Diet, Weight Change, and Obesity in Pregnancy / Pregnancy Eating Attributes (PEAS)

Eunice Kennedy Shriver National Institute Of Child Health & Human Development

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Abstract

The Pregnancy Eating Attributes Study (PEAS) addresses the public health problem of low maternal diet quality and excessive gestational weight gain and postpartum weight retention, which are prevalent across racial/ethnic groups and income levels, and are modifiable risk factors for numerous adverse maternal and child health outcomes. Nutrition and weight management interventions in pregnant women and the general population have achieved only marginal success, indicating the need to identify more effective modifiable targets. An emerging hypothesis posits that energy homeostatic processes are overridden by "hedonic eating," in which food intake is motivated by the neural reward response to food. The relative strength of this reward response varies between individuals and has been positively associated with body weight and weight change in small samples, supporting the need for further investigation in population-based samples. PEAS is an observational prospective cohort study investigating relations of reward-related eating, self-regulation, and the home food environment with dietary intake and weight change during pregnancy and postpartum. Participants were enrolled before 12 weeks gestation and followed, with their infants, until 1 year postpartum. The study collected data on dietary intake, anthropometrics, biospecimens, medical records, self-reported eating and other health-related behaviors, infant feeding, functional magnetic resonance imaging, focus groups, and a laboratory feeding substudy assessing overeating. The overarching goal is to identify neurobehavioral and environmental determinants of diet quality and weight change, and inform best practices for supporting optimal diet quality and weight management during this critical developmental period, leading to improved maternal and child health trajectories. Primary study findings are that greater reward-related eating was associated with worse diet quality during pregnancy, but not with gestational weight gain or postpartum weight retention (Nansel et al 2020 a & b; PMID: 33228724 & PMID 32958906). Lower availability of fruit and vegetables and greater availability of obesogenic foods in the home food environment were associated with worse diet quality, but the associations of reward-related eating with diet and weight did not vary depending on the home food environment or individual self-control. Findings have advanced our understanding of relations among maternal diet, weight, reward-related eating, sleep health, and psychosocial factors. Findings from the laboratory feeding study showed that overall, pregnant women a consumed a similar proportion of highly processed and minimally processed foods following a standardized meal, but their relative intake of each type of food differed, resulting in substantial differences in energy intake (Lipsky et al. 2021 PMID 33109504). Further, only their intake of highly processed food was associated with worse diet quality (Lipsky et al. 2021 PMID 33158801). Qualitative data from the focus groups indicated that women experience cravings as intense and emotional desires for specific food items, and that their decisions either to resist or satisfy cravings were both triggered by and resulted in salient emotional states (Blau et al. 2020 PMID 31813756). Additionally, while women reported that they experienced stronger food cravings in response to increased stress, stress was not associated with overall diet quality (Mooney et al. 2021 PMID 33737210). Other analyses indicated that depression, stress, and poor sleep quality were associated with greater reward-related eating (Betts et al. 2021 PMID: 33933087), and that worse sleep quality and shorter sleep duration were associated with greater maternal reward-related eating, gestational weight gain, and gestational fat gain (Hill et al. 2021 PMID 32945728). We used gaussian graphical models to examine meal-specific patterns by overall diet quality (Schwedhelm et al. 2021 PMID: 34301273), and identified reciprocal associations of maternal feeding to soothe with infant responsiveness to food (Temmen et al. 2021 PMID 34380499), and also found that the timing and frequency of eating was associated with diet quality and energy intake, with several differences between pregnancy and postpartum suggesting that efforts to support optimal dietary intake may require specific strategies for each developmental period (Schweldhelm et al. 2022 PMID 35334823). Findings also suggest the potential relevance of targeting ultra-processed food intake for improving maternal and child health. Ultra-processed food comprised on average 53% of energy intake in pregnancy and was associated with worse diet quality, including lower intake of fruit, vegetables, plant protein, and total protein, and greater intake of refined grains and added sugar (Nansel et al. 2022 PMID 36235585). Greater intake of ultra-processed food in pregnancy was associated with greater risk of excess gestational weight gain, greater inflammation, and greater postpartum weight retention, but not with infant weight (Cummings et al. 2022 PMID 35619114). Further, greater maternal dietary intake of ultra-processed food and shorter duration of exclusive breastfeeding was associated with more obesogenic infant appetitive traits (Cummings et al. 2022 PMID 35922793). Our examination of infant appetitive traits also identified reciprocal associations of maternal feeding to soothe with infant responsiveness to food (Temmen et al. 2021 PMID 34380499) and indicated that lower infant enjoyment of food and greater speed of eating may be associated with suboptimal complementary feeding practices (Sanjeevi et al. 2022 PMID 34481014). Most recently, we examined maternal influences on infant weight status, finding that better pregnancy diet quality was associated with lower infant weight status, and better postpartum diet quality was related to lower infant weight status only in breastfed infants (Lipsky 2023 in press).