Diet Quality defined by the HEI‐2010 and AHEI‐P in Pregnant Northern Plains American Indian Women
Authors: Ferranti Erin , Hartman Terryl J. , Elliott Amy J. , Angal Jyoti , Mitchell Diane C. , Nickleach Dana , Breslow Rosalind 
Published: November 2023

Introduction and Study ObjectiveThe importance of adequate nutrition during pregnancy is well established and is associated with both maternal and fetal outcomes. Adequate nutrition in pregnancy includes both overall diet quality and specific nutrient intake. Research examining diet quality and nutrient intake during pregnancy among Native American women is lacking. The objective of this study was to examine both overall diet quality defined by the Healthy Eating Index‐2010 (HEI‐2010) and Alternate Healthy Eating Index for pregnancy (AHEI‐P) dietary indices and intake of pregnancy‐specific dietary reference intake (DRI) nutrients in pregnant Northern Plains (NP) American Indian women.MethodsThe current study is a secondary analysis from the Safe Passage Study, a prospective study to examine the association between prenatal maternal alcohol intake and adverse health outcomes. Women in this study were NP American Indian women, 16 years and older, at a gestational age of at least 20 weeks. Demographic data included age, level of education, and marital status. Basic medical history included gestational age, smoking history and pre‐pregnancy body mass index (BMI). Dietary intake was assessed by three 24 hour recalls, conducted by unannounced telephone calls, two on week days and one on a weekend day. The recalls were entered into the computer‐directed NDSR system to include preparation, portion sizes, brand‐name foods and dietary supplement use. The data from the three recalls were averaged and then scored for the HEI‐2010 and the AHEI‐P. Higher scores on the dietary indices indicates better diet quality with the HEI‐2010 scored from 0–100 and the AHEI‐P scored from 0–90. Nutrient intakes were compared to the pregnancy‐specific Dietary Reference Intakes.ResultsA total of 170 women were included in this analyses. Mean age was 26.9 (± 5.5) years. Mean scores for the HEI‐2010 were 48.8 (± 10.5) and for the AHEI‐P were 52.0 (± 9.0) indicating suboptimal overall diet quality. Areas of greatest deficiency were in total vegetable intake and green vegetable intake. Other concerns included poor fatty acid ratio, poor white meat to red meat ratio and high intakes of empty calories and sodium. Intake of micronutrients from food and drink alone, excluding supplementation were also suboptimal, particularly for Vitamins D and E, Copper, Iron, Choline and Magnesium. Only 65% of participants reported intake of prenatal vitamin supplements.ConclusionThere is a significant need to identify culturally‐tailored strategies to improve overall diet quality and micronutrient intake among NP American Indian women. Furthermore, identifying reasons for lack of prenatal vitamin supplementation is warranted.Support or Funding InformationThe PASS Research Network is supported by the National Institute on Alcohol Abuse and Alcoholism, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institute on Deafness and Other Communication Disorders through the Cooperative Agreement Mechanism (U01 HD055154, U01 HD045935, U01 HD055155, U01 HD045991, and U01 AA016501). Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.