Association of Periconceptional Dietary Inflammatory Index and Hypertensive Disorders of Pregnancy and Its Subtype

The association between diet and hypertensive disorders of pregnancy (HDP) is inconclusive due incomplete assessment of dietary measures and HDP subtypes.

We determined the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and the risk of HDP subtypes in a large, diverse cohort of pregnant individuals.

We completed a secondary analysis of data from the nuMoM2b study. Participants (n = 7309) were recruited from eight sites across the United States in the first trimester and followed through delivery. Participants completed the Block Food Frequency Questionnaire during the first trimester, which assessed the periconceptional period. Calculated macro and micronutrients from the questionnaire were used to calculate E-DII scores. HDP subtypes included gestational hypertension, preeclampsia without severe features, and preeclampsia with severe features. Multivariable ordinal logistic regression models were used to assess the association between E-DII and HDP subtypes, adjusting for baseline age, body mass index, education, race, and ethnicity as a social construct, and insurance status.

Among 7309 assessed individuals, the mean E-DII score was -0.61, and the frequency of gestational hypertension was 15.5%, preeclampsia without severe features was 4.3%, and preeclampsia with severe features was 4.1%. A higher E-DII score was associated with greater odds of developing an HDP, with worsening E-DII scores associated with greater odds of experiencing a more severe HDP subtype (adjusted OR = 1.15, 95% CI: 1.08, 1.22).

In a multisite prospective US cohort of nulliparous individuals, higher periconceptional E-DII scores indicative of a pro-inflammatory diet was associated with a slightly increased risk of HDP. And the severity of HDP progressively increased with worsening dietary inflammation.