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ECHO Study Investigates Nutrition During Pregnancy and Infant Growth Outcomes

Authors: Monique Hedderson, Assiamira Ferrara, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Nearly one-third of children in the U.S. have overweight or obesity, putting them at risk of adverse health outcomes later in life. More research is needed to inform prevention strategies during critical periods of growth, including pregnancy. This study aimed to understand the association between diet quality during pregnancy and infant growth. Rapid growth from birth to 24 months has been identified as a strong predictor of obesity later in life. ECHO researchers looked at how a mother’s nutrition during this crucial period of development might influence the baby’s size at birth and their growth over time.

What were the study results?

Researchers used two indexes to measure healthy eating patterns: the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP). These scales measure how well foods in a person’s diet align with the U.S. Dietary Guidelines and the diet’s inflammatory potential, respectively. Expectant mothers with higher HEI scores were more likely to have babies with a healthy birthweight and fewer growth issues. Specifically, higher HEI scores were associated with a 12% lower chance of having a baby born large for gestational age (LGA) and a lower chance of rapid growth from birth to 6 months and birth to 24 months. By contrast, a lower score on the EDIP, indicating a less inflammatory diet, was associated with a 24% higher chance of LGA and slower growth to 6 months but faster growth from birth to 12 months. This association was less clear and warrants further study.

What was this study's impact?

The study's findings support the idea that a prenatal diet aligning with U.S. Dietary Guidelines, measured by the HEI, may promote healthy birthweight and infant growth through 24 months. The findings suggest that following USDA dietary guidelines during pregnancy may improve long-term infant growth. This highlights the need for programs or interventions to help pregnant individuals adopt healthy diets.

Who was involved?

The study included 2,854 mother-child pairs from eight ECHO Cohort Study Sites. Among the children, 48.7% were girls, 23.3% were White, 22.4% were Black, 35.8% were Hispanic, 7.8% were Asian, and 7.8% came from other racial backgrounds.

What happened during the study?

The study examined data from mothers and their children in eight different groups that were part of the ECHO Program between 2007 and 2021. Researchers used medical records and study weight and height measurements to track the babies' sizes and growth over time. The mothers' diets during pregnancy were evaluated to calculate HEI and EDIP scores. The study then explored how these diet patterns were associated with babies' size at birth and their growth up to 6, 12, and 24 months old.

To assess rapid growth, the study relied on a measurement called the weight-for-length z-score (WLZ) a tool used to track an infant's growth, it compares a baby’s weight to their length, and tells you how far a baby's weight is from the average weight of babies of the same length. Rapid growth was defined as a significant increase in WLZ scores from birth to 6, 12, or 24 months. Babies whose WLZ scores jumped more than expected moved to a higher percentile on the growth chart, meaning they weighed more relative to their peers of the same length.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

More research is needed to understand the potential benefits of low-inflammatory prenatal dietary patterns in fetal and infant growth. Future studies could investigate how an infant's appetite and feeding habits might influence the connection between a mother's diet during pregnancy and the baby's long-term growth.

Where can I learn more?

Access the full journal article, titled “Prenatal Diet and Infant Growth from Birth to Age 24 months,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published November 21, 2024

Read the associated press release.