{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:35:10Z","timestamp":1777073710896,"version":"3.51.4"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aimed to develop a k-means clustering algorithm to identify distinct food intake patterns through cluster analysis.<\/jats:p>\n                  <jats:p>This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), including nulliparous individuals with singleton pregnancies. Dietary intake data from the 3 months preceding pregnancy were collected using a validated questionnaire. The primary outcome was a composite measure including preterm birth, stillbirth, preeclampsia, eclampsia, gestational diabetes, and small for gestational age. Clusters were formed using a k-means clustering algorithm with Euclidean distance, based on 335 dietary variables. The association between dietary clusters and adverse pregnancy outcomes (APOs) was assessed. Relative risks with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for predefined confounders. A random forest model was also employed to identify features predictive of cluster allocation.<\/jats:p>\n                  <jats:p>The analysis included 7,599 participants, distributed across three clusters: Cluster 1 (n\u2009=\u20094,243, 55.8%), Cluster 2 (n\u2009=\u20092,768, 36.4%), and Cluster 3 (n\u2009=\u2009588, 7.7%). Cluster 2, which serves as the referent cluster, is characterized by a higher intake of vitamin E as \u03b1-tocopherol, vitamin A retinol activity equivalents, vegetables, and fruits, aligning most closely with a healthy diet pattern. Compared with Cluster 2, Cluster 1, characterized by a lower intake of the same nutrients, did not show a significant association with increased odds of APOs (22.7 vs. 25.4%; adjusted relative risk [aRR], 1.07 [95% CI: 0.98\u20131.18]). In contrast, Cluster 3, characterized by higher intake of trans fats, dietary polyunsaturated fatty acids 20:4, red meat, and sugary beverages, was significantly associated with APOs compared with Cluster 2 (31.0 vs. 22.7%; aRR, 1.19 [95% CI: 1.01\u20131.39]).<\/jats:p>\n                  <jats:p>A dietary pattern characterized by a high intake of trans fats, polyunsaturated fatty acids, red meat, and sugary beverages is significantly associated with an increased risk of APOs.<\/jats:p>","DOI":"10.1055\/a-2712-5518","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T23:06:35Z","timestamp":1759187195000},"page":"955-962","source":"Crossref","is-referenced-by-count":0,"title":["Nutrition Pattern and Adverse Pregnancy Outcomes in Nulliparous Individuals: A Cluster Analysis"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2438-1699","authenticated-orcid":false,"given":"Tetsuya","family":"Kawakita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yara H.","family":"Diab","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2054-4684","authenticated-orcid":false,"given":"Kazuma","family":"Onishi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s11936-020-00862-6","article-title":"The association of adverse pregnancy outcomes and cardiovascular disease: Current knowledge and future directions","volume":"22","author":"A S Minhas","year":"2020","journal-title":"Curr Treat Options Cardiovasc Med"},{"issue":"18","key":"ref2","doi-asserted-by":"crossref","first-page":"e902","DOI":"10.1161\/CIR.0000000000000961","article-title":"Adverse pregnancy outcomes and cardiovascular disease risk: Unique opportunities 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