title: Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women's Health.
abstract: BACKGROUND
  Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and pre-eclampsia, are common obstetric complications associated with adverse health outcomes for the mother and child. It remains unclear how dietary intake can influence HDP risk.
  
  
  OBJECTIVE
  We investigated associations between prepregnancy dietary patterns and risk of HDPs.
  
  
  METHODS
  We selected 3582 women participating in the Australian Longitudinal Study on Women's Health, which is an observational population-based study. Women were not pregnant at baseline in 2003 and reported at least one live birth between 2003 and 2012. Diet was assessed by using a validated 101-item food-frequency questionnaire in 2003, and factor analysis was used to identify dietary patterns. HDPs were assessed by using the question, "Were you diagnosed or treated for hypertension during pregnancy?" Generalized estimating equation models were used to estimate RRs (95% CIs) adjusted for dietary, reproductive, sociodemographic, and lifestyle factors.
  
  
  RESULTS
  During 9 y of follow-up of 3582 women, 305 women (8.5%) reported a first diagnosis of HDPs in 6149 pregnancies. We identified 4 dietary patterns labeled as meat, high-fat, and sugar; Mediterranean-style; fruit and low-fat dairy; and cooked vegetables. In the adjusted model, the meat, high-fat, and sugar, fruit and low-fat dairy, and cooked vegetable dietary patterns were not associated with HDP risk. The Mediterranean-style dietary pattern (characterized by vegetables, legumes, nuts, tofu, rice, pasta, rye bread, red wine, and fish) was inversely associated with risk of developing HDPs (quartile 4 compared with quartile 1: RR, 0.58; 95% CI, 0.42, 0.81).
  
  
  CONCLUSIONS
  In this population-based study of Australian women, we observed an independent protective dose-response association between prepregnancy consumption of a Mediterranean-style dietary pattern and HDP risk. Additional studies are recommended to confirm our findings by prospectively examining whether the implementation of the Mediterranean-style dietary pattern before pregnancy has a role in the prevention of HDPs.
authors.affiliation: Schools of Public Health and d.schoenaker@uq.edu.au.
authors.forename: Danielle A J M
authors.initials: DA
authors.lastname: Schoenaker
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands; and.
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.affiliation: Medicine, University of Queensland, Brisbane, Australia; Departments of Obstetric and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Leonie K
authors.initials: LK
authors.lastname: Callaway
authors.affiliation: Schools of Public Health and.
authors.forename: Gita D
authors.initials: GD
authors.lastname: Mishra
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D038441:Diet, Mediterranean; D007887:Fabaceae; D005163:Factor Analysis, Statistical; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008460:Meat; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012098:Reproduction; D012307:Risk Factors; D012959:Socioeconomic Factors; D014675:Vegetables; D016387:Women's Health
keywords: Mediterranean diet; diet; dietary patterns; hypertensive disorders of pregnancy; nutrition; pregnancy