Relationships between consumption of ultra-processed foods, gestational weight gain and neonatal outcomes in a sample of US pregnant women

Background An increasingly large share of diet comes from ultra-processed foods (UPFs), which are assemblages of food substances designed to create durable, convenient and palatable ready-to-eat products. There is increasing evidence that high UPF consumption is indicative of poor diet and is associated with obesity and metabolic disorders. This study sought to examine the relationship between percent of energy intake from ultra-processed foods (PEI-UPF) during pregnancy and maternal gestational weight gain, maternal lipids and glycemia, and neonatal body composition. We also compared the PEI-UPF indicator against the US government’s Healthy Eating Index-2010 (HEI-2010). Methods Data were used from a longitudinal study performed in 2013–2014 at the Women’s Health Center and Obstetrics & Gynecology Clinic in St. Louis, MO, USA. Subjects were pregnant women in the normal and obese weight ranges, as well as their newborns (n = 45). PEI-UPF and the Healthy Eating Index-2010 (HEI-2010) were calculated for each subject from a one-month food frequency questionnaire (FFQ). Multiple regression (ANCOVA-like) analysis was used to analyze the relationship between PEI-UPF or HEI-2010 and various clinical outcomes. The ability of these dietary indices to predict clinical outcomes was also compared with the predictive abilities of total energy intake and total fat intake. Results An average of 54.4 ± 13.2% of energy intake was derived from UPFs. A 1%-point increase in PEI-UPF was associated with a 1.33 kg increase in gestational weight gain (p = 0.016). Similarly, a 1%-point increase in PEI-UPF was associated with a 0.22 mm increase in thigh skinfold (p = 0.045), 0.14 mm in subscapular skinfold (p = 0.026), and 0.62 percentage points of total body adiposity (p = 0.037) in the neonate. Discussion PEI-UPF (percent of energy intake from ultra-processed foods) was associated with and may be a useful predictor of increased gestational weight gain and neonatal body fat. PEI-UPF was a better predictor of all tested outcomes than either total energy or fat intake, and a better predictor of the three infant body fat measures than HEI-2010. UPF consumption should be limited during pregnancy and diet quality should be maximized in order to improve maternal and neonatal health.

1. Over the past month, how often did you drink carrot juice? NEVER (GO TO QUESTION 2) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 1a. Each time you drank carrot juice, how much did you usually drink?
Less than ½ cup (4 ounces) ½ to 1¼ cups (4 to 10 ounces) More than 1¼ cups (10 ounces) 2. Over the past month, how often did you drink tomato juice or other vegetable juice? (Please do not include carrot juice.)

NEVER (GO TO QUESTION 3)
1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 2a. Each time you drank tomato juice or other vegetable juice, how much did you usually drink?
Less than ¾ cup (6 ounces) ¾ to 1¼ cups (6 to 10 ounces) More than 1¼ cups (10 ounces) 3. Over the past month, how often did you drink orange juice or grapefruit juice? NEVER (GO TO QUESTION 4) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 3a. Each time you drank orange juice or grapefruit juice, how much did you usually drink?
Less than ¾ cup (6 ounces) ¾ to 1¼ cups (6 to 10 ounces) More than 1¼ cups (10 ounces) 3b. How often was the orange juice or grapefruit juice you drank calcium-fortified?
Almost never or never About ¼ of the time About ½ of the time About ¾ of the time Almost always or always 4. Over the past month, how often did you drink other 100% fruit juice or 100% fruit juice mixtures (such as apple, grape, pineapple, or others)?
NEVER (GO TO QUESTION 5) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 4a. Each time you drank other 100% fruit juice or 100% fruit juice mixtures, how much did you usually drink?
Almost never or never About ¼ of the time About ½ of the time About ¾ of the time Almost always or always 5. How often did you drink other fruit drinks (such as cranberry cocktail, Hi-C, lemonade, or Kool-Aid, diet or regular)?
NEVER (GO TO QUESTION 6) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week Over the past month… 5a. Each time you drank fruit drinks, how much did you usually drink?
Almost never or never About ¼ of the time About ½ of the time About ¾ of the time Almost always or always 6. How often did you drink milk as a beverage (NOT in coffee, NOT in cereal)? (Please do not include chocolate milk and hot chocolate.)

