Improving dietary energy and antioxidative property benefit early maternal BMI and further manage adverse pregnancy outcomes with better weight gain

Abstract

Dietary characteristics affect maternal status in early pregnancy, which is important for later outcomes. Yet, Chinese dietary guidelines for pregnant women are not specific to obesity, overweight, and underweight. Moreover, because the whole pregnancy process has a long period, an intermediate bridge to connect early maternal BMI and pregnancy outcomes is needed. In this cohort with 1785 Chinese pregnant women from 2020 to 2022, the 37.98% of participants had abnormal BMI in early pregnancy. Less energy from carbohydrates (<50%) but more from protein (>20%) and fat (>30%) led to excessive energy intake, which was a risk factor for maternal obesity (adjusted OR (AOR): 1.49, 95%CI: 1.02-2.17) and overweight (AOR: 1.47, 95%CI: 1.00-2.18). Furthermore, maternal underweight could be induced by the poor antioxidative diet with a 20.28% lower intake of isoflavones (AOR: 2.80, 95%CI: 1.02-7.66), and the imbalanced dietary structure with less energy from fat (<20%) and unsaturated fatty acids (<3%) (AOR: 3.95, 95%CI: 1.42-10.95). Following the timeline of gestation to delivery, early maternal obesity, overweight, and underweight increased the risk of abnormal body weight gain during pregnancy (AOR: 1.91-3.62, 95%CI: 1.20-6.12). Subsequently, the abnormal weight gain further provoked adverse pregnancy events, like gestational diabetes mellitus, hypertensive disorders, cesarean section, and macrosomia (AOR, 1.33-2.58; 95%CI, 1.04-4.17). To minimize these threats, more energy from carbohydrates (>65%) while less energy from protein (<10%) and fat (<20%) were recommended for obese/overweight pregnant women in China. Meanwhile, underweight pregnant women were recommended to increase the intake of dietary antioxidants (especially isoflavones) with more energy from fat (>30%) and unsaturated fatty acids (>11%). Finally, gestational body weight gain, as the potential intermediate bridge, should be paid more attention.