Pregnancy Diet Patterns and their Associations with Birth Outcomes Differ Across Racial and Ethnic Groups

Posted on August 18, 2025August 18, 2025 by Jodi Snare

Dietary patterns during pregnancy can affect maternal blood sugar levels and birth outcomes, with important differences depending on racial and ethnic backgrounds, according to a recent ECHO Cohort study led by Luis E. Maldonado, PhD, MPH, of the University of Southern California.

Which combination of foods most influences blood sugar and birth outcomes during pregnancy remains unclear, especially across different racial and ethnic groups. Studying these differences is important because, although diet is known to affect birth outcomes, variations in dietary patterns may help explain disparities—for example, Hispanic women in the U.S. face higher rates of preterm birth and low birthweight compared to non-Hispanic White women.

“Our findings show it’s important to look at how diet affects birth outcomes in different racial and ethnic groups separately, especially in diverse communities,” said Dr. Maldonado. “Combining all racial and ethnic groups into one might hide important differences in how diet relates to birth outcomes for each group.”

Researchers analyzed data from over 980 pregnant women—420 Hispanic and 564 non-Hispanic White participants—from two ECHO Cohort study sites. Their aim was to identify how different combinations of food related to blood sugar and birth outcomes such as preterm birth and low birthweight.

Key takeaways

Diets high in refined grains (like white bread or white rice) and low in whole grains were linked to babies being born earlier, smaller, or with low birthweight.
Analyzing dietary patterns within specific racial and ethnic groups revealed stronger associations with negative birth outcomes than when looking at the combined group.
Among non-Hispanic White women, whole grains were most strongly associated with better blood sugar control.
Fruit was linked to higher blood sugar levels among Hispanic participants.
Solid fats and nuts and seeds were associated with lower blood sugar levels in both groups.

The study underscores the value of considering dietary patterns separately within racial and ethnic groups to better understand how diet affects pregnancy outcomes. Future research can build on these findings by continuing to explore culturally relevant dietary patterns in diverse populations, helping uncover associations that may be missed in broader, combined analyses.

This collaborative research, titled “Racial/Ethnic-Derived Maternal Diets Predict Birth Outcomes Better than a Diet Derived from a Combined Sample among Hispanic/Latina and non-Hispanic White Pregnant Individuals in the ECHO Cohort,” in Nutrition.

A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

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A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

Analyzing Diets Based on Racial and Ethnic Groups May Better Predict Outcomes

Authors: Luis E. Maldonado, 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?

Researchers wanted to understand how a pregnant person’s diet, especially in relation to their blood sugar levels (fasting blood glucose), affects birth outcomes—like the baby’s weight and whether the baby is born early. Higher fasting blood glucose during pregnancy is known to increase the risk of adverse birth outcomes. However, little is known about whether culturally influenced combinations of foods and beverages play a meaningful role across different racial and ethnic groups. This question is important because, in the U.S., Hispanic pregnant women are disproportionately affected by adverse birth outcomes, such as preterm birth and low birthweight (under 5.5 pounds). By examining dietary patterns within racial and ethnic groups, the researchers aimed to uncover more precise links between diet and birth outcomes. These links might be overlooked when analyzing the population as a whole, since average diets often reflect the eating patterns of the most represented groups in the study.

What were the study results?

Refined grains, such as white bread or white rice, showed the strongest association with higher fasting blood sugar levels among Hispanic and non-Hispanic White women. People who ate diets high in refined grains and low in whole grains were more likely to have babies born with low birthweight, smaller for gestational age, or born preterm.

When dietary patterns were analyzed by racial and ethnic group, the associations between diet, blood sugar, and birth outcomes were stronger than when using a single pattern for the full population. In the group that included non-Hispanic White and Hispanic participants, nuts, seeds, and solid fats such as butter and lard were linked to lower blood sugar. Among non-Hispanic White participants, whole grains and solid fats had the strongest association with improved blood sugar control. In contrast, among Hispanic participants, higher fruit consumption was associated with elevated blood sugar levels. These food-specific associations should be considered within the overall dietary pattern, as individual foods can influence blood sugar – beneficially or adversely – within the broader diet.

What was the study's impact?

The results of this study show the importance of looking at dietary patterns within racial and ethnic groups, particularly in studies with varying representation of different racial and ethnic populations. Analyzing a single, combined group may mask group-specific associations between diet and birth outcomes, as the effects of diet can differ across racial and ethnic backgrounds.

Who was involved?