NEVER (GO TO QUESTION 7)
1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 6a. Each time you drank milk as a beverage, how much did you usually drink?
Less than 1 cup (8 ounces) 1 to 1½ cups (8 to 12 ounces) More than 1½ cups (12 ounces) 6b. What kind of milk did you usually drink? 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 7a. Each time you drank chocolate milk, how much did you usually drink?
Almost never or never About ¼ of the time About ½ of the time About ¾ of the time Almost always or always 8. How often did you drink meal replacement or high-protein beverages (such as Instant Breakfast, Ensure, Slimfast, Sustacal or others)?
NEVER (GO TO QUESTION 9) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 8a. Each time you drank meal replacement or high-protein beverages, how much did you usually drink?
Less than 1 cup (8 ounces) 1 to 1½ cups (8 to 12 ounces) More than 1½ cups (12 ounces) 9. How often did you drink soda or pop? NEVER (GO TO QUESTION 10) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week Over the past month… 9b. How often were these sodas or pop diet or sugar-free? 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 10a. Each time you drank sports drinks, how much did you usually drink?
Less than 12 ounces or less than 1 bottle 12 to 24 ounces or 1 to 2 bottles More than 24 ounces or more than 2 bottles 11. How often did you drink energy drinks (such as Red Bull or Jolt)?
NEVER (GO TO QUESTION 12) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 11a. Each time you drank energy drinks, how much did you usually drink?
Less than 8 ounces or less than 1 cup 8 to 16 ounces or 1 to 2 cups More than 16 ounces or more than 2 cups 12. How often did you drink beer?
NEVER (GO TO QUESTION 13) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 12a. Each time you drank beer, how much did you usually drink?
Less than a 12-ounce can or bottle 1 to 3 12-ounce cans or bottles More than 3 12-ounce cans or bottles 13. How often did you drink water (including tap, bottled, and carbonated water)?
NEVER (GO TO QUESTION 14) 1 time in past month 1 time per day 2-3 times in past month 2-3 times per day 1-2 times per week 4-5 times per day 3-4 times per week 6 or more times per day 5-6 times per week 13a. Each time you drank water, how much did you usually drink?
Less than 12 ounces or less than 1 bottle 12 to 24 ounces or 1 to 2 bottles More than 24 ounces or more than 2 bottles 13b. How often was the water you drank tap water? 69g. Each time cream cheese was added to your bagels or English muffins, how much was usually added?
Less than 1 tablespoon 1 to 2 tablespoons More than 2 tablespoons The next questions ask about your intake of breads other than bagels or English muffins. First, we will ask about bread you ate as part of sandwiches only. Then we will ask about all other bread you ate. 1 time in past month 3-4 times per week 2-3 times in past month 5-6 times per week 1 time per week 1 time per day 2 times per week 2 or more times per day 90a. Each time you ate baked, broiled, roasted, stewed, or fried chicken (including nuggets), how much did you usually eat?

How often did you eat breads or rolls AS PART OF SANDWICHES
Less than 2 drumsticks or wings, less than 1 breast or thigh, or less than 4 nuggets 2 drumsticks or wings, 1 breast or thigh, or 4 to 8 nuggets More than 2 drumsticks or wings, more than 1 breast or thigh, or more than 8 nuggets 90b. How often was the chicken you ate fried chicken (including deep fried) or chicken nuggets? 1 time in past month 3-4 times per week 2-3 times in past month 5-6 times per week 1 time per week 1 time per day 2 times per week 2 or more times per day 134a. Each time sugar or honey was added to foods you ate, how much was usually added?
Less than 1 teaspoon 1 to 3 teaspoons More than 3 teaspoons The following questions are about the kinds of margarine, mayonnaise, sour cream, cream cheese, and salad dressing that you ate. If possible, please check the labels of these foods to help you answer.
135. Over the past month, did you eat margarine?