Maternal Dietary Inflammatory Index during Pregnancy Is Associated with Perinatal Outcomes: Results from the IMPACT BCN Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Assessment of Dietary Intake
2.3. DII Assessment
2.4. Maternal Characteristics
2.5. Perinatal Outcomes
2.6. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population According to DII Tertile
3.2. Maternal Dietary Characteristics and Adherence to MD According to DII Tertile
3.3. Association of DII with Maternal BMI and Newborn’s Birthweight
4. Discussion
4.1. Nutritional Intake According to DII Index
4.2. Mediterranean Diet Adherence
4.3. Perinatal Outcomes and Birthweight
4.4. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | All n = 970 | DII | p y | ||
---|---|---|---|---|---|
Tertile 1 n = 323 | Tertile 2 n = 324 | Tertile 3 n = 323 | |||
DII * | |||||
Range | −5.71 to −0.33 | −5.71 to −3.48 | −3.47 to −2.34 | −2.33 to −0.33 | <0.001 |
Mean ± SD | −2.94 ± 1.12 | −4.23 ± 0.51 | −2.89 ± 0.34 | −1.7 ± 0.45 | <0.001 |
Maternal characteristics | |||||
Age at enrollment (years) | 37.1 ± 4.70 | 37.4 ± 4.54 | 37.2 ± 4.70 | 36 ± 4.82 | 0.083 |
≤24 years | 16 (1.6) | 4 (1.2) | 4 (1.2) | 8 (2.5) | |
25–29 years | 61 (6.3) | 18 (5.6) | 19 (5.9) | 24 (7.4) | |
≥30 years | 893 (92.1) | 301 (93.2) | 301 (92.9) | 291 (90.1) | |
Race and ethnicity a | 0.055 | ||||
Asian | 15 (1.5) | 6 (1.9) | 6 (1.9) | 3 (0.9) | |
Black | 15 (1.5) | 5 (1.5) | 5 (1.5) | 5 (1.5) | |
Latin American | 128 (13.2) | 59 (18.3) | 35 (10.8) | 34 (10.5) | |
White | 794 (81.9) | 245 (75.9) | 271 (83.6) | 278 (86.1) | |
Maghreb | 18 (1.9) | 8 (2.5) | 7 (2.2) | 3 (0.9) | |
Socioeconomic status b | 0.921 | ||||
High | 618 (63.7) | 206 (63.8) | 209 (64.5) | 203 (62.8) | |
Medium | 309 (31.9) | 105 (32.5) | 99 (30.6) | 105 (32.5) | |
Low | 43 (4.4) | 12 (3.7) | 16 (4.9) | 15 (4.6) | |
Pre-pregnancy BMI (kg/m2) | 23.88 ± 4.80 | 23.4 ± 4.98 | 23.7 ± 4.28 | 24.5 ± 5.05 | 0.011 |
<18.5 (n (%)) | 61(6.3) | 28 (8.7) | 14 (4.3) | 19 (5.9) | |
18.5–24.9 | 593 (61.1) | 201 (62.2) | 207 (63.9) | 185 (57.3) | |
≥25 | 316 (32.6) | 94 (29.1) | 103 (31.8) | 119 (36.8) | |
Systolic blood pressure (mmHg) | 105.36 ± 12.02 | 105.79 ± 13.37 | 105.48 ± 11.67 | 104.79 ± 10.85 | 0.564 |
Diastolic blood pressure (mmHg) | 67.73 ± 8.58 | 67.3 ± 8.97 | 68.18 ± 8.37 | 67.71 ± 8.37 | 0.424 |
Education level (schooling years) | 0.500 | ||||
University (yes (%)) | 653 (67.3) | 220 (68.1) | 220 (67.9) | 213 (65.9) | |
Vocational (yes (%)) | 76 (7.8) | 23 (7.1) | 29 (9) | 24 (7.4) | |
Secondary (yes (%)) | 198 (20.4) | 68 (21.1) | 59 (18.2) | 71 (22) | |
Primary (yes (%)) | 34 (3.5) | 7 (2.2) | 13 (4) | 14 (4.3) | |
No education (yes (%)) | 9 (0.9) | 5 (1.5) | 3 (0.9) | 1 (0.3) | |
