{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T19:11:51Z","timestamp":1760037111403,"version":"build-2065373602"},"reference-count":43,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Education (MOE) and the Jeonbuk State, Republic of Korea","award":["2025-RISE-13-WKU"],"award-info":[{"award-number":["2025-RISE-13-WKU"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Maternal diet quality during pregnancy may significantly influence fetal growth and birth weight. Objectives: This study aimed to assess the dietary quality of pregnant women in Korea and investigate its association with the risk of delivering a small-for-gestational-age (SGA) infant. Methods: A total of 1158 pregnant women and their newborns were recruited from the Mothers and Children\u2019s Environmental Health (MOCEH) 2006\u20132010 cohort. Maternal dietary intake during gestational weeks 12\u201328 was assessed using a validated food frequency questionnaire. The nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and Korean Healthy Eating Index (KHEI) were employed to evaluate dietary quality. Birth outcomes were obtained from hospital records, and logistic regression analyses were performed to examine associations between maternal dietary quality and SGA risk. Results: Higher KHEI scores were significantly associated with increased nutrient intake, with the exception of fat, and demonstrated a positive association with the NAR of 15 nutrients. After adjusting for covariates, women in the highest KHEI quartile exhibited a significantly lower risk of SGA birth than those in the lowest quartile (adjusted odds ratio: 0.448; 95% confidence interval: 0.201\u20130.997; P-for-trend = 0.031). Conclusions: Enhanced maternal diet quality, as measured using the KHEI, is associated with improved nutrient intake and a reduced risk of SGA births among Korean pregnant women. These findings underscore the need for public health strategies that promote high-quality diets during pregnancy to improve birth outcomes.<\/jats:p>","DOI":"10.3390\/nu17193056","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T12:05:13Z","timestamp":1758801913000},"page":"3056","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Diet Quality Assessed Using the Korean Healthy Eating Index and Risk of Small-for-Gestational-Age Infants: Findings from the Mothers and Children\u2019s Environmental Health (MOCEH) Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6442-7797","authenticated-orcid":false,"given":"Won","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Food Science and Nutrition, Dongseo University, Busan 47011, Republic of Korea"},{"name":"Institute for Better Living, Wonkwang University, Iksan 54538, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minji","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Nutritional Science and Food Management, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunhee","family":"Ha","sequence":"additional","affiliation":[{"name":"Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea"},{"name":"Department of Environmental Medicine, School of Medicine, Ewha Womans University, Seoul KS013, Republic of Korea"},{"name":"Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea"},{"name":"Department of Medical Science, College of Medicine, Ewha Medical Research Institute, Ewha Womans University, Seoul 03760, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyesook","family":"Kim","sequence":"additional","affiliation":[{"name":"Institute for Better Living, Wonkwang University, Iksan 54538, Republic of Korea"},{"name":"Department of Food and Nutrition, Wonkwang University, Iksan 54538, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.hlc.2015.01.004","article-title":"Delivery of a small-for-gestational-age infant and risk of maternal cardiovascular disease\u2014A population-based record linkage study","volume":"24","author":"Ngo","year":"2015","journal-title":"Heart Lung Circ."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Morken, N.-H., Klungs\u00f8yr, K., and Skjaerven, R. (2014). Perinatal mortality by gestational week and size at birth in singleton pregnancies at and beyond term: A nationwide population-based cohort study. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-172"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.jgyn.2013.09.020","article-title":"Short-term outcome and small for gestational age newborn management","volume":"42","author":"Flamant","year":"2013","journal-title":"J. Gynecol. Obstet. Biol. Reprod."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.earlhumdev.2006.07.002","article-title":"Longitudinal follow-up of height up to five years of age in infants born preterm small for gestational age; comparison to full-term small for gestational age infants","volume":"83","author":"Itabashi","year":"2007","journal-title":"Early Hum. Dev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1159\/000281149","article-title":"Postnatal growth and development in the preterm and small for gestational age infant","volume":"Volume 65","author":"Lucas","year":"2010","journal-title":"Importance of Growth for Health and Development"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"76","DOI":"10.6065\/apem.2013.18.2.76","article-title":"Age at menarche and adult height in girls born small for gestational age","volume":"18","author":"Shim","year":"2013","journal-title":"Ann. Pediatr. Endocrinol. Metab."