Healthy dietary patterns and common pregnancy complications: A prospective and longitudinal study
Open accessAbstract
Background Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower risks of chronic diseases. However, their associations with common pregnancy complications are unclear.Objectives This study investigates the associations of AHEI, AMED, and DASH during periconception and pregnancy with common pregnancy complication risks.Methods The study included 1887 pregnant women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons. Women responded to an FFQ at 8-13 gestational weeks, and they performed a 24-h dietary recall at 16-22 and 24-29 wk. Gestational diabetes (GDM), gestational hypertension, preeclampsia, and preterm delivery were ascertained using medical records.Results Healthier diet indicated by higher AHEI, AMED, and DASH scores was generally related to lower risks of pregnancy complications. Significant inverse associations were observed between AHEI score reported at 16-22 wk and GDM risk [adjusted RR (95% CI), highest (Q4) vs. lowest quartile (Q1): 0.32 (0.16, 0.66), P-trend = 0.002]; DASH score reported at both 8-13 [adjusted RR (95% CI), Q4 vs. Q1: 0.45 (0.17, 1.17), P-trend = 0.04] and 16-22 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.19 (0.05, 0.65), P-trend = 0.01] and gestational hypertension risk; AHEI score reported at 24-29 wk and preeclampsia risk [adjusted RR (95% CI), Q4 vs. Q1: 0.31 (0.11, 0.87), P-trend = 0.03]; AMED score reported at 8-13 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50 (0.25, 1.01), P-trend = 0.03] and DASH score reported at 24-29 wk [adjusted RR (95% CI), Q4 vs. Q1: 0.50, (0.26, 0.96), P-trend = 0.03] and preterm delivery risk.Conclusions Adherence to AHEI, AMED, or DASH during periconception and pregnancy was related to lower risks of GDM, gestational hypertension, preeclampsia, and preterm delivery.This study was registered at ClinicalTrials.gov as NCT00912132.
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The US cohort study reported no inverse association between Mediterranean diet adherence and gestational diabetes mellitus.
“but not in the US cohort study [57].”
From Impact of Mediterranean Diet Adherence During Pregnancy on Preeclampsia, Gestational Diabetes Mellitus, and Excessive Gestational Weight Gain: A Systematic Review of Observational Studies and Randomized Controlled Trials (2025) · cites this paper as [57]
The Discussion says the US cohort's findings suggest an inverse association between all three dietary patterns, including AMED, and gestational diabetes risk. The AMED association was not statistically significant in the adjusted results, but that does not support the claim that the study reported no inverse association. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAmong the seven included studies, five examined gestational diabetes mellitus, four examined preeclampsia, and three examined excessive gestational weight gain.
“Amongst the seven studies, five studies examined the risk of GDM [56,57,59,60,62], four studies examined the risk of preeclampsia [57,58,61,62], and three studies examined the risk of eGWG [56,61,62].”
From Impact of Mediterranean Diet Adherence During Pregnancy on Preeclampsia, Gestational Diabetes Mellitus, and Excessive Gestational Weight Gain: A Systematic Review of Observational Studies and Randomized Controlled Trials (2025) · cites this paper as [57]
The Pregnancy complications section (page unavailable) identifies gestational diabetes and preeclampsia as outcomes of this study, supporting its inclusion in those two groups. It lists preterm delivery and gestational hypertension as other outcomes, but not excessive gestational weight gain; the citation does not support placing this study in the eGWG group. This paper also cannot establish the citing document’s totals across seven studies. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe other three studies examining preeclampsia reported no evidence of an association between Mediterranean diet adherence and preeclampsia.
“whereas the other three studies reported no evidence of an association [57,61,62].”