The study included 420 Hispanic and 564 non-Hispanic White pregnant participants from two ECHO Cohort study sites.

What happened during the study?

During the study, participants shared details about what they ate over a 24-hour period. The researchers analyzed the diets, along with the mother’s blood sugar, to help determine which combinations of foods eaten together in an overall diet are most closely linked to changes in blood sugar levels. They then tested whether the links between diet and birth outcomes were different across racial and ethnic groups by comparing findings from diets derived using group-specific versus combined fasting blood glucose, which have also been previously shown to vary by racial and ethnic population.

Footnote: 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?

Future research could continue exploring how dietary patterns affect birth outcomes in diverse populations, especially by identifying patterns that are specific to different racial and ethnic groups.

Where can I learn more?

Access the full journal article, titled “Racial/Ethnic-Derived Maternal Diets Predict Birth Outcomes Better than a Diet Derived from a Combined Sample among Hispanic/Latina and non-Hispanic White Pregnant Individuals in the ECHO Cohort,” in Nutrition.

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

Published June 12, 2025

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A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

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Pregnancy and birth

NIH Study Finds No Association Between Prenatal Dietary Patterns and Autism Diagnoses, But Potential Links with Broader Traits

Posted on March 17, 2025 by Jodi Snare

Three validated dietary patterns were not associated with diagnosis, but healthy eating during pregnancy showed a modest link with lower scores for traits related to autism

Expectant mothers with higher diet quality—measured by the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P)—had children with modestly lower scores for traits related to autism spectrum disorder (ASD), according to ECHO Cohort research led by Kristen Lyall, ScD, and Rachel Vecchione, MPH, of Drexel University. However, the study did not find a significant association between these prenatal dietary patterns and a formal ASD diagnosis.

Previous research has suggested potential links between prenatal diet and neurodevelopmental conditions, but most studies focused on individual foods or nutrients rather than overall dietary patterns. In this study, ECHO researchers examined overall dietary patterns to better understand effects of usual dietary intake across foods.

“This study broadly supports the importance of a healthy diet during pregnancy. Autism is a complex condition with many contributing factors. Here, we found some evidence to suggest a healthy diet during pregnancy may be linked with reduced likelihood of broader traits related to autism, but effect sizes were small,” said Dr. Lyall.

The study included up to 6,084 mother-child pairs from 14 ECHO Cohort Study Sites, which included general population sites and sites with a higher chance of ASD occurring in families.

This collaborative research, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” is published in Nutrients.

ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

Authors: Rachel Vecchione, Kristen Lyall, 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?

Diet during pregnancy plays a major role in fetal development. Prior research has shown associations between several dietary factors and certain neurodevelopmental conditions in children, including autism spectrum disorder (ASD). ASD is a neurodevelopmental condition that affects social communication and behaviors, and presents in a wide variety of behaviors, abilities, and challenges.

This study helped to fill gaps in understanding the relationship between maternal dietary patterns during pregnancy and ASD-related outcomes in children. Most previous studies examining links between prenatal diet and ASD and other neurodevelopmental outcomes have focused on individual foods or nutrients, rather than overall dietary patterns. Dietary patterns may be useful to examine because they summarize the usual intake of a wide range of foods and may capture combined effects across many nutrients. Dietary patterns that capture the intake of recommended foods may also help to provide clearer communication than summaries across individual nutrients. This study therefore aimed to provide a comprehensive assessment by examining several established dietary patterns and their associations with ASD-related traits and diagnoses.

What were the study results?

Dietary patterns examined in this study included the Healthy Eating Index (HEI) and the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P), as well as the Empirical Dietary Inflammatory Index (EDIP). Both the HEI and AHEI-P are validated dietary patterns that are measures of overall diet quality. Higher scores on these patterns indicate better adherence to dietary guidelines. In contrast, higher scores on the EDIP indicate a more pro-inflammatory diet.

The study found that higher prenatal scores on the HEI the AHEI-P were associated with modest decreases in ASD-related traits. However, there were no significant associations between prenatal intake of these dietary patterns and ASD diagnosis. The findings suggest that while there may not be strong associations between prenatal dietary patterns and ASD diagnosis itself, there may be subtle associations with broader traits like social communication difficulties that warrant further investigation.

Footnote: 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 was the study's impact?

This study contributes to the understanding of how prenatal diet may relate to ASD-related characteristics in children. It also highlights the need to further study the potential mechanisms linking prenatal diet to ASD-related traits and to consider broader dietary patterns in addition to individual nutrients and foods.

Who was involved?

