2020-2025 Dietary Guidelines for Americans in Pregnancy: Adherence Shortfalls and Associations with Gestational
Leyre Notario Barandiaran1, Antonio J Signes-Pastor2, Katherine P Himes3
1Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.
Background:
The 2020-2025 Dietary Guidelines for Americans (DGA) include, for the first time, tailored recommendations for pregnant females, and guidance on weight management. In the United States, nearly 50% of pregnant females exceed the recommended gestational weight gain (GWG), whereas only ∼30% gain weight within the established guidelines. Optimal nutrition during pregnancy is essential for maternal and fetal health, and for achieving appropriate GWG.
Objectives:
This study evaluated adherence to the 2020-2025 DGA during pregnancy and examined its association with GWG.
Methods:
We included 1452 pregnant participants from the New Hampshire birth cohort study. Intake of specific food groups and nutrients was estimated by a validated food frequency questionnaire. The difference between prepregnancy weight and the last recorded weight prior to delivery was used to calculate GWG. Adherence to the food groups and nutrient intake was based on the 2020‒2025 DGA and the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine for pregnant people. The association between overall and individual adherence to food groups and nutrients in relation to GWG was evaluated by multinomial regression analysis. Models were adjusted for age, prepregnancy body mass index (in kg/m2), gestational smoking, educational level, parity, infant birth weight, gestational age, and energy intake.
Results:
Only 3% of participants met the recommended intake for all 5 core 2020‒2025 DGA food groups, with particularly low adherence observed for fruits, grains, and dairy. Intake of several nutrients also fell below recommendations. Just 30% of females achieved GWG within the recommendations. Participants adherent to the 2020-2025 DGA had 19% and 4% higher odds of having GWG within the recommended range compared with under- and overrecommendations, respectively (odds ratio: 0.81; 95% confidence interval: 0.81, 0.81; and odds ratio: 0.96; 95% confidence interval: 0.95, 0.97).
Conclusions:
Adherence to the 2020‒2025 DGA and GWG guidelines was low in this rural cohort. Addressing inadequate dietary patterns and promoting balanced nutrient intake may improve pregnancy outcomes and support healthier GWG trajectories. However, because an adequate diet alone was associated with recommended GWG in only ∼19% of participants, additional strategies are likely needed to help more pregnant individuals meet GWG recommendations.
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