Eating Behavior from Pregnancy through Early Childhood

The Pregnancy Eating Attributes Study (PEAS) addresses the public health problem of poor maternal diet quality, excessive gestational weight gain, and postpartum weight retention, which are prevalent across racial/ethnic groups and income levels and are modifiable risk factors for numerous adverse maternal and child health outcomes. PEAS is an observational prospective cohort study investigating determinants of dietary intake and weight change during pregnancy and postpartum, as well as infant feeding behaviors. Participants were enrolled at less than 12 weeks gestation and followed, with their infants, until one year postpartum; data include dietary intake, anthropometrics, biospecimens, medical records, self-reported eating and other health-related behaviors, and infant feeding. Primary study findings, reported previously, were that greater propensity for reward-related (i.e., hedonic) eating was associated with worse diet quality during pregnancy, but not with gestational weight gain or postpartum weight retention. Lower availability of fruit and vegetables and greater availability of obesogenic foods in the home food environment were associated with worse diet quality, but the associations of reward-related eating with diet and weight did not vary depending on the home food environment or individual self-control.

Work in the current year indicates that factors associated with weight outcomes in the general population may not similarly impact pregnancy weight outcomes. Intakes of sugar-sweetened beverages and non-nutritive sweetened beverages were not associated with gestational weight gain, postpartum weight retention, blood glucose, or insulin, suggesting that sweetened beverage intake within a moderate range may not be a significant risk factor for excess pregnancy-related weight gain or glucose dysregulation in pregnancy and postpartum. Further, eating in the absence of hunger (EAH), measured in a controlled laboratory paradigm, was unassociated with weight outcomes, eating behaviors, or well-being in pregnant adults. Findings suggest the need for further research across various developmental periods to determine the utility of laboratory EAH measurement as an indicator of behavioral susceptibility to excessive energy intake leading to weight gain.

Recent findings also advance knowledge regarding the measurement of reward-related eating in pregnancy and postpartum. Though considered a stable trait, reward-related eating may differ during pregnancy and postpartum, given the physical and psychological changes common during these periods. Thus, we examined measurement invariance of the Power of Food Scale, a self-report measure of hedonic hunger. The measure demonstrated longitudinal measurement equivalence across pregnancy and postpartum, and partial equivalence with young adult women. Findings support the validity of the measure for use in pregnant and postpartum populations; however, direct comparisons with non-pregnant populations should be avoided.

Given emerging evidence suggesting the importance of the microbiome in perinatal and child health, along with findings in the general population linking diet, microbiome, and disease, we explored associations of dietary intake with the microbiome during pregnancy and in infancy. Overall pregnancy diet quality was not associated with diversity of the gastrointestinal microbiome, possibly due to the general reduction in alpha diversity (the diversity within a single microbial community) observed during this developmental period. However, added sugar intake was associated with microbial function of copper ion homeostasis, which may contribute to oxidative stress, and greater saturated fat intake increased the likelihood of belonging to the taxa enterotype predominantly composed of Firmicutes. Novel findings also demonstrated differences in the infant gut microbial composition by the type of feeding, as well as associations of breastfeeding parents’ diet with the infant microbiome. Higher diet quality was associated with lower abundance of infant gut microbial genera that have been previously implicated in inflammation. Findings suggest the potential of the parent’s dietary intake during breastfeeding to support the development of infant gut microbiome associated with favorable short- and long-term health outcomes.

Sprouts: Development of Eating Behaviors in Early Childhood addresses the public health problem of poor diet quality in children, which tracks into adulthood and has multiple adverse health consequences. Inadequate intake of whole plant foods and excessive intake of discretionary foods (i.e., energy-dense foods and beverages that contribute minimally to other nutritional requirements) begin in early childhood, which is a critical period for the development of food preferences and eating behaviors. These behaviors in turn influence child growth and adiposity, as well as long-term eating patterns, underscoring the need for research elucidating influences on early childhood diet quality. Sprouts follows the offspring of PEAS participants from child age 3.5 through five years. Dietary intake, anthropometrics, laboratory-assessed behavioral data, and parent-reported feeding/eating behaviors were collected from PEAS parents and children. With this well characterized cohort followed from early pregnancy through early primary school, we will investigate how prenatal and infant exposures, parent feeding practices, and behavioral factors influence the development of child eating behaviors, diet, and growth from ages three to seven years.

Findings from the initial waves of data collection highlight the importance of early life food exposures. Infant exposure to fruits and vegetables was associated with higher early childhood diet quality; additionally, this association was stronger in children with higher food avoidance appetitive traits, suggesting a possible sensitive period for these infants. Exposure to discretionary food in the first two years of life was consistently associated with lower diet quality in early childhood regardless of the strength of appetitive traits (i.e., inherent disposition related to food approach and avoidance). Findings suggest that improving child diet quality may require stronger efforts to limit exposure to discretionary foods in infancy.

Analyses in the current year also reflect advances in measurement development. A latent profile analysis of the 12 subscales of the Comprehensive Feeding Practices Questionnaire yielded three distinct profiles of parent feeding practices, which differed meaningfully in home fruit and vegetable availability and child diet quality. These profiles facilitate examining multiple parent feeding behaviors in combination, thereby providing a comprehensive characterization of parent feeding practices. In pooled data from four studies, we developed and evaluated a brief version of the Anticipated Effects of Food Scale. The abbreviated measure demonstrated good internal consistency and convergent validity with the full measure, and reproduced associations of the full measure with added sugar intake, symptoms of food addiction, eating motives, and ad libitum food intake.