Our analysis examined the impact of maternal dietary patterns and lifestyle factors on markers of fetal growth, specifically birthweight and size for gestational age (small- (SGA) or large-for-gestational age (LGA)). The Infant Feeding Practices Study II, a prospective cohort study, surveyed pregnant women during their 3rd trimester, of which a subgroup ( ) completed a food frequency questionnaire. Maternal dietary patterns were evaluated by diet scores (Alternative Healthy Eating Index for Pregnancy and alternate Mediterranean diet) and by carbohydrate quality (glycemic index and glycemic load). Poisson regression with robust standard errors was used to examine the relative risk of SGA and separately LGA, with dietary patterns and other lifestyle factors. Linear regression was used to determine the association of birthweight and early infant growth with better dietary patterns. Relative risk of SGA and LGA was not associated with dietary patterns. Birthweight and infant growth were not associated with maternal diet. Smoking, however, increased the risk of delivering an SGA infant (RR = 2.92, 95% CI: 1.58–5.39), while higher prepregnancy BMI increased the risk of delivering an LGA infant (RR = 1.06, 95% CI: 1.03–1.09). Future studies are needed to evaluate whether deficiencies in more specific maternal dietary nutrients play a role in fetal growth. 1. Introduction Fetal growth is an important determinant not only of infant survival but also of future chronic disease risk. Both low and high birthweight have been associated with increased infant mortality and long-term morbidity [1, 2]. Low birthweight has additionally been associated with elevated risk of type 2 diabetes [3], while high birthweight for gestational age has been associated with increased risk of overweight and obesity in adulthood [4, 5]. Due to the lifelong implications of fetal growth defined by size-at-birth, further research is needed to understand its determinants. Maternal nutrition is the major fuel for fetal growth [6]. While many studies have examined the role of individual nutrients during pregnancy [7–9], recent focus on nutritional epidemiology has shifted from examining the effect of single nutrients to assessing overall diet quality. Assessing nutrition as a dietary index may be more informative as it accounts for the combined effect of nutrients in foods [10]. In this regard, existing analyses on prenatal dietary patterns with birthweight have been scant and findings have been inconsistent [11]. As a result, further research is needed to understand the role of maternal
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