{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T06:27:59Z","timestamp":1786429679190,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      This study aimed to investigate the association between a pro-inflammatory diet in pregnancy, assessed\n                      <jats:italic>via<\/jats:italic>\n                      the Dietary Inflammatory Index (DII), and abnormal perinatal outcomes (APOs), including miscarriage and stillbirth. Leveraging the UK Biobank cohort, we evaluated whether higher DII scores were associated with increased APOs risk. Additionally, we explored interactions between DII, lifestyle factors (physical inactivity, smoking exposure), and socioeconomic determinants to identify modifiable pathways for reducing APOs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 10,353 women from the UK Biobank with pregnancy records and \u22652 valid 24-h dietary assessments (collected during pregnancy between 2006 and 2019). DII scores were computed using intakes of 20 nutrients (e.g., fats, vitamins, and fiber) linked to inflammation. APOs (miscarriage\/stillbirth) were derived from self-reported questionnaires. Covariates (age, BMI, physical activity, income, education, and smoking) were adjusted in logistic regression models comparing DII quartiles (Q1: anti-inflammatory; Q4: pro-inflammatory). A sensitivity analysis using miscarriage and stillbirth as separate outcomes was conducted. A formal test for nonlinear trend (p-for-trend) was performed across quartiles. Analyses used R 4.1.1 and Python 3.7.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with the most pro-inflammatory group (Q4), the risk of abnormal perinatal outcomes was 14% lower in the most anti-inflammatory group (Q1; OR = 0.86, 95% CI: 0.76\u20130.97) in model 1, 13% lower (OR = 0.87, 95% CI: 0.77\u20130.98) in model 2, and 14% lower (OR = 0.86, 95% CI: 0.76\u20130.97) in model 3. Additionally, compared with the most pro-inflammatory group (Q4), the low anti-inflammatory group (Q2) was associated with an 17% lower risk of abnormal perinatal outcomes in model 3 and low pro-inflammatory group (Q3) was associated with an 12% lower risk of abnormal perinatal outcomes in model 3. Physically inactive women, smokers, and those with lower education had higher DII scores and APO incidence (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Household income and tobacco exposure were also significantly associated with APOs (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher DII scores were associated with higher risks of miscarriage and stillbirth. Anti-inflammatory diets confer protective effects, underscoring diet optimization as a key intervention strategy. Lifestyle factors (inactivity, smoking) and lower education amplify both pro-inflammatory diets and APO susceptibility. These findings support integrating dietary inflammation screening into prenatal care to mitigate adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1819828","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:36:53Z","timestamp":1786426613000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pro-inflammatory diet in pregnancy associated with increased risk of abnormal perinatal outcomes: evidence from dietary inflammatory index in the UK biobank"],"prefix":"10.3389","volume":"14","author":[{"given":"Lili","family":"Sheng","sequence":"first","affiliation":[{"name":"Department of Gynecology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"He","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Shanghai East Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochen","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghal Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Shanghai Health and Medical Center (SHMC)","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengnan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghal Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiming","family":"Cao","sequence":"additional","affiliation":[{"name":"Yunnan Provincial Health and Rehabilitation Center","place":["Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Luo","sequence":"additional","affiliation":[{"name":"TCM Development Office (Education and Research Office), Punan Branch of Renji Hospital, Shanghai Jiaotong University School of Medicine (Punan Hospital in Pudong New District, Shanghai)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]},{"name":"Department of Reproductive Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1001\/jamainternmed.2024.0276","article-title":"Adverse pregnancy outcomes and long-term mortality in women","volume":"184","author":"Crump","year":"2024","journal-title":"Jama Intern Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"165354","DOI":"10.1016\/j.bbadis.2018.12.005","article-title":"Oxidative stress: normal pregnancy versus preeclampsia","volume":"1866","author":"Chiarello","year":"2020","journal-title":"Biochim Et Biophys Acta-Mole Basis Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e13316","DOI":"10.1111\/aji.13316","article-title":"Specific inflammatory profile in each pregnancy complication: A comparative study","volume":"84","author":"Brien","year":"2020","journal-title":"Am J Reprod Immunol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.3389\/fimmu.2020.02025","article-title":"T