The study included 6,084 mother-child pairs from 14 ECHO Cohort Study Sites. The participants were socioeconomically and demographically diverse, drawn from a large U.S.-wide sample, including general population sites and sites with a higher chance of ASD occurring in families.

What happened during the study?

Researchers collected data from individual sites that used Food Frequency Questionnaires to assess diet during pregnancy and enable the calculation of dietary patterns. The study examined associations between three dietary patterns and ASD-related outcomes while adjusting for potential confounding factors such as maternal age, pre-pregnancy BMI, sociodemographic factors, and child characteristics.

What happens next?

Future studies could help researchers confirm the results of this study and explore the subtle associations between prenatal diet and ASD-related traits. Further research could also examine multiple ASD-related outcomes, using larger and more diverse samples, and investigate potential mechanisms linking prenatal diet to ASD-related traits.

Where can I learn more?

Access the full journal article, titled “Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental influences on Child Health Outcomes Consortium,” in Nutrients.

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

Published November 6, 2024

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

ECHO Research Explores Potential Value of Nutrition Data Collected from Pregnancy Through Adolescence for Understanding Child Health

Posted on December 1, 2023April 11, 2024 by Jodi Snare

Collaborative ECHO research led by Megan Bragg, PhD, RD and Kristen Lyall, ScD of the A.J. Drexel Autism Institute highlights the opportunity for researchers to access the large amount of diet information already collected from the ECHO Cohort. This research, titled “Opportunities for examining child health impacts of early-life nutrition in the ECHO Program: Maternal and child dietary intake data from pregnancy to adolescence”, is published in Current Developments in Nutrition.

This study aimed to describe dietary intake data available in the ECHO Program as of August 2022, from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. As of that date, 66 ECHO Cohort Study Sites across the country had collected diet information using a variety of methods, including dietary recalls, food frequency questionnaires, and questionnaires about supplement use. Diet information from these study sites is especially useful because it has been collected from a large group of diverse people, and because many families provided information more than once over the course of pregnancy and childhood.

Often, data collected on diet provide only a snapshot that can’t address how early-life diet affects later child health outcomes. The ECHO Cohort Consortium is addressing these challenges by gathering information over time about the dietary habits of individuals during pregnancy and childhood from a large, diverse group of participants.

“Researchers need information about what people eat during pregnancy and childhood from a large, diverse group of people in order to answer questions about nutrition,” said Dr. Bragg. “ECHO is unique because study sites have collected and continue to collect this information.”

Information from over 33,000 pregnancies and more than 31,000 children in the ECHO Program is now accessible to researchers. This de-identified data is publicly available to researchers through the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) to encourage broad use to answer important questions about nutrition and child health.

Access the brief flash talk from one of the authors in the following video:

Read the research summary.

ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

Authors: Megan Bragg, Kristen Lyall, 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 the study needed?

Improving nutrition during pregnancy and childhood is a key focus for public health in the United States. Many pregnant women and children face deficiencies in essential vitamins and minerals coupled with excess salt, saturated fats, and sugars in their diets. Socioeconomic factors may affect access to nutritious food, contributing to disparities in rates of diet-related chronic disease that could affect pregnancy outcomes and child growth and development. Often, data collected on diet provide only a snapshot that can't address how early-life diet affects later child health outcomes. The ECHO Cohort Consortium is addressing these challenges by gathering information over time about the dietary habits of individuals during pregnancy and childhood from a large, diverse group of participants. This study examines the types of diet information collected from the ECHO Cohort and provides examples of how researchers can use this data to learn more about the role of nutrition in child health outcomes.

What were the study results?

This study aimed to describe dietary intake data available in the ECHO Program as of August 2022, from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health. As of that date, 66 ECHO Cohort Study Sites across the country had collected diet information using a variety of methods, including dietary recalls, food frequency questionnaires, and questionnaires about supplement use. Diet information from these study sites is especially useful because it has been collected from a large group of diverse people, and because many families provided information more than once over the course of pregnancy and childhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study highlights the large amount of diet information already available from the ECHO Cohort and the opportunities for researchers to access this publicly available resource to answer important questions about nutrition and child health outcomes.

Who was involved?

This study examined data from pregnant women and children at 66 ECHO Cohort Study Sites in 34 U.S. states who answered questions about their diets by August 2022. Data about more than 26,000 pregnant women and 27,000 children is publicly available.

What happened during the study?

