Pitt research finds women have poor diets before pregnancy
March 17, 2017 12:00 AM
Cheryl Senter/The New York Times
By Jill Daly / Pittsburgh Post-Gazette
A wide range of women have poor diets in the months leading up to their first pregnancy, according to research published Friday and led by the University of Pittsburgh Graduate School of Public Health. Their food choices, with too many empty calories and too few nutrients, fell far short of national dietary guidelines set to reduce the risk of premature birth, restricted fetal growth, preeclampsia and maternal obesity.
Although none of the women reached the dietary goals, black, Hispanic and less-educated women had a poorer diet than white women and those with college degrees, according to the study, published in the Journal of the Academy of Nutrition and Dietetics.
“One of the most concerning aspects of the results for me is that one-third of calories from their diets was solid fats and sugars,” said nutritional epidemiologist Lisa Bodnar, the lead author.
“The recommendation is [no more than] 9 to 13 percent empty calories. These women were consuming three times the recommended amount,” Ms. Bodnar said.
The study analyzed the results of questionnaires filled out by 7,511 women in eight U.S. medical centers. They reported on what they ate and drank during the three months around conception. Non-Hispanic white women made up 69 percent of the group; 18 percent were Hispanic and 13 percent were non-Hispanic black women. In education, those with high school or less made up 18 percent of the group; some college, 29 percent; college graduate, 30 percent; and graduate degree, 24 percent.
Top dietary sources for energy were soda, pasta dishes, grain desserts such as cake or cookies, refined bread, and beer, wine and spirits. Soda was the top energy source among women who were non-Hispanic black (8.7 percent), Hispanic (6.2), high school-educated (9.2) or who had some college (7.1). Women with a college or graduate degree got more energy calories from beer, wine and spirits than any other source (5.0 and 5.6 percent, respectively).
Energy from solid fat added up to an average of 18 percent, the study said, with cheese, eggs, egg dishes and pizza the top sources. The top two fat sources were different for black women and women with high school education or less: fatty meat (sausage, hot dogs, bacon and ribs) and cakes and cookies.
Energy from added sugars made up 14 percent of calories on average, and sugar-sweetened drinks — soda, sports drinks and energy drinks — were the top sources.
“All of these women were high in empty calories, low in nutrition and high in added sugars and alcohol,” Ms. Bodnar said. “We would like the source of their energy to be nutrient-dense food, food with a lot of vitamins and minerals.”
Key prenatal nutrients are iron, folate (a B vitamin) and calcium. Iron helps to form hemoglobin, which carries oxygen in the blood. Folate is needed to develop the neural tube, from which the brain and spinal cord form. Calcium builds bones and helps maintain healthy blood pressure.
In the women’s diets, the study found primary sources of iron were instant cereals (14.1 percent for the group overall); yeast bread, non-100 percent whole wheat (6.4 percent); pasta dishes (5.4); grain desserts (4.2) and pizza (4.1). Green salad was the only vegetable in the top 10 of the iron category overall (3.9 percent) and higher among white (13.9 percent) and college- and graduate-degree women (14.6 and 16.1). Iron from cereals was higher among women who were black (14.5 percent), Hispanic (13.7), with high school education or less (16.2) and some college (13.2).
Green salad and ready-to-eat cereals were the top two sources for folate for all the groups except black women, where the top two were cereals and orange or grapefruit juice. Reduced-fat milk and cheese were the top two foods serving as calcium sources.
In addition to the higher amounts of sugary drinks, black, Hispanic and non-college-graduate women were lower in their intake of nutrient-dense foods, such as beans, nuts and seeds, seafood, fruits and vegetables.
“The diet quality gap among nonpregnant individuals is thought to be a consequence of many factors,” the study said, “including the access to and price of healthy foods, knowledge of a healthful diet, and pressing needs that may take priority over a healthful diet.”
Ms. Bodnar said something positive might be done about women’s choice of beverages:
“If we can find a beverage that substitutes for soda or alcohol, we'd be finding a simple way to reduce the calories and added sugars. It could have a real impact on obesity in the U.S.”
She continued, “If we could move people to diet soda, they'd be better off,” although there are concerns about the safety of artificial sweeteners.
“We would like people to drink more water. The bottom line is, we have to get people to stop drinking not just soda, but energy drinks, sweet tea, fruit juice drinks … sometimes they have just as much sugar [as soda].”
One limitation of the study, she pointed out, is that people have difficulty recalling what they’ve eaten.
“Overall, diet is something very hard to measure,” she said, adding, however, that the study found that the pregnant women’s reports follow national trends for children and non-pregnant adults.
“Race/ethnicity and education. Those are really two of the most important factors that show health inequalities,” the researcher said, pointing out that non-Hispanic black women and women with lower levels of education have higher risk of poor outcomes for their pregnancies, including a baby more likely to die before the first birthday and problems with growth.
A resource that already exists for women with low incomes is the federally funded WIC program (for women, infants and children). Ms. Bodnar said along with nutritional counseling, women receive food packages that provide a healthy diet.
Moving away from a preference for sugary and salty foods can take time, Ms. Bodnar said. “It takes a little while to modify your taste preferences.”
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