地位的标志物。
在有健康饮食指数数据的 8259 名队列女性中，健康饮食指数平均得分为 63（±13）/100。健康饮食指数得分最低的四分位数女性更可能年轻、非西班牙裔黑人和西班牙裔、公保、低收入和吸烟。她们更可能患有合并症（肥胖、慢性高血压、妊娠前糖尿病、心理健康障碍）、孕前体重指数更高、受教育程度更低。得分最低的四分位数女性经历的会阴重大撕裂较少，产后出血需要输血和妊娠高血压疾病更频繁，这在多变量分析（在考虑年龄、体重指数、吸烟、慢性高血压、妊娠前糖尿病和心理健康障碍的情况下）中仍然存在，将每个四分位数的女性与四分位数 4 进行比较。此外，与四分位数 4 的女性相比，四分位数 1 和 2 的女性经历了更大的调整相对风险剖宫产分娩。新生儿结局也因饮食四分位数而异，健康饮食指数最低四分位数的女性发生早产、新生儿重症监护病房入院、小于胎龄儿和低出生体重的风险更高，而巨大儿的风险更低；所有新生儿结果在多变量分析中也仍然存在。在多变量模型中纳入社会经济地位标志物（种族/民族、保险状况、婚姻状况）的敏感性分析支持了这些发现。
美国女性围孕期饮食质量较差。较差的围孕期饮食质量与不良的产妇和新生儿结局相关，即使在考虑了潜在的合并症和体重指数之后，这表明围孕期饮食可能是现有健康差异背后重要的社会或生物学健康决定因素。
