Katherine A Sauder1, Robyn N Harte1, Brandy M Ringham1, Patricia M Guenther2, Regan L Bailey3, Akram Alshawabkeh4, José F Cordero5, Anne L Dunlop6, Erin P Ferranti6, Amy J Elliott7, Diane C Mitchell8, Monique M Hedderson9, Lyndsay A Avalos9, Yeyi Zhu9, Carrie V Breton1, Leda Chatzi10, Jin Ran10, Irva Hertz-Picciotto11, Margaret R Karagas12, Vicki Sayarath12, Joseph Hoover13, Debra MacKenzie13, Kristen Lyall14, Rebecca J Schmidt11, Thomas G O'Connor15, Emily S Barrett16, Karen M Switkowski17, Sarah S Comstock18, Jean M Kerver19, Leonardo Trasande20, Frances A Tylavsky21, Rosalind J Wright22, Srimathi Kannan23, Noel T Mueller24, Diane J Catellier25, Deborah H Glueck1, Dana Dabelea1. 1. Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 2. Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA. 3. Department of Nutrition Science, Purdue University, West Lafayette, IN, USA. 4. College of Engineering, Northeastern University, Boston, MA, USA. 5. Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA. 6. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA. 7. Avera Research Institute, Sioux Falls, SD, USA. 8. Department of Nutritional Sciences, Penn State University, University Park, PA, USA. 9. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA. 10. Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. 11. Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA. 12. Department of Epidemiology, Dartmouth College, Hanover, NH, USA. 13. Community Environmental Health Program, College of Pharmacy at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 14. AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA. 15. Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA. 16. Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA. 17. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. 18. Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA. 19. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA. 20. Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA. 21. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 22. Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 23. Department of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA. 24. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 25. RTI International, Research Triangle Park, NC, USA.
Abstract
BACKGROUND: Inadequate or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes. OBJECTIVE: The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity, education, and prepregnancy BMI. METHODS: Fifteen observational cohorts in the US Environmental influences on Child Health Outcomes (ECHO) Consortium assessed participant dietary intake with 24-h dietary recalls (n = 1910) or food-frequency questionnaires (n = 7891) from 1999-2019. We compared the distributions of usual intake of 19 micronutrients from food alone (15 cohorts; n = 9801) and food plus dietary supplements (10 cohorts with supplement data; n = 7082) to estimate the proportion with usual daily intakes below their age-specific daily Estimated Average Requirement (EAR), above their Adequate Intake (AI), and above their Tolerable Upper Intake Level (UL), overall and within sociodemographic and anthropometric subgroups. RESULTS: Risk of inadequate intake from food alone ranged from 0% to 87%, depending on the micronutrient and assessment methodology. When dietary supplements were included, some women were below the EAR for vitamin D (20-38%), vitamin E (17-22%), and magnesium (39-41%); some women were above the AI for vitamin K (63-75%), choline (7%), and potassium (37-53%); and some were above the UL for folic acid (32-51%), iron (39-40%), and zinc (19-20%). Highest risks for inadequate intakes were observed among participants with age 14-18 y (6 nutrients), non-White race or Hispanic ethnicity (10 nutrients), less than a high school education (9 nutrients), or obesity (9 nutrients). CONCLUSIONS: Improved diet quality is needed for most pregnant females. Even with dietary supplement use, >20% of participants were at risk of inadequate intake of ≥1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities.
BACKGROUND: Inadequate or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes. OBJECTIVE: The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity, education, and prepregnancy BMI. METHODS: Fifteen observational cohorts in the US Environmental influences on Child Health Outcomes (ECHO) Consortium assessed participant dietary intake with 24-h dietary recalls (n = 1910) or food-frequency questionnaires (n = 7891) from 1999-2019. We compared the distributions of usual intake of 19 micronutrients from food alone (15 cohorts; n = 9801) and food plus dietary supplements (10 cohorts with supplement data; n = 7082) to estimate the proportion with usual daily intakes below their age-specific daily Estimated Average Requirement (EAR), above their Adequate Intake (AI), and above their Tolerable Upper Intake Level (UL), overall and within sociodemographic and anthropometric subgroups. RESULTS: Risk of inadequate intake from food alone ranged from 0% to 87%, depending on the micronutrient and assessment methodology. When dietary supplements were included, some women were below the EAR for vitamin D (20-38%), vitamin E (17-22%), and magnesium (39-41%); some women were above the AI for vitamin K (63-75%), choline (7%), and potassium (37-53%); and some were above the UL for folic acid (32-51%), iron (39-40%), and zinc (19-20%). Highest risks for inadequate intakes were observed among participants with age 14-18 y (6 nutrients), non-White race or Hispanic ethnicity (10 nutrients), less than a high school education (9 nutrients), or obesity (9 nutrients). CONCLUSIONS: Improved diet quality is needed for most pregnant females. Even with dietary supplement use, >20% of participants were at risk of inadequate intake of ≥1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities.
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