Socio-economic and Racial Prenatal Diet Quality Disparities in a National US Sample

Overview

Journal Public Health Nutr

Publisher Cambridge University Press

Date 2019 Dec 5

PMID 31796144

Citations 11

Authors

Haley W Parker

Alison Tovar

Karen McCurdy

Maya Vadiveloo

Affiliations

Soon will be listed here.

Abstract

Objective: To examine differences in prenatal diet quality by socio-economic status (SES) and race/ethnicity.

Design: A secondary, cross-sectional analysis. Race and SES were self-reported prenatally; SES was categorized into four groups: high-income, middle-income and low-income WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) participant/non-participant. The Alternative Healthy Eating Index for Pregnancy (AHEI-P) measured diet quality, including four moderation and nine adequacy components (higher scores = healthier diet). Generalized linear models adjusted for covariates and post hoc testing with Tukey adjustment compared AHEI-P scores between groups, using a threshold of P < 0·05.

Setting: Infant Feeding Practices Study II, conducted in a national US convenience cohort.

Participants: Women in their third trimester (n 1322) with dietary history.

Results: Participants were of 28·9 (se 5·6) years on average and predominantly non-Hispanic White (84 %); approximately one-third participated in WIC and 17 % were high-income. The mean AHEI-P score was 61·7 (se 10·8) of 130 points. High-income women had higher total (62·4 (se 1·0)) and moderation component AHEI-P scores than middle-income (60·1 (se 0·8), P = 0·02), low-income WIC participants (58·3 (se 0·8), P < 0·0001) and non-participants (58·9 (se 0·9), P = 0·001). Non-Hispanic Black participants had lower total (57·8 (se 1·4)) and adequacy scores than Other races (i.e. neither non-Hispanic Black nor White, 62·1 (se 0·9), P = 0·02).

Conclusions: Disparities in prenatal diet quality were observed, with non-Hispanic Black women, low-/middle-income and WIC participants having lower diet quality. However, interventions are needed to improve prenatal diet quality broadly among US women.

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References

Wang D, Leung C, Li Y, Ding E, Chiuve S, Hu F . Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med. 2014; 174(10):1587-95. PMC: 5924699. DOI: 10.1001/jamainternmed.2014.3422. View

Mameli C, Mazzantini S, Zuccotti G . Nutrition in the First 1000 Days: The Origin of Childhood Obesity. Int J Environ Res Public Health. 2016; 13(9). PMC: 5036671. DOI: 10.3390/ijerph13090838. View

Forbes L, Graham J, Berglund C, Bell R . Dietary Change during Pregnancy and Women's Reasons for Change. Nutrients. 2018; 10(8). PMC: 6115730. DOI: 10.3390/nu10081032. View

Bodnar L, Siega-Riz A . A Diet Quality Index for Pregnancy detects variation in diet and differences by sociodemographic factors. Public Health Nutr. 2003; 5(6):801-9. DOI: 10.1079/PHN2002348. View

Subar A, Freedman L, Tooze J, Kirkpatrick S, Boushey C, Neuhouser M . Addressing Current Criticism Regarding the Value of Self-Report Dietary Data. J Nutr. 2015; 145(12):2639-45. PMC: 4656907. DOI: 10.3945/jn.115.219634. View

Rifas-Shiman S, Rich-Edwards J, Kleinman K, Oken E, Gillman M . Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort. J Am Diet Assoc. 2009; 109(6):1004-11. PMC: 4098830. DOI: 10.1016/j.jada.2009.03.001. View

Siega-Riz A, Bodnar L, Savitz D . What are pregnant women eating? Nutrient and food group differences by race. Am J Obstet Gynecol. 2002; 186(3):480-6. DOI: 10.1067/mob.2002.121078. View

Stang J, Huffman L . Position of the Academy of Nutrition and Dietetics: Obesity, Reproduction, and Pregnancy Outcomes. J Acad Nutr Diet. 2016; 116(4):677-91. DOI: 10.1016/j.jand.2016.01.008. View

Hillier S, Olander E . Women's dietary changes before and during pregnancy: A systematic review. Midwifery. 2017; 49:19-31. DOI: 10.1016/j.midw.2017.01.014. View

10.

Godfrey K, Barker D . Fetal programming and adult health. Public Health Nutr. 2001; 4(2B):611-24. DOI: 10.1079/phn2001145. View

11.

Shin D, Lee K, Song W . Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy. Nutrients. 2016; 8(3):162. PMC: 4808890. DOI: 10.3390/nu8030162. View

12.

Drewnowski A, Darmon N . Food choices and diet costs: an economic analysis. J Nutr. 2005; 135(4):900-4. DOI: 10.1093/jn/135.4.900. View

13.

Satia J . Diet-related disparities: understanding the problem and accelerating solutions. J Am Diet Assoc. 2009; 109(4):610-5. PMC: 2729116. DOI: 10.1016/j.jada.2008.12.019. View

14.

Fein S, Labiner-Wolfe J, Shealy K, Li R, Chen J, Grummer-Strawn L . Infant Feeding Practices Study II: study methods. Pediatrics. 2008; 122 Suppl 2:S28-35. DOI: 10.1542/peds.2008-1315c. View

15.

Hiza H, Casavale K, Guenther P, Davis C . Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet. 2012; 113(2):297-306. DOI: 10.1016/j.jand.2012.08.011. View

16.

Morales M, Berkowitz S . The Relationship between Food Insecurity, Dietary Patterns, and Obesity. Curr Nutr Rep. 2018; 5(1):54-60. PMC: 6019322. DOI: 10.1007/s13668-016-0153-y. View

17.

Suitor C, Gardner J, Feldstein M . Characteristics of diet among a culturally diverse group of low-income pregnant women. J Am Diet Assoc. 1990; 90(4):543-9. View

18.

Liu C, Liu H . Concerns and Structural Barriers Associated with WIC Participation among WIC-Eligible Women. Public Health Nurs. 2016; 33(5):395-402. PMC: 5527844. DOI: 10.1111/phn.12259. View

19.

Webb Girard A, Olude O . Nutrition education and counselling provided during pregnancy: effects on maternal, neonatal and child health outcomes. Paediatr Perinat Epidemiol. 2012; 26 Suppl 1:191-204. DOI: 10.1111/j.1365-3016.2012.01278.x. View

20.

Kirkpatrick S, Dodd K, Reedy J, Krebs-Smith S . Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children. J Acad Nutr Diet. 2012; 112(5):624-635.e6. PMC: 3775640. DOI: 10.1016/j.jand.2011.11.012. View