{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:49:19Z","timestamp":1789134559551,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["5R01ES019196"],"award-info":[{"award-number":["5R01ES019196"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["R01DK118455"],"award-info":[{"award-number":["R01DK118455"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["UH3OD023289"],"award-info":[{"award-number":["UH3OD023289"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institutes of Health","award":["5R01ES019196"],"award-info":[{"award-number":["5R01ES019196"]}]},{"name":"National Institutes of Health","award":["R01DK118455"],"award-info":[{"award-number":["R01DK118455"]}]},{"name":"National Institutes of Health","award":["UH3OD023289"],"award-info":[{"award-number":["UH3OD023289"]}]},{"name":"NIH Environmental Influences on Child Health Outcomes (ECHO) Program","award":["5R01ES019196"],"award-info":[{"award-number":["5R01ES019196"]}]},{"name":"NIH Environmental Influences on Child Health Outcomes (ECHO) Program","award":["R01DK118455"],"award-info":[{"award-number":["R01DK118455"]}]},{"name":"NIH Environmental Influences on Child Health Outcomes (ECHO) Program","award":["UH3OD023289"],"award-info":[{"award-number":["UH3OD023289"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Meeting the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines is associated with a reduced risk of adverse perinatal outcomes. Overall diet quality comprehensively assesses dietary components and accounts for interactions between them. While GWG is influenced by maternal diet, its association with overall diet quality\u2014measured by various dietary quality indices\u2014is not well-defined. We prospectively estimated the relationship between four established dietary quality indices and the risk of GWG rate above (excessive) or below (inadequate) IOM guidelines in a multi-racial and ethnic cohort of 2914 pregnant people from the Pregnancy Environment and Lifestyle Study (2014\u20132019). We assessed diet quality using the Healthy Eating Index 2010 (HEI-2010), alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Empirical Dietary Inflammatory Index (EDIP). Following the first trimester, 56% of the cohort had excessive GWG, and 14% had inadequate GWG. Poor diet quality (below the 75th percentile), measured by HEI-2010, was associated with a higher risk of excessive GWG in the second and third trimesters [RR = 1.03 (1.00, 1.06)]. Effect modification of this relationship by race and ethnicity and pre-pregnancy BMI was assessed. We found poor diet quality to be associated with elevated risk of excessive GWG among Black participants [RR = 1.14 (1.02, 1.28)] and White participants [RR 1.07 (1.01, 1.12)]. This was also the case for participants with pre-pregnancy BMI &lt; 25.0 [RR 1.05 (1.00, 1.10)]. These results suggest that diet quality measured by the HEI-2010 is associated with excessive GWG, and the associations appear to be stronger among pregnant people without overweight or obesity and pregnant people who identify as Black or White race and ethnicity.<\/jats:p>","DOI":"10.3390\/nu15040835","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T05:29:05Z","timestamp":1675661345000},"page":"835","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Dietary Quality Indices in Early Pregnancy and Rate of Gestational Weight Gain among a Prospective Multi-Racial and Ethnic Cohort"],"prefix":"10.3390","volume":"15","author":[{"given":"Emily F.","family":"Liu","sequence":"first","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assiamira","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique M.","family":"Hedderson","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/GCO.0b013e328332d24e","article-title":"New guidelines for weight gain during pregnancy: What obstetrician\/gynecologists should know","volume":"21","author":"Rasmussen","year":"2009","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_2","first-page":"e571","article-title":"Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes","volume":"202","author":"Zilko","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.3945\/ajcn.2009.28950","article-title":"Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: Evidence from 21 y postpartum follow-up","volume":"91","author":"Mamun","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"259.e1","DOI":"10.1016\/j.ajog.2014.02.030","article-title":"Maternal gestational weight gain and offspring risk for childhood overweight or obesity","volume":"211","author":"Sridhar","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1097\/AOG.0b013e31818a5d50","article-title":"Maternal gestational weight gain and offspring weight in adolescence","volume":"112","author":"Oken","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"322.e1","DOI":"10.1016\/j.ajog.2006.11.027","article-title":"Gestational weight gain and child adiposity at age 3 years","volume":"196","author":"Oken","year":"2007","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.ajog.2017.05.040","article-title":"Gestational weight gain","volume":"217","author":"Kominiarek","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.ajog.2015.06.016","article-title":"Prepregnancy body weight and gestational weight gain\u2014Recommendations and reality in the USA and in Germany","volume":"213","author":"Dudenhausen","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.3945\/ajcn.115.110742","article-title":"Macronutrient composition and gestational weight gain: A systematic review","volume":"103","author":"Tielemans","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1017\/S000711452100012X","article-title":"Changes in diet quality and body weight over 10 years: The Multiethnic Cohort Study","volume":"126","author":"Kang","year":"2021","journal-title":"Br. J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"685S","DOI":"10.1093\/ajcn\/nqy372","article-title":"The Pregnancy and Birth to 24 Months Project: A series of systematic reviews on diet and health","volume":"109","author":"Stoody","year":"2019","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1007\/s10995-013-1383-x","article-title":"Is gestational weight gain associated with diet quality during pregnancy?","volume":"18","author":"Shin","year":"2014","journal-title":"Matern. Child Health J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/0260106020903926","article-title":"Associations between prenatal diet quality and gestational weight gain","volume":"26","author":"Schlaff","year":"2020","journal-title":"Nutr. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.3945\/jn.115.228718","article-title":"Development and Validation of an Empirical Dietary Inflammatory Index","volume":"146","author":"Tabung","year":"2016","journal-title":"J. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1093\/jn\/nxy319","article-title":"Long-Term Change in both Dietary Insulinemic and Inflammatory Potential Is Associated with Weight Gain in Adult Women and Men","volume":"149","author":"Tabung","year":"2019","journal-title":"J. