Diet Quality in Pregnancy and the Risk of Fetal Growth Restriction


      The Healthy Eating Index 2015 (HEI) is a tool developed by the US Department of Agriculture to assess the quality of a diet by evaluating 13 nutritional components. Given the link between maternal malnutrition and adverse long term pediatric outcomes, we tested the hypothesis that a high-quality diet (high HEI score) in pregnancy is associated with a lower risk of fetal growth restriction (FGR).

      Study Design

      This is a secondary analysis of a prospective cohort study in patients with singleton pregnancies who completed the NIH Dietary Health Questionnaire II (DHQ-II) in the third trimester or within 3 months of delivery. Patients with fetal anomalies, IVF pregnancies, and deliveries at an outside hospital were excluded. The primary outcome was fetal growth restriction, defined as estimated fetal weight < 10th percentile at time of delivery. Secondary outcomes were hypertensive disorders of pregnancy (HDP), large for gestational age (LGA), and gestational diabetes (GDM). These outcomes were compared between patients with and without a high HEI, defined as a score ≥70.


      Among 762 patients with DHQ-II data, 128 (17%) had a high HEI score and 634 (83%) had a lower HEI score. The mean HEI score was 60. After adjusting for obesity and chronic hypertension, patients with a high HEI were 67% less likely to have FGR (aRR=0.33, 0.13-0.68) and 54% less likely to have HDP (aRR=0.46, 0.24-0.79) compared to those with lower HEI. There was no difference in LGA infants, or GDM between groups.


      A high quality diet is associated with decreased risk of FGR and hypertensive disorders of pregnancy. HEI may be a useful tool to identify modifiable dietary risks for prevention of pregnancy complications.
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