helper (Th) cell profiles in pregnancy and recurrent pregnancy losses: Th1\/Th2\/Th9\/Th17\/Th22\/Tfh Cells","volume":"11","author":"Wang","year":"2020","journal-title":"Front Immunol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"901","DOI":"10.3389\/fmicb.2017.00901","article-title":"The effect of TGF-\u03b2 on treg cells in adverse pregnancy outcome upon Toxoplasma gondii infection","volume":"8","author":"Zhao","year":"2017","journal-title":"Front Microbiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1034\/j.1600-0897.2002.01131.x","article-title":"Dominant IL-10 and TGF-\u03b2 mRNA expression in \u03b3\u03b4T cells of human early pregnancy decidua suggests immunoregulatory potential","volume":"48","author":"Nagaeva","year":"2002","journal-title":"Am J Reprod Immunol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.3390\/nu14112284","article-title":"Maternal dietary inflammatory index during pregnancy is associated with perinatal outcomes: results from the IMPACT BCN trial","volume":"14","author":"Casas","year":"2022","journal-title":"Nutrients"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.3390\/nu14102087","article-title":"An overview of obesity, cholesterol, and systemic inflammation in preeclampsia","volume":"14","author":"Alston","year":"2022","journal-title":"Nutrients"},{"key":"B9","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s12016-009-8178-2","article-title":"Toll-like receptors in pregnancy disorders and placental dysfunction","volume":"39","author":"Riley","year":"2010","journal-title":"Clin Rev Allergy Immunol."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.117.155903","article-title":"Emerging understanding and measurement of plasma volume expansion in pregnancy","author":"Vricella","year":"2017","journal-title":"Am J Clin Nutrit."},{"key":"B11","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: a unique complexity","volume":"63","author":"Mor","year":"2010","journal-title":"Am J Reprod Immunol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1111\/j.1600-0897.2010.00852.x","article-title":"Th1\/Th2\/Th17 and regulatory T-cell paradigm in pregnancy","volume":"63","author":"Saito","year":"2010","journal-title":"Am J Reprod Immunol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.arr.2017.09.001","article-title":"Health relevance of the modification of low grade inflammation in ageing (inflammageing) and the role of nutrition","volume":"40","author":"Calder","year":"2017","journal-title":"Ageing Res Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1096\/fasebj.31.1_supplement.151.1","article-title":"Adherence to a Mediterranean Diet (MedDiet) for 6 months improves dietary quality and dietary inflammatory index in a western population: results from the Mediterranean diet for cognition and cardiovascular health in the elderly (MedLey) study","volume":"31","author":"Clark","year":"2017","journal-title":"Faseb J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2798","DOI":"10.3390\/nu13082798","article-title":"Effect of an antenatal lifestyle intervention on dietary inflammatory index and its associations with maternal and fetal outcomes: a secondary analysis of the PEARS trial","volume":"13","author":"Killeen","year":"2021","journal-title":"Nutrients"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1016\/j.ajcnut.2025.07.005","article-title":"Heterogeneity in the association between a dietary pattern high in fat, sugar, and sodium and adverse pregnancy outcomes by maternal characteristics: a United States pregnancy cohort study","volume":"122","author":"Bodnar","year":"2025","journal-title":"Am J Clin Nutrit."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.3390\/nu18071065","article-title":"Maternal dietary patterns, socioeconomic conditions, and birth outcomes in the MAMI-MED and Piccolipi\u00f9 Italian birth cohorts","volume":"18","author":"Favara","year":"2026","journal-title":"Nutrients"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.3390\/nu17091570","article-title":"Relationship between dietary inflammatory index, diets, and cardiovascular medication","volume":"17","author":"de Coca","year":"2025","journal-title":"Nutrients"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1016\/j.ajogmf.2025.101609","article-title":"Association between the dietary inflammatory index and adverse pregnancy outcomes","volume":"7","author":"Bharmal","year":"2025","journal-title":"Am J Obstet Gynecol Mfm."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1371\/journal.pmed.1001779","article-title":"UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age","volume":"12","author":"Sudlow","year":"2015","journal-title":"Plos Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1017\/S1368980011000942","article-title":"Development and evaluation of the Oxford WebQ, a low-cost, web-based method for assessment of previous 24 h dietary intakes in large-scale prospective studies","volume":"14","author":"Liu","year":"2011","journal-title":"Public Health Nutrit."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1017\/S1368980013002115","article-title":"Designing and developing a literature-derived, population-based dietary inflammatory index","volume":"17","author":"Shivappa","year":"2014","journal-title":"Public Health Nutrit."