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2 retracted
RETRACTED: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1200303 · Cited by 4,257 · see citing works
RetractedEstruch, R., Ros, E., Salas-Salvadó, J., Covas, M.-I., Corella, D., Arós, F., Gómez-Gracia, E., Ruiz-Gutiérrez, V., Fiol, M., Lapetra, J., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmc1806491 · Cited by 1,008 · see citing works
RetractedSacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., Obarzanek, E., Conlin, P. R., Miller, E. R., Simons-Morton, D. G., et al. (2001) · New England Journal of Medicine · doi:10.1056/nejm200101043440101 · Cited by 5,638 · see citing works
Classification and Diagnosis of Diabetes
Fajans, S. S. (1990) · Medical Entomology and Zoology · Cited by 2,356 · see citing works
Onuegbu, A. J., Olisekodiaka, J. M., Udo, J., Umeononihu, O. S., Amah, U. K., Okwara, J. E., & Atuegbu, C. (2015) · Medical Principles and Practice · doi:10.1159/000381778 · Cited by 2,057 · see citing works
Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease
Chiuve, S. E., Fung, T. T., Rimm, E. B., Hu, F. B., McCullough, M. L., Wang, M., Stampfer, M. J., & Willett, W. C. (2012) · The Journal of Nutrition · doi:10.3945/jn.111.157222 · Cited by 1,951 · see citing works
McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0098-8 · Cited by 1,850 · see citing works
Self-citationMaternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London
Sebire, N. J., Jolly, M., Harris, J. P., Wadsworth, J., Joffe, M., Beard, R. W., Regan, L., & Robinson, S. (2001) · International Journal of Obesity · doi:10.1038/sj.ijo.0801670 · Cited by 1,740 · see citing works
2. Classification and Diagnosis of Diabetes
American Diabetes Association (2017) · Diabetes Care · doi:10.2337/dc17-s005 · Cited by 1,603 · see citing works
Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women
Fung, T. T. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.7.713 · Cited by 1,567 · see citing works
ACOG Practice Bulletin No. 33: Diagnosis and Management of Preeclampsia and Eclampsia
ACOG Committee on Obstetric Practice (2002) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(01)01747-1 · Cited by 1,180 · see citing works
Subar, A. F., Kirkpatrick, S. I., Mittl, B., Zimmerman, T. P., Thompson, F. E., Bingley, C., Willis, G., Islam, N. G., Baranowski, T., McNutt, S., et al. (2012) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2012.04.016 · Cited by 934 · see citing works
Lisonkova, S., & Joseph, K. S. (2013) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2013.08.019 · Cited by 926 · see citing works
Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women
Fung, T. T., Rexrode, K. M., Mantzoros, C. S., Manson, J. E., Willett, W. C., & Hu, F. B. (2009) · Circulation · doi:10.1161/circulationaha.108.816736 · Cited by 916 · see citing works
Development and Validation of a Pregnancy Physical Activity Questionnaire
Chasan‐Taber, L., Schmidt, M. D., Roberts, D. E., Hosmer, D. W., Markenson, G. R., & Freedson, P. S. (2004) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000142303.49306.0d · Cited by 863 · see citing works
Thangaratinam, S., Rogozinska, E., Jolly, K., Glinkowski, S., Roseboom, T., Tomlinson, J. W., Kunz, R., Mol, B. W., Coomarasamy, A., & Khan, K. S. (2012) · BMJ · doi:10.1136/bmj.e2088 · Cited by 802 · see citing works
Slattery, M. M., & Morrison, J. J. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11476-0 · Cited by 675 · see citing works
Schwingshackl, L., & HOFFMANN, G. E. (2014) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2014.03.003 · Cited by 592 · see citing works
Umesawa, M., & Kobashi, G. (2016) · Hypertension Research · doi:10.1038/hr.2016.126 · Cited by 568 · see citing works
Association of Maternal Endothelial Dysfunction With Preeclampsia
Chambers, J. C. (2001) · JAMA · doi:10.1001/jama.285.12.1607 · Cited by 539 · see citing works
Physiology of Pregnancy and Nutrient Metabolism
King, J. C. (2000) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/71.5.1218s · Cited by 525 · see citing works
Trying to understand gestational diabetes
Catalano, P. M. (2014) · Diabetic Medicine · doi:10.1111/dme.12381 · Cited by 456 · see citing works
Folate and neural tube defects
Pitkin, R. M. (2007) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/85.1.285s · Cited by 443 · see citing works
Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus
Zhang, C., Liu, S., Solomon, C. G., & Hu, F. B. (2006) · Diabetes Care · doi:10.2337/dc06-0266 · Cited by 378 · see citing works
Self-citationDietary Quality during Pregnancy Varies by Maternal Characteristics in Project Viva: A US Cohort
Rifas‐Shiman, S. L., Rich-Edwards, J. W., Kleinman, K., Oken, E., & Gillman, M. W. (2009) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2009.03.001 · Cited by 347 · see citing works
Does gestational hypertension become pre‐eclampsia?