},{"key":"ref_7","first-page":"S54","article-title":"Neurodevelopmental outcome of small-for-gestational-age infants","volume":"52","author":"Goldenberg","year":"1998","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/uog.12391","article-title":"Neurodevelopmental outcome of full-term small-for-gestational-age infants with normal placental function","volume":"42","author":"Savchev","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/0883073809333538","article-title":"Neurological outcome in preterm small for gestational age infants compared to appropriate for gestational age preterm at the age of 18 months: A prospective study","volume":"25","author":"Karagianni","year":"2010","journal-title":"J. Child Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1079\/PHN2001145","article-title":"Fetal programming and adult health","volume":"4","author":"Godfrey","year":"2001","journal-title":"Public Health Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/epirev\/mxq001","article-title":"Maternal nutrition and birth outcomes","volume":"32","author":"Fraser","year":"2010","journal-title":"Epidemiol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1830","DOI":"10.1016\/S0140-6736(18)30311-8","article-title":"Before the beginning: Nutrition and lifestyle in the preconception period and its importance for future health","volume":"391","author":"Stephenson","year":"2018","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1016\/S0140-6736(18)30312-X","article-title":"Origins of lifetime health around the time of conception: Causes and consequences","volume":"391","author":"Fleming","year":"2018","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/j.1365-3016.2012.01281.x","article-title":"Effect of women\u2019s nutrition before and during early pregnancy on maternal and infant outcomes: A systematic review","volume":"26","author":"Ramakrishnan","year":"2012","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e016777","DOI":"10.1136\/bmjopen-2017-016777","article-title":"The importance of maternal diet quality during pregnancy on cognitive and behavioural outcomes in children: A systematic review and meta-analysis","volume":"7","author":"Borge","year":"2017","journal-title":"BMJ Open"},{"key":"ref_16","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_17","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/2230-8229.97523","article-title":"A study of maternal dietary intake during pregnancy in Riyadh, Saudi Arabia","volume":"14","author":"Almurshed","year":"2007","journal-title":"J. Fam. Community Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.plefa.2009.02.007","article-title":"Associations of maternal prenatal dietary intake of n-3 and n-6 fatty acids with maternal and umbilical cord blood levels","volume":"80","author":"Donahue","year":"2009","journal-title":"Prostaglandins Leukot. Essent. Fatty Acids"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13403","DOI":"10.1111\/mcn.13403","article-title":"Diet quality during pregnancy and its association with social factors: 3D Cohort Study (Design, Develop, Discover)","volume":"18","author":"Yu","year":"2022","journal-title":"Matern. Child Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.jada.2009.03.001","article-title":"Dietary quality during pregnancy varies by maternal characteristics in Project Viva: A US cohort","volume":"109","author":"Kleinman","year":"2009","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_21","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_22","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.numecd.2005.08.006","article-title":"Dietary patterns: A Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk","volume":"16","author":"Panagiotakos","year":"2006","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","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 Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0007114514003341","article-title":"Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: A systematic review and meta-analysis","volume":"113","author":"Siervo","year":"2015","journal-title":"Br. J. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4162\/nrp.2022.16.2.233","article-title":"Development of the Korean healthy eating index for adults, based on the Korea National Health and Nutrition Examination Survey","volume":"16","author":"Yun","year":"2022","journal-title":"Nutr. Res. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s10654-009-9370-7","article-title":"The mothers and children\u2019s environmental health (MOCEH) study","volume":"24","author":"Kim","year":"2009","journal-title":"Eur. