title: Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy.
abstract: Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003-2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight), and 30 kg/m² (obese) were used to categorize pregnant women's weight status. Diet quality during pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2-11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2-11.7, AOR 5.4; 95% CI 2.0-14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p < 0.05). Serum iron concentration (ng/dL) was significantly higher in normal weight women compared to overweight women (86.2 ± 5.0 vs. 68.9 ± 3.0, p < 0.05). An inverse association was found between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those women entering pregnancy as overweight and obese.
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, G. Malcolm Trout FSHN Building, East Lansing, MI 48824, USA. shinda@msu.edu.
authors.forename: Dayeon
authors.initials: D
authors.lastname: Shin
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, G. Malcolm Trout FSHN Building, East Lansing, MI 48824, USA. kyungwon@msu.edu.
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Food Science and Human Nutrition, Michigan State University, 469 Wilson Road, G. Malcolm Trout FSHN Building, East Lansing, MI 48824, USA. song@msu.edu.
authors.forename: Won O
authors.initials: WO
authors.lastname: Song
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D001835:Body Weight; D004032:Diet; D005260:Female; D006801:Humans; D016015:Logistic Models; D039382:Maternal Nutritional Physiological Phenomena; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009752:Nutritional Status; D009753:Nutritive Value; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Healthy Eating Index (HEI)-2010; National Health and Nutrition Examination Survey; diet quality; nutritional biomarkers; pre-pregnancy body mass index (BMI)