# 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

## TL;DR

This study tracks how the diets of Brazilian women change from late pregnancy to 8.5 months postpartum, finding shifts in nutrients like carbohydrates, fat, and vitamins.

## Contribution

The study provides longitudinal insights into dietary changes during pregnancy and postpartum, identifying specific nutrient trends and socioeconomic associations.

## Key findings

- Carbohydrate and fibre intake decreased, while total fat intake increased from pregnancy to postpartum.
- Micronutrient intake like vitamins B2, B9, C, calcium, and magnesium declined over time.
- Prepregnancy BMI and socioeconomic factors were linked to changes in macronutrient and micronutrient intake.

## 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.

The trajectories of energy, macro, and micronutrient intake from pregnancy to 8.5 months postpartum showed a stability in energy and protein, a decline in carbohydrates and fibre, and discrete increases in total fat, mono, poly, and saturated fat. In addition, there was a decline in the intake of most micronutrients.

Carbohydrate and fibre dietary intake decreased, and total fat, monounsaturated, polyunsaturated and saturated increased from the third trimester of pregnancy to 8.5 months postpartum.Vitamin B2, B9, C, calcium, magnesium, phosphorus and potassium intake trajectories decline over time.Pre‐pregnancy BMI was inversely associated with carbohydrate and fibre intake over time and positively associated with monounsaturated, saturated and total fat.Higher maternal age, education, and income were associated with increased micronutrient intake, except for sodium, which decreased.The adequacy percentage of usual intake was low for iron, vitamin D and B6 in the third trimester of pregnancy. Vitamin A and C adequacy was reduced by half over 8.5 months postpartum.

Carbohydrate and fibre dietary intake decreased, and total fat, monounsaturated, polyunsaturated and saturated increased from the third trimester of pregnancy to 8.5 months postpartum.

Vitamin B2, B9, C, calcium, magnesium, phosphorus and potassium intake trajectories decline over time.

Pre‐pregnancy BMI was inversely associated with carbohydrate and fibre intake over time and positively associated with monounsaturated, saturated and total fat.

Higher maternal age, education, and income were associated with increased micronutrient intake, except for sodium, which decreased.

The adequacy percentage of usual intake was low for iron, vitamin D and B6 in the third trimester of pregnancy. Vitamin A and C adequacy was reduced by half over 8.5 months postpartum.