title: Diet quality in early pregnancy and its effects on fetal growth outcomes: the Infancia y Medio Ambiente (Childhood and Environment) Mother and Child Cohort Study in Spain.
abstract: BACKGROUND
  Maternal diet has been associated with fetal growth outcomes; however, evidence is scarce on the role of dietary quality.
  
  
  OBJECTIVE
  The objective was to assess the effect of diet quality during the first trimester of pregnancy, as measured by the Alternate Healthy Eating Index (AHEI) adapted for pregnancy, on fetal growth.
  
  
  METHODS
  We studied 787 women and their newborns from a Spanish cohort study. Diet quality was assessed by using a modification of the AHEI. Adjusted birth weight, birth length, and head circumference were used as continuous outcomes. We used a customized model to define fetal growth restriction in weight, length, and head circumference.
  
  
  RESULTS
  After adjustment of multivariate models, a positive association was observed between diet quality and adjusted birth weight and adjusted birth length. The greatest differences were found between the fourth and first quintiles of the AHEI. Newborns of women in the fourth quintile were on average 126.3 g (95% CI: 38.5, 213.9 g) heavier and 0.47 cm (95% CI: 0.08, 0.86 cm) longer than those in the lowest quintile (P for trend = 0.009 and 0.013, respectively). Women with the highest AHEI scores had a significantly lower risk of delivering a fetal growth-restricted infant for weight (odds ratio: 0.24; 95% CI: 0.10, 0.55; P for trend = 0.001) than did women in the lowest quintile, but this was not the case for fetal growth restriction in length (P for trend = 0.538) or head circumference (P for trend = 0.070).
  
  
  CONCLUSIONS
  A high-quality diet in the first trimester of pregnancy is associated with birth size and the risk of fetal growth restriction.
authors.affiliation: Centro Superior de Investigación en Salud Pública, Valencia, Spain. rodriguez_claber@gva.es <rodriguez_claber@gva.es>
authors.forename: Clara L
authors.initials: CL
authors.lastname: Rodríguez-Bernal
authors.forename: Marisa
authors.initials: M
authors.lastname: Rebagliato
authors.forename: Carmen
authors.initials: C
authors.lastname: Iñiguez
authors.forename: Jesús
authors.initials: J
authors.lastname: Vioque
authors.forename: Eva M
authors.initials: EM
authors.lastname: Navarrete-Muñoz
authors.forename: Mario
authors.initials: M
authors.lastname: Murcia
authors.forename: Francisco
authors.initials: F
authors.lastname: Bolumar
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marco
authors.forename: Ferran
authors.initials: F
authors.lastname: Ballester
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology*; D015331:Cohort Studies; D004032:Diet / Q000592:standards*; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D006257:Head / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000502:physiology*; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013030:Spain; D011795:Surveys and Questionnaires; D055815:Young Adult