Use of assisted reproductive technologies (yes (%)) | 262 (27.0) | 82 (25.4) | 89 (27.5) | 91 (28.2) | 0.709 |
Medical history | |||||
Autoimmune disease (yes (%)) | 159 (16.4) | 43 (13.3) | 59 (18.2) | 57 (17.6) | 0.184 |
Obesity c (yes (%)) | 109 (11.2) | 29 (9) | 31 (9.6) | 49 (15.2) | 0.106 |
Thyroid disorder (yes (%)) | 110 (11.3) | 34 (10.5) | 38 (11.7) | 38 (11.8) | 0.852 |
Diabetes (yes (%)) | 48 (4.9) | 18 (5.6) | 14 (4.3) | 16 (5) | 0.764 |
Minor psychiatric disorder d (yes (%)) | 38 (3.9) | 10 (3.1) | 16 (4.9) | 12 (3.7) | 0.470 |
Chronic hypertension (yes (%)) | 41 (4.2) | 15 (4.6) | 14 (4.3) | 12 (3.7) | 0.837 |
Chronic kidney disease (yes (%)) | 23 (2.4) | 6 (1.9) | 10 (3.1) | 7 (2.2) | 0.565 |
Adverse obstetric history | |||||
Previous SGA (yes (%)) | 157 (16.2) | 44 (13.6) | 55 (17) | 58 (18) | 0.292 |
Previous preterm birth (yes (%)) | 54 (5.6) | 21 (6.5) | 15 (4.6) | 18 (5.6) | 0.583 |
Previous preeclampsia (yes (%)) | 49 (5.1) | 17 (5.3) | 21 (6.5) | 11 (3.4) | 0.198 |
Previous stillbirth (yes (%)) | 26 (2.7) | 6 (1.9) | 11 (3.4) | 9 (2.8) | 0.476 |
Nulliparous (yes (%)) | 400 (41.2) | 128 (39.6) | 146 (45.1) | 126 (39) | 0.227 |
During pregnancy | |||||
Smoking habit (yes (%)) | 64 (6.6) | 16 (5) | 23 (7.1) | 25 (7.7) | 0.648 |
Alcohol consumption (yes (%)) | 14 (1.4) | 6 (1.9) | 3 (0.9) | 5 (1.5) | 0.066 |
Drug consumption (yes (%)) | 3 (0.3) | 0 (0) | 2 (0.6) | 1 (0.3) | 0.296 |
Physical exercise (yes (%)) | 219 (22.6) | 98 (30.3) | 72 (22.2) | 49 (15.2) | <0.001 |
Yoga or pilates (yes (%)) | 189 (19.5) | 91 (28.2) | 64 (19.8) | 34 (10.5) | <0.001 |
Gestational age at randomization, mean (SD), weeks | 20.85 ± 0.68 | 20.85 ± 0.69 | 20.85 ± 0.68 | 20.85 ± 0.67 | 0.999 |
Perinatal outcome | |||||
GDM (yes (%)) | 93 (9.6) | 23 (7) | 42 (12.6) | 28 (9) | 0.282 |
Preeclampsia (yes (%)) | 72 (7.4) | 33 (10.1) | 19 (5.7) | 20 (6.5) | 0.587 |
Birthweight, mean (SD), g | 3195.74 ± 523.4 | 3246.79 ± 501.73 | 3185.14 ± 500.5 | 3155.28 ± 562.91 | 0.077 |
Cesarean section (yes (%)) | 327 (33.7) | 104 (31.8) | 121 (36.3) | 102 (32.9) | 0.126 |
Gestational age at delivery, mean (SD), weeks | 39.42 ± 1.76 | 39.54 ± 1.51 | 39.4 ± 1.8 | 39.31 ± 1.94 | 0.246 |
Birthweight percentile, mean (SD) | 42.66 ± 29.96 | 44.22 ± 30.56 | 42.33 ± 28.79 | 41.43 ± 30.5 | 0.481 |
SGA (yes (%)) | 161 (16.6) | 65 (19.9) | 46 (13.8) | 50 (16.1) | 0.400 |
Severe SGA (yes (%)) | 60 (6.2) | 31 (9.5) | 15 (4.5) | 14 (4.5) | 0.228 |
Prematurity (yes (%)) | 60 (6.2) | 20 (6.1) | 19 (5.7) | 21 (6.8) | 0.695 |
Combined adverse perinatal outcome (yes (%)) | 209 (21.5) | 85 (26) | 61 (18.3) | 63 (20.3) | 0.485 |
Characteristics | All n = 97 | DII | p y | ||
---|---|---|---|---|---|
Tertile 1 n = 323 | Tertile 2 n = 324 | Tertile 3 n = 323 | |||
EVOO (g/day) | 50 (25 to 50) | 50 (25 to 50) | 50 (25 to 50) | 25 (10 to 50) | 0.001 |