Saudan, P., Brown, M. A., Buddle, M. L., & Jones, M. (1998) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1998.tb09971.x · Cited by 283 · see citing works
Calcium Supplementation to Prevent Hypertensive Disorders of Pregnancy
Belizán, J. M., Villar, J., González, L. M., Campodonico, L., & Bergel, E. F. (1991) · New England Journal of Medicine · doi:10.1056/nejm199111143252002 · Cited by 273 · see citing works
Assaf-Balut, C., García de la Torre, N., Durán, A., Fuentes, M., Bordiú, E., del Valle, L., Familiar, C., Ortolá, A., Jiménez, I., Herraiz, M. A., et al. (2017) · PLOS ONE · doi:10.1371/journal.pone.0185873 · Cited by 224 · see citing works
Diet during early pregnancy and development of gestational diabetes
Radesky, J. S., Oken, E., Rifas‐Shiman, S. L., Kleinman, K., Rich-Edwards, J. W., & Gillman, M. W. (2007) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2007.00899.x · Cited by 211 · see citing works
Brief Review: Hypertension in Pregnancy
Solomon, C. G., & Seely, E. W. (2001) · Hypertension · doi:10.1161/01.hyp.37.2.232 · Cited by 206 · see citing works
Calcium supplementation to prevent hypertensive disorders of pregnancy
Belizán, J. M., Villar, J., Gonzalez, L., Campodónico, L., & Bergel, E. F. (1992) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(92)91075-y · Cited by 200 · see citing works
Relation of the Mediterranean diet with the incidence of gestational diabetes
Karamanos, B. G., Thanopoulou, A. C., Anastasiou, E., Assaad-Khalil, S. H., Albache, N., Bachaoui, M., Slama, C. B., Ghomari, H. E., Jotić, A., Lalic, N. M., et al. (2013) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2013.177 · Cited by 193 · see citing works
Wattar, B. H. A., Dodds, J. P., Placzek, A., Beresford, L., Spyreli, E., Moore, A. P., Carreras, F. J. G., Austin, F., Murugesu, N., Roseboom, T. J., et al. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002857 · Cited by 177 · see citing works
ACOG Practice Bulletin No. 33: Diagnosis and Management of Preeclampsia and Eclampsia
(2002) · Obstetrics and Gynecology · doi:10.1097/00006250-200201000-00028 · Cited by 156 · see citing works
Cohort Profile: NICHD Fetal Growth Studies–Singletons and Twins
Grewal, J., Grantz, K. L., Zhang, C., SCISCIONE, A. C., Wing, D. A., Grobman, W. A., Newman, R., Wapner, R. J., D’Alton, M. E., Skupski, D. W., et al. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyx161 · Cited by 152 · see citing works
Self-citationKibret, K. T., Chojenta, C., Gresham, E., Tegegne, T. K., & Loxton, D. J. (2018) · Public Health Nutrition · doi:10.1017/s1368980018002616 · Cited by 142 · see citing works
Maternal Dietary Patterns during the Second Trimester Are Associated with Preterm Birth
Martin, C. L., Sotres‐Alvarez, D., & Siega‐Riz, A. M. (2015) · Journal of Nutrition · doi:10.3945/jn.115.212019 · Cited by 124 · see citing works
Dietary patterns before and during pregnancy and maternal outcomes: a systematic review
Raghavan, R., Dreibelbis, C., Kingshipp, B. L., Wong, Y. P., Abrams, B. F., Gernand, A. D., Rasmussen, K. M., Siega‐Riz, A. M., Stang, J. L., Casavale, K. O., et al. (2018) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy216 · Cited by 124 · see citing works
Gyamfi‐Bannerman, C., & Ananth, C. V. (2014) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000000546 · Cited by 118 · see citing works
Kahleova, H., Salas-Salvadó, J., Rahelić, D., Kendall, C. W., Rembert, E., & Sievenpiper, J. L. (2019) · Nutrients · doi:10.3390/nu11092209 · Cited by 114 · see citing works
Dietary patterns before and during pregnancy and birth outcomes: a systematic review.
Raghavan, R., Dreibelbis, C., Kingshipp, B., Wong, Y. P., Abrams, B., Gernand, A., Rasmussen, K., Siega-riz, A., Stang, J., Casavale, K., et al. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqy353 · Cited by 100 · see citing works
Shannon, O. M., Mendes, I. C., Köchl, C., Mazidi, M., Ashor, A. W., Rubele, S., Minihane, A. M., Mathers, J. C., & Siervo, M. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa002 · Cited by 83 · see citing works
C-reactive protein and later preeclampsia
Rebelo, F. M., Schlüssel, M. M., Vaz, J. D. S., Franco‐Sena, A. B., Pinto, T. J. P., Bastos, F. I., Adegboye, A. R. A., & Kac, G. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e32835b0556 · Cited by 77 · see citing works
Jacobs, S., Boushey, C. J., Franke, A. A., Shvetsov, Y. B., Monroe, K. R., Haiman, C. A., Kolonel, L. N., Marchand, L. L., & Maskarinec, G. (2017) · British Journal Of Nutrition · doi:10.1017/s0007114517002033 · Cited by 72 · see citing works
Effects of dietary interventions on pregnancy outcomes: a systematic review and meta‐analysis
Gresham, E., Bisquera, A., Byles, J., & Hure, A. J. (2014) · Maternal and Child Nutrition · doi:10.1111/mcn.12142 · Cited by 70 · see citing works
Trimester-Specific Assessment of Diet Quality in a Sample of Canadian Pregnant Women
Savard, C., Lemieux, S., Carbonneau, É., Provencher, V., Gagnon, C., Robitaille, J., & Morisset, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16030311 · Cited by 69 · see citing works
Births in the United States, 2017.
Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2018) · PubMed · Cited by 69 · see citing works
Rodríguez‐Rejón, A. I., Castro‐Quezada, I., Ruano-Rodríguez, C., Ruiz‐López, M. D., Sánchez‐Villegas, A., Toledo, E., Artacho, R., Estruch, R., Salas‐Salvadó, J., Covas, M. I., et al. (2014) · Journal of Nutrition and Metabolism · doi:10.1155/2014/985373 · Cited by 61 · see citing works
Fetal growth patterns in pregnancy-associated hypertensive disorders: NICHD Fetal Growth Studies
Mateus, J., Newman, R., Zhang, C., Pugh, S. J., Grewal, J., Kim, S., Grobman, W. A., Owen, J., SCISCIONE, A. C., Wapner, R. J., et al. (2019) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.06.028 · Cited by 51 · see citing works
Self-citationKallela, J., Jääskeläinen, T., Kortelainen, E., Heinonen, S., Kajantie, E., Kere, J., Kivinen, K., Pouta, A., & Laivuori, H. (2016) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-016-1010-0 · Cited by 48 · see citing works
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Zaragoza-Martí, A., Ruiz-Ródenas, N., Herranz-Chofre, I., Sánchez-SanSegundo, M., Serrano Delgado, V. D. L. C., & Hurtado-Sánchez, J. A. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.813942 · Cited by 67 · see citing works
Xu, J., Wang, H., Bian, J., Xu, M., Jiang, N., Luo, W., Zu, P., Yin, W., & Zhu, P. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2023.100159 · Cited by 58 · see citing works
Antasouras, G., Papadopoulou, S., Alexatou, O., Papandreou, D., Mentzelou, M., Migdanis, A., Psara, E., Migdanis, I., Chrysafi, M., Tyrovolas, S., et al. (2023) · Medicina · doi:10.3390/medicina59091547 · Cited by 17 · see citing works
Epidemiology of hypertensive disorders in pregnancy
Stuart, J. J., Gray, K. J., Rich-Edwards, J. W., & Roberts, J. M. (2022) · Chesley's Hypertensive Disorders in Pregnancy · doi:10.1016/b978-0-12-818417-2.00023-3 · Cited by 11 · see citing works
Sharma, S., Esposito, S., Di Castelnuovo, A., Gialluisi, A., De Domenico, P., de Gaetano, G., Bonaccio, M., & Iacoviello, L. (2025) · Nutrients · doi:10.3390/nu17101723 · Cited by 9 · see citing works
- Authors
- Li, M., Grewal, J., Hinkle, S. N., Yisahak, S. F., Grobman, W. A., Newman, R. B., Skupski, D. W., Chien, E. K., Wing, D. A., Grantz, K. L., & Zhang, C.
- Affiliations
- National Institutes of Health (US)
- Northwestern University (US)
- Medical University of South Carolina (US)
- NewYork–Presbyterian Hospital (US)
- Brown University (US)
- University of California, Irvine (US)
- Corresponding author
- Zhang, Cuilin
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 114
- Issue
- 3
- Pages
- 1229-1237
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC8408886
- OpenAlex
- W3165403262
- Cited by
- 76
- References
- 50
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 18 · 2023: 18 · 2022: 8 · 2021: 1
- FWCI
- 9.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HHSN275200800013C, HHSN275200800002I, HHSN27500006, HHSN275200800003IC, HHSN275200800014C, HHSN275200800012C, HHSN275200800028C, HHSN275201000009C, HHSN275201000001Z)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- pregnancy complications, Healthy Eating Index, alternate Mediterranean diet, DASH diet, dietary habits, gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm birth, maternal diet, dietary adherence, gestational age, 24-hour dietary recall, food frequency questionnaire, chronic disease prevention
- MeSH terms
- Diet, Healthy, Adult, Female, Humans, Pregnancy, Pregnancy Complications, Risk Factors, Young Adult
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