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, reported previously, were 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. Diet quality was stable across pregnancy and postpartum, with no population-level differences across pregnancy trimesters. Diet quality was lower among participants of lower education, those receiving financial aid, and those who were not living with a partner (Lipsky et. al, 2024; PMID 39307187). Work in the previous year has explored associations of dietary intake with the microbiome during pregnancy and in infancy. Overall pregnancy diet quality was not associated with diversity of the gastrointestinal microbiome, possibly due to the general decrease in alpha diversity observed during this developmental period. However, added sugar intake was associated with microbial function of copper ion homeostasis, which may contribute to oxidative stress, and greater saturated fat intake increased the likelihood of belonging to the taxa enterotype predominantly composed of Firmicutes (Dreisbach et al., 2024; PMID 39307280). Novel findings also demonstrated differences in the infant gut microbial composition by the type of feeding, as well as associations of breastfeeding parents’ diet with the infant microbiome. Higher diet quality was associated with lower abundance of infant gut microbial genera that have been previously implicated in inflammation (Sanjeevi et. al, in press). Findings suggest the potential of the parent’s dietary intake during breastfeeding to support the development of infant gut microbiome associated with favorable short- and long-term health outcomes. Recent findings also indicate that factors associated with weight outcomes in the general population may not similarly impact pregnancy weight outcomes. Intakes of sugar-sweetened beverages and non-nutritive sweetened beverages were not associated with gestational weight gain, postpartum weight retention, blood glucose, or insulin, suggesting that sweetened beverage intake within a moderate range may not be a significant risk factor for excess pregnancy-related weight gain or glucose dysregulation in pregnancy and postpartum (Kwan et al., 2025; PMID 40669308). Further, eating in the absence of hunger, measured in a controlled laboratory paradigm, was unassociated with weight outcomes, eating behaviors, or well-being in pregnant adults (Lipsky et al., 2025; PMID 40554514). Findings suggest the need for further research across various developmental periods to determine the utility of laboratory EAH measurement as an indicator of behavioral susceptibility to excessive energy intake leading to weight gain. Recent findings also advance knowledge regarding the measurement of reward-related eating in pregnancy and postpartum. Though considered a stable trait, reward-related eating may differ during pregnancy and postpartum, given the physical and psychological changes common during these periods. Thus, we examined measurement invariance of the Power of Food Scale, a self-report measure of hedonic hunger. The measure demonstrated longitudinal measurement equivalence across pregnancy and postpartum, and partial equivalence with young adult women (Mooney et al., 2025; PMID 32958906). Findings support the validity of the measure for use in pregnant and postpartum populations; however, direct comparisons with non-pregnant populations should be avoided.