Greater Ultra-Processed Food Intake Is Associated With Multiple Dimensions of Poorer Diet Quality During Pregnancy and Postpartum

Abstract Objectives This study examined associations of ultra-processed food intake with dimensions of diet quality during pregnancy and postpartum. Methods Participants in the Pregnancy Eating Attributes Study completed 24-hour dietary recalls during each pregnancy trimester and at 6 weeks, 6 months, and 12 months postpartum, from which pregnancy and postpartum Healthy Eating Index 2015 (HEI) total and component scores were calculated. Percent energy intake from ultra-processed foods (UPF) was calculated for pregnancy and postpartum using the NOVA classification system for categorizing processing level. Of 458 women enrolled, dietary data were available from 365 during pregnancy and 266 during postpartum. Pearson correlations examined associations of UPF intake with HEI total and component scores. Food group intake per 1000 kcal was then compared between women in the lower and upper UPF quartiles for HEI components significantly correlated with UPF. Results UPF intake accounted for 53 ± 15% energy intake in pregnancy, and was inversely associated with total HEI (r = −0.55, P < 0.001) and with 9 of 13 component scores (r = −0.16 to −0.50, P < 0.01). Compared to women in the highest quartile of UPF intake, those in the lowest quartile had 19.0 points higher total HEI (95% CI 15.0, 23.1) and consumed 1.8 times more vegetables, 3.4 times more greens and beans, 2.7 times more total fruit, 3.4 times more whole fruit, 1.7 times more whole grain, 1.6 times more total protein, 3.4 times more seafood & plant protein, 0.7 times less refined grains, and 0.5 times less added sugar (P < 0.01 all comparisons). UPF was higher among women in the youngest tertile (< 29 y; UPF 58%, P < 0.001), with less than a bachelor's degree (UPF 59%, P < 0.001), and with poverty-income ratio ≤ 1.85 (UPF 57%, P < 0.01), but did not differ by parity. UPF in postpartum was correlated r = 0.40 (P < 0.001) with UPF in pregnancy. Mean postpartum UPF (51 ± 17%) and associations of UPF with diet quality indicators were consistent with those in pregnancy. Conclusions UPF accounted for more than half of energy intake during pregnancy and the postpartum period and was associated with poorer diet quality across most HEI components. Reducing processed food intake may represent a singular intervention target with broad impact on adherence to dietary guidelines. Funding Sources This research was supported by the NICHD Intramural Research Program.