Disparities in Risks of Inadequate and Excessive Intake of Micronutrients during Pregnancy

Author:

Sauder Katherine A1ORCID,Harte Robyn N1,Ringham Brandy M1,Guenther Patricia M2,Bailey Regan L3,Alshawabkeh Akram4,Cordero José F5,Dunlop Anne L6,Ferranti Erin P6,Elliott Amy J7,Mitchell Diane C8,Hedderson Monique M9,Avalos Lyndsay A9,Zhu Yeyi9ORCID,Breton Carrie V1,Chatzi Leda10,Ran Jin10,Hertz-Picciotto Irva11,Karagas Margaret R12,Sayarath Vicki12,Hoover Joseph13,MacKenzie Debra13,Lyall Kristen14,Schmidt Rebecca J11,O'Connor Thomas G15,Barrett Emily S16,Switkowski Karen M17,Comstock Sarah S18,Kerver Jean M19,Trasande Leonardo20,Tylavsky Frances A21ORCID,Wright Rosalind J22,Kannan Srimathi23,Mueller Noel T24,Catellier Diane J25,Glueck Deborah H1,Dabelea Dana1ORCID,Smith P B26,Newby K L26,Benjamin D K26,Jacobson L P2728,Parker C B29,

Affiliation:

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

26. Duke Clinical Research Institute, Durham, NC

27. Data Analysis Center

28. Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD

29. Research Triangle Institute, Durham, NC

Abstract

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.

Funder

Environmental influences on Child Health Outcomes

National Institutes of Health

Environmental Protection Agency

Autism Speaks

Publisher

Oxford University Press (OUP)

Subject

Nutrition and Dietetics,Medicine (miscellaneous)

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