Researchers examined the diet information that study sites collected from pregnant women and children through August 2022, including questionnaires and medical records. Researchers sorted this information by the type of questionnaire and whether it was from a pregnant woman or a child. Many participants contributed data from both the pregnant woman and the child and reported on their diet more than once.

What happens next?

The ECHO Program will continue to collect diet information from participants. Information from over 33,000 pregnancies and more than 31,000 children in the ECHO Program is now accessible to researchers. This de-identified data is publicly available to researchers through the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) to encourage broad use to answer important questions about nutrition and child health.

Where can I learn more?

Access the full journal article, titled “Opportunities for examining child health impacts of early-life nutrition in the ECHO Program: Maternal and child dietary intake data from pregnancy to adolescence” in Current Developments in Nutrition.

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

Published November 2023

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

ECHO Researchers Find Connection Between Mothers’ Food Quality During Pregnancy and their Duration of Breastfeeding

Posted on November 28, 2022March 31, 2025 by Jodi Snare

Collaborative ECHO research led by Emily Zimmerman, PhD of Northeastern University investigates the relationship between mothers’ food sources and preparation during pregnancy and the length of time they breastfed. Pregnant participants who reported eating the least processed food and take-out, tended to breastfeed for an average of 41 weeks (10 months), while pregnant participants who reported eating the most processed food and take-out breastfed for an average of 16 weeks. This research, titled “Association Between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in The Environmental influences on Child Health Outcome (ECHO) Program,” is published in Nutrients.

This study included 751 mothers who were at least 18 years old and their infants from 12 ECHO cohorts located across the United States. Mothers reported on their food source and preparation during pregnancy and were placed in one of three groups: high, moderate, or low food source quality. Mothers also reported on their breastfeeding duration.

“This is the first time that maternal food source during pregnancy has been examined and linked to breastfeeding duration in such a large and diverse cohort,” said Dr. Zimmerman. “Our findings are in line with our hypothesis that mothers who reported eating more processed and fast foods and less food prepared at home breastfed for a shorter duration.”

Future studies are needed to understand the relation between breastfeeding duration and maternal food quality over time. These studies can also provide more specific information on maternal diet, food source, and preparation during pregnancy while considering other important factors, like socioeconomic status, that may affect the types of foods mothers have access to.

Read the research summary.

ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

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ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

Authors: Emily Zimmerman, et al.

Who sponsored this study?

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

What were the study results?

The results from this study suggested that pregnant women who reported eating the most processed food and take-out tended to breastfeed for an average of 16 weeks (4 months), while pregnant women who reported eating the least amount of processed food and take-out breastfed for an average of 41 weeks (10 months).

Footnote: 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 was the study's impact?

This is the first large and diverse cohort study examining the potential link between maternal food quality during pregnancy and breastfeeding duration. The results from this study suggest that pregnant women who eat a lot of processed food or take-out during pregnancy, tend to breastfeed for a shorter period of time.

Why was this study needed?

Breastfeeding promotes positive health outcomes for infants, but few studies have looked at the connection between the quality of mothers’ food during pregnancy and the length of time they breastfed. This study examined the relationship between self-reported food quality and preparation (e.g., organic foods, processed foods, take out) during pregnancy and breastfeeding duration.

Who was involved?

This study included 751 mothers who were at least 18 years old and their infants from 12 ECHO cohorts located across the United States.

What happened during the study?

Mothers reported on their food source and preparation during pregnancy and were placed in one of three groups: high, moderate, or low food source quality. Mothers also reported on their breastfeeding duration. Researchers investigated whether there was a relationship between the mothers’ food quality during pregnancy and the length of time they breastfed.

What happens next?

Future studies are needed to understand the relation between breastfeeding duration and maternal food quality over time. These studies can also provide more specific information on maternal diet, food source, and preparation during pregnancy while considering other important factors, like socioeconomic status, that may affect the types of foods mothers have access too.

Where can I learn more?

Access the full journal article, titled “Association Between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in The Environmental influences on Child Health Outcome (ECHO) Program,” in Nutrients.

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, 2022

Access the associated article.

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ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

A Diet High in Refined Grains and Low in Whole Grains in Pregnancy Linked to Lower Birthweights and Pre-term Births

Analyzing Diets Based on Racial and Ethnic Groups May Better Predict Outcomes

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ECHO Cohort Study Finds No Significant Associations Between Prenatal Dietary Patterns and ASD Diagnosis

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ECHO Program Collects Valuable Data on Nutrition During Pregnancy and Early Life

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ECHO Study Suggests Eating Processed Foods May Affect How Long Mothers Breastfeed Their Babies

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