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12937-017-0242-9","article-title":"Association between maternal intake of n-6 to n-3 fatty acid ratio during pregnancy and infant neurodevelopment at 6 months of age: Results of the MOCEH cohort study","volume":"16","author":"Kim","year":"2017","journal-title":"Nutr. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"939","DOI":"10.3346\/jkms.2016.31.6.939","article-title":"Percentile distributions of birth weight according to gestational ages in Korea (2010\u20132012)","volume":"31","author":"Lee","year":"2016","journal-title":"J. Korean Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1017\/S1368980014001712","article-title":"Reproducibility and validity of an FFQ developed for the Korea National Health and Nutrition Examination Survey (KNHANES)","volume":"18","author":"Kim","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/S0002-8223(21)04795-7","article-title":"Validity of a dietary score for assessing nutrient adequacy","volume":"78","author":"Guthrie","year":"1981","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1093\/jn\/nxx005","article-title":"Better diet quality during pregnancy is associated with a reduced likelihood of an infant born small for gestational age: An analysis of the prospective New Hampshire Birth Cohort Study","volume":"148","author":"Emond","year":"2018","journal-title":"J. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.3945\/ajcn.2009.28866","article-title":"Diet quality in early pregnancy and its effects on fetal growth outcomes: The INMA Mother and Child Cohort Study in Spain","volume":"91","author":"Rebagliato","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"786409","DOI":"10.1155\/2013\/786409","article-title":"Maternal dietary patterns during third trimester in association with birthweight characteristics and early infant growth","volume":"2013","author":"Poon","year":"2013","journal-title":"Scientifica"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1017\/S0007114511002625","article-title":"Mediterranean diet adherence during pregnancy and fetal growth: INMA (Spain) and RHEA (Greece) mother\u2013child cohort studies","volume":"107","author":"Chatzi","year":"2012","journal-title":"Br. J. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5720\/kjcn.2020.25.1.61","article-title":"Relation between the total diet quality based on Korean Healthy Eating Index and the incidence of metabolic syndrome constituents and metabolic syndrome among a prospective cohort of Korean adults","volume":"25","author":"Shin","year":"2020","journal-title":"Korean J. Community Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Park, S., Kim, K., Lee, B.-K., and Ahn, J. (2020). Association of the healthy eating index with estimated cardiovascular age in adults from the KNHANES 2013\u20132017. Nutrients, 12.","DOI":"10.3390\/nu12102912"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mousa, A., Naqash, A., and Lim, S. (2019). Macronutrient and micronutrient intake during pregnancy: An overview of recent evidence. Nutrients, 11.","DOI":"10.3390\/nu11020443"},{"key":"ref_38","first-page":"856","article-title":"Comparison of nutrient intakes between Korean and United States adults","volume":"38","author":"Chung","year":"2005","journal-title":"J. Nutr. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"258","DOI":"10.4163\/jnh.2016.49.4.258","article-title":"Estimated dietary intake of vitamin A in Korean adults: Based on the Korea National Health and Nutrition Examination Survey 2007\u20132012","volume":"49","author":"Kim","year":"2016","journal-title":"J. Nutr. Health"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Salcedo-Bellido, I., Mart\u00ednez-Galiano, J.M., Olmedo-Requena, R., Mozas-Moreno, J., Bueno-Cavanillas, A., Jimenez-Moleon, J.J., and Delgado-Rodr\u00edguez, M. (2017). Association between vitamin intake during pregnancy and risk of small for gestational age. Nutrients, 9.","DOI":"10.3390\/nu9121277"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1093\/aje\/154.5.466","article-title":"Validity and reproducibility of a food frequency questionnaire for pregnant Finnish women","volume":"154","author":"Erkkola","year":"2001","journal-title":"Am. J. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1079\/PHN2001181","article-title":"Validation of a quantitative food-frequency questionnaire for use in Western Mali","volume":"4","author":"Torheim","year":"2001","journal-title":"Public Health Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Willett, W. (2012). Nutritional Epidemiology, Oxford University Press. [3rd ed.].","DOI":"10.1093\/acprof:oso\/9780199754038.001.0001"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3056\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:49:25Z","timestamp":1760035765000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/19\/3056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":43,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nu17193056"],"URL":"https:\/\/doi.org\/10.3390\/nu17193056","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2025,9,25]]}}}