Trajectories of Dietary Energy, Macro and Micronutrient Intake From the Third Trimester of Pregnancy to 8.5 Months Postpartum Among Brazilian Women: The Mothers, Infants and Lactation Quality Study.

Abstract

Pregnancy and lactation increase maternal nutritional requirements. This study evaluated the trajectories of maternal dietary energy, macro- and micronutrient intake from the third trimester of pregnancy to 8.5 months postpartum, associated factors, and micronutrient intake adequacy. Longitudinal study with mother-infant pairs recruited in a hospital in Rio de Janeiro, Brazil, during the third trimester of pregnancy. At least one 24-h recall was answered in the third trimester of pregnancy (n = 369) and three visits postpartum [M1: 1.0-3.49 (n = 196), M2: 3.5-5.99 (n = 145), and M3: 6.0-8.5 months (n = 108)]. The dietary nutritional composition was calculated using the Brazilian Food Composition Table, and the adequacy percentage was determined based on the dietary reference intakes (estimated average requirement or adequate intake). The usual intake was determined using the Multiple Source Method, which involves fitting z-scores with Generalised Mixed-Effect Models. Carbohydrate and fibre dietary intake decreased 1.84 and 0.41 g, monthly, from the third trimester of pregnancy to 8.5 months postpartum. Total fat intake increased 0.89 g per month. Vitamin B2, B9, C, calcium, phosphorus and magnesium intake decreased over time, while vitamin E, selenium, and sodium increased. Prepregnancy body mass index, age, education, and income were significantly associated with changes in macro- and micronutrients over time. Intake adequacy was lowest at the third trimester of pregnancy for vitamin D (29.7%), B6 (53.2%) and iron (60.1%). Vitamins A and C at 8.5 months showed a significant reduction in adequacy compared to the third trimester of pregnancy. Nutritional education strategies should target pregnant women and their families during pregnancy and the postpartum period. They are essential for promoting adequate nutrition and preventing nutrient deficiencies and/or excesses that can adversely affect maternal and infant health.