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

Katherine A Sauder; Robyn N Harte; Brandy M Ringham; Patricia M Guenther; Regan L Bailey; Akram Alshawabkeh; José F Cordero; Anne L Dunlop; Erin P Ferranti; Amy J Elliott; Diane C Mitchell; Monique M Hedderson; Lyndsay A Avalos; Yeyi Zhu; Carrie V Breton; Leda Chatzi; Jin Ran; Irva Hertz-Picciotto; Margaret R Karagas; Vicki Sayarath; Joseph Hoover; Debra MacKenzie; Kristen Lyall; Rebecca J Schmidt; Thomas G O'Connor; Emily S Barrett; Karen M Switkowski; Sarah S Comstock; Jean M Kerver; Leonardo Trasande; Frances A Tylavsky; Rosalind J Wright; Srimathi Kannan; Noel T Mueller; Diane J Catellier; Deborah H Glueck; Dana Dabelea; Program Collaborators for Environmental influences on Child Health Outcomes (ECHO)

doi:10.1093/jn/nxab273

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

J Nutr. 2021 Nov 2;151(11):3555-3569. doi: 10.1093/jn/nxab273.

Authors

Katherine A Sauder¹, Robyn N Harte¹, Brandy M Ringham¹, Patricia M Guenther², Regan L Bailey³, Akram Alshawabkeh⁴, José F Cordero⁵, Anne L Dunlop⁶, Erin P Ferranti⁶, Amy J Elliott⁷, Diane C Mitchell⁸, Monique M Hedderson⁹, Lyndsay A Avalos⁹, Yeyi Zhu⁹, Carrie V Breton¹, Leda Chatzi¹⁰, Jin Ran¹⁰, Irva Hertz-Picciotto¹¹, Margaret R Karagas¹², Vicki Sayarath¹², Joseph Hoover¹³, Debra MacKenzie¹³, Kristen Lyall¹⁴, Rebecca J Schmidt¹¹, Thomas G O'Connor¹⁵, Emily S Barrett¹⁶, Karen M Switkowski¹⁷, Sarah S Comstock¹⁸, Jean M Kerver¹⁹, Leonardo Trasande²⁰, Frances A Tylavsky²¹, Rosalind J Wright²², Srimathi Kannan²³, Noel T Mueller²⁴, Diane J Catellier²⁵, Deborah H Glueck¹, Dana Dabelea¹; Program Collaborators for Environmental influences on Child Health Outcomes (ECHO)

Collaborators

Program Collaborators for Environmental influences on Child Health Outcomes (ECHO):
P B Smith, K L Newby, D K Benjamin, L P Jacobson, C B Parker

Affiliations

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.

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.

Keywords: Dietary Reference Intakes; diet; dietary supplements; micronutrients; minerals; pregnancy; vitamins.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Child
Diet
Dietary Supplements
Female
Humans
Micronutrients*
Nutritional Requirements
Pregnancy
Vitamins*

Substances

Micronutrients
Vitamins

Abstract

Publication types

MeSH terms

Substances

Grants and funding