Abstract MP62: Healthful Dietary Patterns in Pregnancy are Related to Lower Risks of Common Pregnancy Complications in a Longitudinal Cohort
Authors: Li Mengying , Hinkle Stefanie N , Yisahak Samrawit , Grantz Katherine L , Tekola-Ayele Fasil , Grewal Jagteshwar , Zhang Cuilin 
Published: March 2020

Introduction:
Healthful dietary patterns such as alternate healthy eating index (aHEI), alternate Mediterranean diet (aMED), and dietary approaches to stop hypertension (DASH) have been recommended in the U.S. to prevent chronic diseases. However, data on their relations with common pregnancy complications are sparse. Further, longitudinal dietary data in pregnancy are scarce.

Hypothesis:
Healthful dietary patterns (
i.e.
, higher aHEI, aMED, and DASH score) in pregnancy is related to lower risks of gestational diabetes (GDM), gestational hypertension (GHTN), preeclampsia (PE), and preterm delivery (PTD).

Methods:
The study included 1,897 pregnant women from the NICHD Fetal Growth Studies-Singletons. Women responded to a food frequency questionnaire on their habitual diet in the past 3 months at visit 0 (gestational weeks 8-13) and a 24-hour dietary recall at visit 1 (weeks 16-22) and 2 (weeks 24-29). Cardiometabolic biomarkers (
e.g.
, fasting glucose, insulin, C-reactive protein [CRP], and lipids) were measured in a sub-sample. GDM, GHTN, PE, and PTD were ascertained by medical records review. Relative risks (RRs) and 95% confidence interval (CI) of the outcome by dietary pattern scores at visit 0, 1, and 2 (GHTN, preeclampsia, PTD only) were estimated by log-binomial models adjusting covariates including pre-pregnancy BMI.

Results:
Both aHEI and aMED at visit 1 were significantly and inversely related to GDM risk; for example, the RRs for increasing quartiles of aHEI at visit 1 were 1.00, 0.71, 0.67, and 0.32 (
p
-trend = 0.002). DASH at visit 0 and 1 was significantly and inversely related to GHTN risk; the RRs for increasing quartiles of DASH at visit 0 were 1.00, 0.90, 0.33, and 0.46 (
p
-trend = 0.04). aHEI at visit 2 was significantly and inversely related to PE risk; the RRs for increasing quartiles of aHEI were 1.00, 0.85, 0.67, and 0.37 (
p
-trend = 0.03). Lastly, aMED at visit 0 and DASH at visit 2 were significantly and inversely related to PTD risk, the RRs for increasing quartiles of aMED at visit 0 were 1.00, 0.81, 0.50, and 0.51 (
p
-trend = 0.03). In longitudinal analyses, sustained adherence to aMED (i.e., above median score) over visits 0 and 1 was related to a 48% lower GDM risk (RR = 0.52; 95% CI: 0.28, 0.99) compared to non-adherence (
i.e.
, below median score) at both visits; sustained adherence to DASH at visits 0, 1, and 2 was related to a 73% lower GHTN risk (RR = 0.27; 95% CI: 0.07, 0.97). In addition, healthful dietary patterns at visit 0 were generally related to a favorable cardiometabolic profile at visit 1 (
i.e.
, lower glucose, insulin, HOMA-IR, CRP, cholesterol, and LDL).

Conclusions:
Healthful dietary patterns in pregnancy were related to lower risks of GDM, GHTN, PE, and PTD, although the magnitude and significance varied by the timing of dietary assessment and dietary pattern. Further, sustained adherence to healthful dietary patterns over pregnancy were related to lower risks of GDM and GHTN.