Better infant growth linked to healthy prenatal diet following USDA guidelines

A study of over 2,800 mother-child pairs across eight ECHO Cohort sites links a prenatal diet following USDA guidelines to healthier infant growth patterns, reducing risks associated with obesity.

In a recent study published in JAMA Network Open, researchers from the United States (US) examined how dietary patterns during pregnancy affect the size of the infant at birth and their growth trajectories up to 24 months.

The researchers used dietary quality indices, such as the Empirical Dietary Inflammatory Pattern (EDIP) and the Healthy Eating Index (HEI), to investigate their association with infant growth rates and potential obesity risks.

Background

Childhood obesity is a growing concern, especially in Western countries, with early life factors playing a critical role in shaping long-term health. Birth weight and growth rates in infancy are strongly linked to future obesity risk, with infants who are born either small or large for gestational age having a higher risk of adverse health outcomes.

Moreover, rapid weight gain in the first year of life further elevates the risk of childhood obesity. While nutrition during pregnancy is a vital determinant of fetal growth and early childhood development, existing research has largely focused on individual food items rather than overall dietary patterns.

Although measures such as the HEI and the EDIP provide more holistic assessments of diet quality and its potential inflammatory effects, their impact on infant growth remains underexplored. Understanding these relationships could provide critical opportunities for early interventions to promote healthy growth and prevent childhood obesity starting in infancy.

About the study

In the present cohort study, the researchers analyzed data from 2,854 birthing parent-child pairs across eight cohorts in the ECHO or Environmental Influences on Child Health Outcomes program. Participants were included if they had dietary data during pregnancy and infant growth measurements at birth and at least one follow-up at 6-, 12-, or 24-months post-birth.

The HEI, which is a measure of adherence to US dietary guidelines, and the EDIP, which reflects the inflammatory potential of a diet, were used to assess prenatal dietary quality. Dietary information was collected from the participants through food frequency questionnaires or 24-hour recalls, with HEI scores divided into high and low categories based on whether the score was greater or lower than 80 respectively.  

Additionally, the  EDIP scores were categorized as less inflammatory if they were less than or equal to 63.6 and more inflammatory if it was greater than that value. Anthropometric measurements of weight and length were standardized using weight-for-length z-scores, which were used to classify infant growth trajectories as rapid, slow, or within reference ranges.

The researchers used multinomial logistic regression models to analyze the data, and the analyses were adjusted for factors such as maternal education, age, pre-pregnancy body mass index (BMI), tobacco use, and dietary assessment methods. Furthermore, the growth outcomes were compared with birth measurements to assess changes in weight-for-length z-scores at specific intervals. The analyses spanned from March 2021 to August  2024 and utilized harmonized data from a demographically diverse US population.

Major findings

The researchers observed that prenatal diet quality had a significant influence on infant growth patterns. Higher maternal HEI scores, which reflected healthier diets, correlated with lower odds of infants being large for gestational age and reduced rapid or slow growth during the first two years.

Specifically, infants born to parents with high HEI scores had 12% lower odds of being large for gestational age and lower risks of rapid growth in the first six months (20% reduction) and the first two years (18% reduction) of life. Additionally, high HEI scores also lowered the likelihood of slow growth at six, 12, and 24 months by 35%, 26%, and 35%, respectively.

Conversely, a less inflammatory prenatal diet, indicated by low EDIP scores, had mixed associations. While it increased the odds of being large for gestational age by 24%, it reduced rapid growth risk at six months by 23% but was also linked to a higher likelihood of slow growth by 50% at 24 months. While extreme growth patterns, such as extremely rapid growth, were less likely with healthier maternal diets, the associations between EDIP scores and growth in infants were less consistent.

The results emphasized the importance of diet quality during pregnancy in shaping infant growth trajectories, with potential implications for childhood obesity prevention strategies. However, while a healthy diet adhering to US guidelines showed clear benefits, the role of less inflammatory diets warrants further exploration.

Conclusions

Overall, the study identified the critical role of prenatal diet quality in influencing infant growth patterns and determining the risks associated with childhood obesity. While adherence to healthier dietary guidelines during pregnancy was linked to favorable growth trajectories, the impact of low-inflammatory diets remained complex.

These findings reinforced the importance of targeted nutritional interventions during pregnancy to promote healthy early-life growth. They indicated the need for future research into maternal dietary patterns and long-term health outcomes in infants.