Refined olive oil (g/day) | 0 (0 to 6.96) | 0 (0 to 0) | 0 (0 to 9.46) | 0 (0 to 10) | 0.073 |
Total nuts (g/day) | 12.86 (4.29 to 27.71) | 25.71 (12.86 to 42.57) | 12.86 (4.29 to 25.71) | 6 (0 to 12.86) | <0.001 |
Vegetables (g/day) | 269.15 (198.67 to 355.9) | 376.81 (307.07 to 446.77) | 269.04 (214.76 to 327.8) | 192.78 (141.93 to 234.81) | <0.001 |
Legumes (g/day) | 42.86 (30 to 64.29) | 56.19 (41.43 to 79.52) | 42.86 (30 to 57.98) | 33.33 (20 to 43.33) | <0.001 |
Fruits (g/day) | 306.43 (207.14 to 412.5) | 388.57 (303.57 to 513) | 307.71 (218.57 to 406.67) | 218.86 (148.21 to 307.82) | <0.001 |
Refined cereals (g/day) | 60 (32.14 to 89.71) | 51.43 (17.14 to 77.14) | 60 (34.14 to 94.29) | 72.57 (38.29 to 94.29) | <0.001 |
Whole grain cereals (g/day) | 25.71 (0 to 60) | 47.14 (12.79 to 70.61) | 31.07 (4.29 to 60) | 8.57 (0 to 47.14) | <0.001 |
Fish or seafood (g/day) | 68 (42.6 to 95.9) | 83.14 (55.98 to 113.95) | 65.9 (42.33 to 92.57) | 55.67 (34.39 to 77.87) | <0.001 |
Blue fish (g/day) | 8.33 (0 to 17.86) | 17.86 (8.33 to 17.86) | 8.33 (0 to 17.86) | 8.33 (0 to 17.86) | <0.001 |
Lean meat (g/day) | 74.29 (42.86 to 85.71) | 74.29 (52.86 to 85.71) | 74.29 (52.86 to 85.71) | 69.29 (41.43 to 85.71) | 0.106 |
Processed meat (g/day) | 28.57 (14.29 to 50) | 24.76 (10.48 to 49.29) | 28.57 (21.43 to 50) | 28.57 (14.29 to 50) | 0.085 |
Pastries, cakes, or sweets (g/day) | 30.1 (13.74 to 55.76) | 28.57 (12.42 to 55.71) | 30.24 (14.29 to 50.59) | 30.48 (12.41 to 60.71) | 0.782 |
Dairy products (g/day) | 300 (184.42 to 410.18) | 312.5 (174.64 to 440.48) | 310.36 (196.61 to 427.32) | 275 (187.86 to 366.13) | 0.019 |
Onion (g/day) | 15 (5 to 15) | 15 (15 to 27.5) | 15 (15 to 15) | 15 (5 to 15) | <0.001 |
Garlic (g/day) | 0.3 (0 to 0.9) | 0.9 (0.3 to 1.65) | 0.9 (0.14 to 0.9) | 0.14 (0 to 0.3) | <0.001 |
Oregano (g/day) | 2.14 (0 to 2.14) | 0.21 (0.07 to 0.21) | 0.21 (0 to 0.21) | 0.07 (0 to 0.21) | <0.001 |
Pepper (g/day) | 0 (0 to 2.14) | 0.33 (0 to 2.14) | 0 (0 to 2.14) | 0 (0 to 0.71) | <0.001 |
Alcohol (g/day) | 0 (0 to 0.09) | 0 (0 to 0.19) | 0 (0 to 0.09) | 0 (0 to 0.09) | 0.002 |
MD Score | 8 (6 to 10) | 9 (7 to 11) | 8 (6 to 9) | 6 (4.25 to 8) | <0.001 |
Characteristics | All n = 970 | DII | p y | ||
---|---|---|---|---|---|
Tertile 1 n = 323 | Tertile 2 n = 324 | Tertile 3 n = 323 | |||
Energy (kcal/day) | 2412.32 ± 449.4 | 2717.83 ± 361.31 | 2421.29 ± 365.41 | 2097.82 ± 387.77 | <0.001 |
Protein (g/day) | 102 ± 23.09 | 115.35 ± 21.25 | 102.05 ± 19.81 | 88.6 ± 19.99 | <0.001 |
Carbohydrate (g/day) | 211.8 (179.53 to 248.39) | 243.56 (213.2 to 278.39) | 212.07 (186.52 to 241.83) | 181.07 (155.53 to 211.33) | <0.001 |
Fiber (g/day) | 32.04 (25.36 to 39.48) | 41.83 (37.53 to 47.19) | 32.21 (28.28 to 35.54) | 23.64 (19.83 to 26.74) | <0.001 |
