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Mom’s Poor Diet in Pregnancy Linked to Baby’s Higher Weight at Birth

Kaiser Permanente study shows replacing empty calories with whole grains lead to a 25 percent decreased risk of large-for-gestational age offspring.

Researchers at Kaiser Permanente Northern California’s Divison of Research have found that a pregnant mom’s poor diet, in addition to being bad for her own health, is linked to poor fetal growth.

The study, “Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: A prospective multi-racial/ethnic cohort study,” was published in December 2018 in the International Journal of Epidemiology.

The study investigated whether diet quality during pregnancy was related to birthweight. The researchers found an association between poorer maternal diet quality during early pregnancy and greater offspring birthweight, as well as an increased risk of large-for-gestational age infants.

Co-lead author Monique Hedderson, PhD, Kaiser Permanente research scientist

“We found that pregnant women whose diet adhered to the United States Department of Agriculture (USDA) guidelines for a healthy diet were less likely to have an infant that was born too large, a risk factor for developing obesity later in childhood,” said co-first author Monique Hedderson, a research scientist at Kaiser Permanente Northern California’s Division of Research. “This study supports the notion that clinicians should encourage women to follow the USDA guidelines for healthy eating during pregnancy, not only for their health but also for the health of their baby.”

Emerging evidence suggests that a mom’s nutritional choices during pregnancy may impact fetal and long-term offspring growth and disease risk in later life. Less understood, however, is whether these nutritional choices impact fetal growth extremes, such as large- or small-for-gestational age infants, which in turn are important predictors of future childhood and adult health, including cardiometabolic diseases. Previous research on fetal growth extremes and diet during pregnancy focused on isolated foods or nutrients rather than examining the overall diet quality and have reported inconsistent findings.

The study analyzed a diverse cohort of 2,269 women from the prospective Pregnancy Environment and Lifestyle Study during the years 2014-2017, led by senior author Assiamira Ferrara, MD, PhD, associate director of Women’s and Children’s Health at the Division of Research. Their dietary intake during early pregnancy was assessed by a questionnaire and then examined in relationship to their offspring’s birthweight measures.

Approximately 80 percent of women did not achieve good diet quality, as measured by the Healthy Eating Index-2010, a measure based on adherence to the USDA Dietary Guidelines for Americans.

The study found that the poorer a mom’s diet in early pregnancy, the greater the risk of babies being heavier at birth and large-for-gestational age as infants, independent of maternal obesity. The women who had the poorest diet quality had nearly double the risk of large-for-gestational age offspring, compared to the women with the best diet quality.

Co-lead author Yeyi Zhu, PhD, Kaiser Permanente research scientist

“Women complicated with gestational diabetes are at higher risk of delivering a large-for-gestational age baby, despite lifestyle modification or medication therapy they have received,” said co-first author Yeyi Zhu, a Research Scientist at the Division of Research. “Our finding of a more pronounced association between poor diet quality in pregnancy and higher risk of delivering a large-for-gestational baby among women without gestational diabeteshighlights the importance of promoting diet quality among all pregnant women, regardless of their status of gestational diabetes.”

The study found an association between replacing empty calories with whole grains and a 25 percent decreased risk of large-for-gestational age offspring.

The study authors hope that the findings may inform potential prevention strategies and dietary guidelines for pregnant women, such as the substitution of empty calories with whole grains to mitigate the risk of excess fetal growth.

“Pregnant women who are seeking healthier alternatives for empty calories from solid fats, alcohol, and added sugars may consider whole grains,” Zhu said.

The study was funded by the National Institute of Environmental Health Sciences, the National Institutes of Health, and the Health Resources and Services Administration.

Additional co-authors from the Division of Research include Sneha Sridhar, Fei Xu, and Juanran Feng.

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