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhu, Y., Hedderson, M.M., Feng, J., Mevi, A.A., and Ferrara, A. (2017). The Pregnancy Environment and Lifestyle Study (PETALS): A population-based longitudinal multi-racial birth cohort. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1301-0"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/oxfordjournals.aje.a114416","article-title":"A data-based approach to diet questionnaire design and testing","volume":"124","author":"Block","year":"1986","journal-title":"Am. J. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1016\/0895-4356(90)90099-B","article-title":"Validation of a self-administered diet history questionnaire using multiple diet records","volume":"43","author":"Block","year":"1990","journal-title":"J. Clin. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1220S","DOI":"10.1093\/ajcn\/65.4.1220S","article-title":"Adjustment for total energy intake in epidemiologic studies","volume":"65","author":"Willett","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"365","DOI":"10.15585\/mmwr.mm6816a1","article-title":"Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18\u201344 Years\u2014United States, 2015\u20132017","volume":"68","author":"Denny","year":"2019","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ije\/dyy285","article-title":"Poor diet quality in pregnancy is associated with increased risk of excess fetal growth: A prospective multi-racial\/ethnic cohort study","volume":"48","author":"Zhu","year":"2019","journal-title":"Int. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.jand.2012.12.016","article-title":"Update of the Healthy Eating Index: HEI-2010","volume":"113","author":"Guenther","year":"2013","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1001\/archinte.168.7.713","article-title":"Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women","volume":"168","author":"Fung","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1161\/CIRCULATIONAHA.108.816736","article-title":"Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women","volume":"119","author":"Fung","year":"2009","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ehrhardt, C., Deibert, C., Fl\u00f6ck, A., Merz, W.M., Gembruch, U., Bockler, A., D\u00f6tsch, J., Joisten, C., and Ferrari, N. (2022). Impact of Diet Quality during Pregnancy on Gestational Weight Gain and Selected Adipokines-Results of a German Cross-Sectional Study. Nutrients, 14.","DOI":"10.3390\/nu14071515"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.profoo.2015.06.010","article-title":"Use of automated self-administered 24-hour recalls (ASA24-2011) and diet quality scores to characterize women who met or Exceeded Weight Gain Recommendations during Pregnancy","volume":"4","author":"Graziano","year":"2015","journal-title":"Procedia Food Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1038\/sj.ejcn.1601771","article-title":"Diet during pregnancy in relation to maternal weight gain and birth size","volume":"58","author":"Lagiou","year":"2004","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Parker, H.W., Tovar, A., McCurdy, K., and Vadiveloo, M. (2019). Associations between pre-pregnancy BMI, gestational weight gain, and prenatal diet quality in a national sample. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0224034"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Augustin, H., Winkvist, A., and B\u00e4rebring, L. (2020). Poor Dietary Quality is Associated with Low Adherence to Gestational Weight Gain Recommendations among Women in Sweden. Nutrients, 12.","DOI":"10.3390\/nu12020317"},{"key":"ref_30","unstructured":"Rasmussen, K.M., and Yaktine, A.L. (2009). Weight Gain During Pregnancy: Reexamining the Guidelines."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1038\/ijo.2015.15","article-title":"Maternal obesity and metabolic risk to the offspring: Why lifestyle interventions may have not achieved the desired outcomes","volume":"39","author":"Catalano","year":"2015","journal-title":"Int. J. Obes."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.annepidem.2014.02.009","article-title":"Racial differences in gestational weight gain and pregnancy-related hypertension","volume":"24","author":"Liu","year":"2014","journal-title":"Ann. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/0029-7844(96)00023-3","article-title":"Determinants of gestational weight gain outside the recommended ranges among black and white women","volume":"87","author":"Caulfield","year":"1996","journal-title":"Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1017\/S1368980013003224","article-title":"Racial\/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population","volume":"17","author":"Brunst","year":"2014","journal-title":"Public Health Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1067\/mob.2002.121078","article-title":"What are pregnant women eating? Nutrient and food group differences by race","volume":"186","author":"Bodnar","year":"2002","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.jand.2017.01.016","article-title":"Racial or Ethnic and Socioeconomic Inequalities in Adherence to National Dietary Guidance in a Large Cohort of US Pregnant Women","volume":"117","author":"Bodnar","year":"2017","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/j.1753-4887.2001.tb07001.x","article-title":"Dietary fiber and weight regulation","volume":"59","author":"Howarth","year":"2001","journal-title":"Nutr. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/nbu.12280","article-title":"Dietary energy density: Applying behavioural science to weight management","volume":"42","author":"Rolls","year":"2017","journal-title":"Nutr. Bull."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"280S","DOI":"10.1093\/jn\/130.2.280S","article-title":"Dietary glycemic index and obesity","volume":"130","author":"Ludwig","year":"2000","journal-title":"J. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1365-3016.2006.00691.x","article-title":"Changes in dietary intake from the first to the second trimester of pregnancy","volume":"20","author":"Willett","year":"2006","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.3945\/jn.109.109579","article-title":"Women\u2019s dietary patterns change little from before to during pregnancy","volume":"139","author":"Crozier","year":"2009","journal-title":"J. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jand.2015.09.020","article-title":"American Diet Quality: Where It Is, Where It Is Heading, and What It Could Be","volume":"116","author":"Wilson","year":"2016","journal-title":"J. Acad. Nutr. Diet."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/4\/835\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:25:38Z","timestamp":1760120738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/4\/835"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,6]]},"references-count":42,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["nu15040835"],"URL":"https:\/\/doi.org\/10.3390\/nu15040835","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,6]]}}}