Total fat (g/day) | 129.54 (110.8 to 151.81) | 144.41 (126.82 to 164.92) | 129.81 (113.25 to 150.84) | 115.27 (97.8 to 132.27) | <0.001 |
SFAs (g/day) | 34.13 (28.47 to 40.52) | 36.73 (31.31 to 42.69) | 34.53 (29.03 to 40.47) | 30.71 (26.69 to 38.29) | <0.001 |
MUFAs (g/day) | 66.17 ± 17.23 | 72.91 ± 15.51 | 66.74 ± 17.28 | 58.86 ± 15.92 | <0.001 |
PUFAs (g/day) | 18.04 (14.75 to 23.1) | 22.82 (18.55 to 27.77) | 18.2 (15.5 to 22.16) | 14.67 (12.91 to 17.48) | <0.001 |
Linoleic acid (g/day) | 13.07 (10.53 to 17.1) | 16.55 (12.69 to 20.3) | 13.07 (10.66 to 16.64) | 10.91 (9.39 to 13.34) | <0.001 |
α-Linolenic acid (g/day) | 1.18 (0.94 to 1.72) | 1.7 (1.17 to 2.04) | 1.17 (0.98 to 1.67) | 0.96 (0.79 to 1.19) | <0.001 |
EPA (g/day) | 0.13 (0.08 to 0.19) | 0.17 (0.12 to 0.23) | 0.13 (0.08 to 0.18) | 0.11 (0.06 to 0.15) | <0.001 |
DHA (g/day) | 0.28 (0.15 to 0.38) | 0.34 (0.21 to 0.46) | 0.27 (0.15 to 0.37) | 0.2 (0.1 to 0.33) | <0.001 |
Trans-FA (g/day) | 1.39 (0.9 to 1.93) | 1.33 (0.83 to 1.77) | 1.37 (0.85 to 1.9) | 1.51 (0.98 to 2.1) | 0.006 |
Cholesterol (mg/day) | 329.37 (271.94 to 387.11) | 352.56 (290.57 to 419.63) | 332.07 (280.83 to 390.09) | 301.47 (242.94 to 357.17) | <0.001 |
Vitamins | |||||
Vitamin A (µg/day) | 1232.06 (925.37 to 1605.67) | 1647.04 (1353.22 to 1995.93) | 1239.6 (1018.95 to 1514.61) | 880.25 (696.21 to 1093.78) | <0.001 |
Vitamin C (mg/day) | 241.62 (172.22 to 326.08) | 348.1 (278.38 to 423.19) | 246.67 (191.3 to 295.85) | 159.67 (122.7 to 203.88) | <0.001 |
Vitamin D (µg/day) | 4.56 (3.46 to 5.91) | 5.65 (4.3 to 7.16) | 4.49 (3.44 to 5.66) | 3.83 (2.92 to 5) | <0.001 |
Vitamin E (mg/day) | 17.94 (14.85 to 21.73) | 22.62 (19.46 to 26.79) | 17.7 (15.68 to 20.11) | 14.12 (12.07 to 16.39) | <0.001 |
Vitamin B1 (mg/day) | 1.81 (1.54 to 2.11) | 2.12 (1.87 to 2.39) | 1.81 (1.59 to 2.04) | 1.52 (1.31 to 1.77) | <0.001 |
Vitamin B2 (mg/day) | 2.09 (1.76 to 2.45) | 2.42 (2.16 to 2.76) | 2.09 (1.81 to 2.38) | 1.73 (1.48 to 1.99) | <0.001 |
Vitamin B3 (mg/day) | 23.74 (20.21 to 27.28) | 27.74 (24.74 to 30.69) | 23.49 (20.81 to 26.05) | 20.28 (16.84 to 22.98) | <0.001 |
Vitamin B6 (mg/day) | 2.79 ± 0.67 | 3.4 ± 0.51 | 2.76 ± 0.43 | 2.22 ± 0.45 | <0.001 |
Vitamin B9 (µg/day) | 471.52 (376.29 to 581.24) | 613.43 (555.07 to 700.19) | 470.34 (420.74 to 519.52) | 347.85 (298.9 to 393.19) | <0.001 |
Vitamin B12 (µg/day) | 6.33 (4.89 to 8.3) | 7.5 (5.8 to 9.56) | 7.5 (5.8 to 9.56) | 7.5 (5.8 to 9.56) | <0.001 |
Β-carotene (µg/day) | 5481.21 (3853.48 to 7339.81) | 7627.1 (6353.83 to 9270.43) | 5447.07 (4429.53 to 6880.58) | 3561.99 (2744.51 to 4845.43) | <0.001 |
Minerals | |||||
Zinc (mg/day) | 11.92 (10.21 to 14.07) | 14.34 (12.25 to 15.85) | 12.1 (10.84 to 13.6) | 10.06 (8.7 to 11.32) | <0.001 |
