title: Pregnancy Requires Major Changes in the Quality of the Diet for Nutritional Adequacy: Simulations in the French and the United States Populations.
abstract: BACKGROUND
  Maternal nutrition is critical to the health of both mother and offspring, but there is a paucity of data on the nutritional adequacy of diets during pregnancy.
  
  
  OBJECTIVE
  Our objective was to identify to what extent pregnancy reduces the nutritional adequacy of the expecting mother's diet and if this nutritional gap can be resolved by simple quantitative or qualitative changes in the diet.
  
  
  METHODS
  We evaluated the observed overall nutritional adequacy of diets of French and American women of childbearing age participating in ENNS (n = 344) and NHANES (n = 563) using the probabilistic approach of the PANDiet system, resulting in a 100-point score. Then, we simulated the changes in the PANDiet scores of women of childbearing age who would remain on their diet during pregnancy. Finally, by either increasing the quantity of consumed foods or using eleven snacks recommended during pregnancy, we simulated the effect of a 150-kcal increase in the energy intake of French women.
  
  
  RESULTS
  Observed PANDiet scores were equal to 59.3 ± 7.0 and 58.8 ± 9.3 points respectively in France and in the US. Simulation of pregnancy for women of childbearing age led to a decrease in nutritional adequacy for key nutrients during pregnancy and resulted in reducing PANDiet scores by 3.3 ± 0.1 and 3.7 ± 0.1 points in France and in the US. Simulated 150-kcal increases in energy intake proved to be only partially effective in filling the gap both when the quantity of food consumed was increased and when recommended snacks were used.
  
  
  CONCLUSIONS
  The decrease in nutritional adequacy induced by pregnancy cannot be addressed by simply following generic dietary guidelines.
authors.affiliation: UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 75005, Paris, France.
authors.forename: Clélia M
authors.initials: CM
authors.lastname: Bianchi
authors.affiliation: UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 75005, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Mariotti
authors.affiliation: INSERM, UMR_S U1166, Nutriomics team, F-75013, Paris, France.|Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique des Hôpitaux de Paris, Pitié-Salpêtrière hospital, Nutrition department, F-75013, Paris, France.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Verger
authors.affiliation: UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 75005, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Huneau
mesh_terms: D000328:Adult; D004032:Diet; D005260:Female; D005602:France; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena; D009749:Nutrition Surveys; D011247:Pregnancy; D011336:Probability; D014481:United States