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Cover of Dietary Patterns before and during Pregnancy and Risk of Hypertensive Disorders of Pregnancy: A Systematic Review

Dietary Patterns before and during Pregnancy and Risk of Hypertensive Disorders of Pregnancy: A Systematic Review

, DrPH, MPH, MSc, , MPH, , PhD, , MLS, MPH, , MLS, , DrPH, RD, , MS, RD, , PhD, MPH, RD, , PhD, MPH, RD, , ScD, RD, , PhD, , PhD, MPH, RDN, , PhD, RD, , MS, RDN, and , PhD.

Author Information and Affiliations
Alexandria (VA): USDA Nutrition Evidence Systematic Review; .

TECHNICAL ABSTRACT

Background

  • Systematic reviews were conducted as part of the U.S. Department of Agriculture and Department of Health and Human Services Pregnancy and Birth to 24 Months Project.
  • The goal of this systematic review was to examine the following question: What is the relationship between dietary patterns before and during pregnancy and risk of hypertensive disorders of pregnancy?

Conclusion Statement and Grades

  • Limited evidence in healthy Caucasian women with access to health care suggests that dietary patterns before and during pregnancy higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with a reduced risk of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension. Not all components of the assessed dietary patterns were associated with all hypertensive disorders.
    Grade: Limited
  • Evidence is insufficient to estimate the association between dietary patterns before and during pregnancy and risk of hypertensive disorders of pregnancy in minority women and those of lower socioeconomic status.
    Grade: Grade not assignable

Methods

  • The systematic review was conducted using a priori design.
  • Literature searches were conducted using PubMed, Embase, Cochrane, and other databases to identify studies that evaluated the relationship between dietary patterns before and during pregnancy and risk of hypertensive disorders of pregnancy, and hand-searches were conducted.
  • Studies were dual screened, and those that met the following criteria were included in the review: randomized controlled trials (RCTs), prospective or retrospective cohort studies or nested case-control studies; studies enrolling human subjects who were pregnant women or women capable of becoming pregnant, healthy or at elevated chronic disease risk (only some, not all, could have a chronic or pregnancy-related condition), and between the ages of 15 and 44; subjects from countries with high or very high human development (2015 Human Development Index); and studies published in English between January 1980 and January 2017 in peer-reviewed journals.
  • The intervention or exposure was dietary patterns before and/or during pregnancy measured via indices and scores, cluster or factor analysis, reduced rank regression, or other methods. The outcome were risk of hypertensive disorders of pregnancy and related intermediate outcomes (blood pressure and proteinuria).
  • Data from each included article were extracted, risk of bias was assessed, and both were checked for accuracy.
  • The evidence was qualitatively synthesized, a conclusion statement was developed, and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the internal validity/risk of bias, adequacy, consistency, impact, and generalizability of available evidence.

Summary of Evidence

  • This systematic review includes 8 studies (sample size ranging from 290 to 72,072) within 4 cohorts and 1 RCT, published between 2005 and 2016.
  • The studies used multiple approaches to assess dietary patterns, which makes it difficult to compare findings across studies. Three studies used indices/scores to assess dietary patterns, four studies used factor or principal component analysis and one RCT assigned participants to either an experimental or control diet.
  • Despite this variability, 5 of the 8 included studies reported statistically significant associations between dietary patterns and hypertensive disorders of pregnancy (HDP) risk among healthy Caucasian women with access to health care. An additional study showed an association between dietary patterns and blood pressure but not preeclampsia or gestational hypertension.
    • Dietary patterns characterized by higher intakes of vegetables, fruits, whole grains, nuts, legumes, fish and vegetable oils were associated with a 30-42% decreased risk of HDP and a 14-29% decreased risk of preeclampsia.
    • Two of the dietary patterns assessed were reported to be detrimental: traditional and processed food patterns, characterized by higher intakes of meats, potatoes and processed foods. One was associated with a 21% increased risk of preeclampsia and the other was associated with an increased risk of high blood pressure during pregnancy.
  • Generalizability of the included studies is limited to healthy Caucasian women who have access to health care. Minority women and those of lower socioeconomic status are underrepresented in this body of evidence.
  • The body of evidence has several limitations:
    • The evidence base includes eight studies from only four unique cohorts and one RCT
    • All but one of the studies were conducted outside the United States in predominantly Caucasian women
    • Dietary patterns vary considerably across studies, making it difficult to compare findings
    • No adjustment was made for many key confounding factors, and
    • The data are primarily observational, limiting the ability to draw any casual inferences. The RCT was done among 240 women and was not powered to examine HDP (addressed by the authors as “hypertensive complications”). Additionally, the timing of the intervention in the RCT may have been too late in pregnancy to have seen an effect.
  • Additional research is needed that should:
    • Include diverse populations from the U.S. and elsewhere with varying racial/ethnic and socioeconomic backgrounds
    • Develop and validate novel epidemiological tools that can accurately capture the complexity of dietary habits
    • Improve comparability across studies by increasing the uniformity of 1) diet assessment tools used across different regions and populations, 2) methods used to define dietary patterns, and 3) timing of dietary assessment
    • Adjust for key confounding factors in observational studies, including parity, educational attainment, smoking status, race/ethnicity, maternal age, family poverty income ratio, pre-pregnancy BMI, mean total energy intake, and gestational diabetes mellitus (and/or justify how and why confounders were chosen)
    • Include well-designed and sufficiently powered RCTs
    • Include and assess effect measure modification in multiethnic subgroups within the U.S., and
    • Use robust statistical methods such as multiple imputation to handle missing data.
FUNDING SOURCE: United States Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Alexandria, VA

Suggested citation:

Raghavan R, Dreibelbis C, Kingshipp BJ, Wong, YP, Terry N, Abrams B, Bartholomew A, Bodnar LM, Gernand A, Rasmussen K, Siega-Riz AM, Stang JS, Casavale KO, Spahn JM, Stoody E. Dietary Patterns before and during Pregnancy and Risk of Hypertensive Disorders of Pregnancy: A Systematic Review. April 2019. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.PB242018.SR0101

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Related citation:

This systematic review has also been published in the American Journal of Clinical Nutrition: Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, et al. Dietary patterns before and during pregnancy and maternal outcomes: a systematic review. Am J Clin Nutr. 2019;109(7):705S–28S. Available at: https://doi.org/10.1093/ajcn/nqy216 [PubMed: 30982868].

Related citations are published in the American Journal of Clinical Nutrition:

  • P/B-24 Project overview: Stoody EE, Spahn JM, Casavale KO. The Pregnancy and Birth to 24 Months Project: a series of systematic reviews on diet and health. Am J Clin Nutr. 2019;109(7):685S–97S. Available at: https://doi.org/10.1093/ajcn/nqy372 [PubMed: 30982878].
  • P/B-24 Project systematic review methodology: Obbagy JE, Spahn JM, Wong YP, Psota TL, Spill MK, Dreibelbis C, Gungor DE, Nadaud P, Raghavan R, Callahan EH, English LK, Kingshipp BL, LaPergola CC, Shapiro MJ, Stoody EE. Systematic review methodols used in the Pregnancy and Birth to 24 Months Project. Am J Clin Nutr. 2019;109(7):698S–704S. Available at https://doi.org/10.1093/ajcn/nqy226 [PubMed: 30445449].

Copyright Notice

The contents of this document may be used and reprinted without permission. Endorsements by NESR, NGAD, CNPP, FNS, or USDA of derivative products developed from this work may not be stated or implied.

Bookshelf ID: NBK579818PMID: 35503867DOI: 10.52570/NESR.PB242018.SR0101

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