Iron (mg/day) | 15.95 (13.51 to 18.59) | 19.46 (17.65 to 21.74) | 15.94 (14.43 to 17.45) | 12.71 (11.27 to 14.04) | <0.001 |
Magnesium (mg/day) | 437.41 (359.96 to 510.06) | 545.09 (488.22 to 622.47) | 440.92 (394.65 to 477.09) | 331.41 (294.23 to 379.52) | <0.001 |
Selenium (µg/day) | 101.32 (84.15 to 121.61) | 117.71 (98.4 to 136.98) | 101.39 (87.62 to 116.1) | 86.98 (72.85 to 103.87) | <0.001 |
Tertiles of DII Score (1 = Lower DII Score and 3 = Higher DII Score) | ||||||
---|---|---|---|---|---|---|
Outcome | n = 970 | Model 1 | Model 2 | Model 3 | Model 4 | |
Pre-pregnancy BMI, kg/m2 | ||||||
DII continuous | 970 | 22.43 ± 4.1 | 0.41 (−0.07 to 0.9) | 0.30 (0.10 to 0.49) | 0.29 (0.09 to 0.49) | 0.32 (0.12 to 0.52) |
DII tertile | ||||||
Tertile 1 | 323 | 23.41 ± 4.98 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Tertile 2 | 324 | 23.72 ± 4.28 | 0.45 (−0.77 to 1.67) | 0.44 (−0.06 to 0.93) | 0.41 (−0.09 to 0.92) | 0.42 (−0.08 to 0.92) |
Tertile 3 | 323 | 24.50 ± 5.05 | 1.35 (−0.03 to 2.72) | 0.82 (0.26 to 1.39) | 0.80 (0.24 to 1.37) | 0.88 (0.31 to 1.45) |
Birthweight percentile | ||||||
DII continuous | 970 | 39.87 ± 29.05 | −3.17 (−6.57 to 0.24) | −3.37 (−6.70 to −0.04) | −3.62 (−6.94 to −0.30) | −4.05 (−7.42 to −0.68) |
DII tertile | ||||||
Tertile 1 | 323 | 44.22 ± 30.56 | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) | 1 (Ref.) |
Tertile 2 | 324 | 42.33 ± 28.79 | −2.51 (−11.20 to 6.18) | −2.52 (−10.99 to 5.96) | −3.12 (−11.59 to 5.36) | −3.86 (−12.36 to 4.65) |
Tertile 3 | 323 | 41.43 ± 30.5 | −7.16 (−16.96 to 2.64) | −8.08 (−17.67 to 1.51) | −8.56 (−18.12 to 0.99) | −9.84 (−19.57 to −0.12) |
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Casas, R.; Castro-Barquero, S.; Crovetto, F.; Larroya, M.; Ruiz-León, A.M.; Segalés, L.; Nakaki, A.; Youssef, L.; Benitez, L.; Casanovas-Garriga, F.; et al. Maternal Dietary Inflammatory Index during Pregnancy Is Associated with Perinatal Outcomes: Results from the IMPACT BCN Trial. Nutrients 2022, 14, 2284. https://doi.org/10.3390/nu14112284
Casas R, Castro-Barquero S, Crovetto F, Larroya M, Ruiz-León AM, Segalés L, Nakaki A, Youssef L, Benitez L, Casanovas-Garriga F, et al. Maternal Dietary Inflammatory Index during Pregnancy Is Associated with Perinatal Outcomes: Results from the IMPACT BCN Trial. Nutrients. 2022; 14(11):2284. https://doi.org/10.3390/nu14112284
Chicago/Turabian StyleCasas, Rosa, Sara Castro-Barquero, Francesca Crovetto, Marta Larroya, Ana Maria Ruiz-León, Laura Segalés, Ayako Nakaki, Lina Youssef, Leticia Benitez, Francesc Casanovas-Garriga, and et al. 2022. "Maternal Dietary Inflammatory Index during Pregnancy Is Associated with Perinatal Outcomes: Results from the IMPACT BCN Trial" Nutrients 14, no. 11: 2284. https://doi.org/10.3390/nu14112284