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.3389\/fnut.2021.732099","article-title":"Association between diet-related inflammation and COPD: findings from NHANES III","volume":"8","author":"Liu","year":"2021","journal-title":"Front Nutrit."},{"key":"B24","doi-asserted-by":"publisher","first-page":"3651","DOI":"10.1016\/j.jri.2022.103651","article-title":"The dietary inflammatory index as a predictor of pregnancy outcomes: systematic review and meta-analysis","volume":"152","author":"de Freitas","year":"2022","journal-title":"J Reprod Immunol."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-822130-3.00004-1","author":"Phillips","year":"2022","journal-title":"Chapter 12\u2014Inflammatory Potential of Diet and Health Outcomes in Pregnancy, Infancy, and Childhood, in Diet, Inflammation, and Health"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2789","DOI":"10.3390\/nu12092789","article-title":"Association of dietary inflammatory index with serum IL-6, IL-10, and CRP concentration during pregnancy","volume":"12","author":"Pieczy\u0144ska","year":"2020","journal-title":"Nutrients"},{"key":"B27","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1080\/15592294.2017.1347241","article-title":"Maternal inflammatory diet and adverse pregnancy outcomes: Circulating cytokines and genomic imprinting as potential regulators?","volume":"12","author":"McCullough","year":"2017","journal-title":"Epigenetics"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1016\/j.immuni.2017.11.018","article-title":"Natural killer cells promote fetal development through the secretion of growth-promoting factors","volume":"47","author":"Fu","year":"2017","journal-title":"Immunity"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1093\/humrep\/dev098","article-title":"First do no harm: uterine natural killer (NK) cells in assisted reproduction","volume":"30","author":"Moffett","year":"2015","journal-title":"Human Reprod"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1496","DOI":"10.3390\/ijms19051496","article-title":"Oxidative stress in preeclampsia and placental diseases","volume":"19","author":"Aouache","year":"2018","journal-title":"Int J Mol Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1111\/j.1365-2141.2005.05847.x","article-title":"Thrombophilia in pregnancy: a systematic review","volume":"132","author":"Robertson","year":"2006","journal-title":"Brit J Haematol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12966-018-0701-5","article-title":"Patterns of leisure-time physical activity across pregnancy and adverse pregnancy outcomes","volume":"15","author":"Catov","year":"2018","journal-title":"Int J Behav Nutrit Phys Activ."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2819","DOI":"10.1080\/14767058.2022.2162819","article-title":"Physical activity during pregnancy and adverse birth outcome: a prospective cohort study in China","volume":"36","author":"Li","year":"2023","journal-title":"J Mater-Fetal Neonatal Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"S51","DOI":"10.1097\/00001648-200309001-00107","article-title":"Maternal exposure to environmental tobacco smoke (ETS) and pregnancy outcomes in prospective cohort study","volume":"14","author":"Fazel","year":"2003","journal-title":"Epidemiology"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1080\/00913847.2018.1443665","article-title":"The association between physical activity and dietary inflammatory index on mortality risk in US adults","author":"Edwards","year":"2018","journal-title":"Phys Sports Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.nutres.2015.11.009","article-title":"Anti-inflammatory dietary inflammatory index scores are associated with healthier scores on other dietary indices","volume":"36","author":"Wirth","year":"2016","journal-title":"Nutrit Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1186\/s12889-025-22454-4","article-title":"Diet inflammatory potential modifies the association between tobacco smoke exposure and lung function","volume":"25","author":"Li","year":"2025","journal-title":"Bmc Public Health"},{"key":"B38","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1139\/apnm-2016-0274","article-title":"Association between maternal dietary inflammatory index (DII) and abortion in Iranian women and validation of DII with serum concentration of inflammatory factors: case-control study","volume":"42","author":"Vahid","year":"2017","journal-title":"Appl Physiol Nutrit Metabol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"3552","DOI":"10.1080\/14767058.2018.1466275","article-title":"Association between inflammatory potential of diet and odds of gestational diabetes mellitus among Iranian women","volume":"32","author":"Shivappa","year":"2019","journal-title":"J Mater-Fetal Neonatal Med."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1819828\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:36:54Z","timestamp":1786426614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1819828\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":39,"alternative-id":["10.3389\/fpubh.2026.1819828"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1819828","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"article-number":"1819828"}}