Social determinants and dietary patterns in MAMI-MED cohort: a principal component analysis

Abstract Background Maternal diet during the periconceptional period influences mother and child health. Adherence to specific dietary profiles, results from a complex interplay of various factors, requiring innovative methods to analyze nutritional data. This study identifies dietary patterns, examines social determinants of adherence, and their association with maternal and infant health outcomes. Methods We used data from the MAMI-MED birth cohort, an ongoing prospective study enrolling women in the first trimester of pregnancy at the ARNAS Garibaldi Nesima (Catania, Italy). Maternal characteristics and maternal-infant health outcomes were collected through ad hoc questionnaires administered at recruitment and at delivery. Maternal nutritional profiles were identified using Principal Component Analysis (PCA) on dietary data collected via a Food Frequency Questionnaire. Results On a total of 1,564 women, two nutritional profiles were identified. The Western profile was characterized by high intake of ultra-processed foods; the healthy profile was based on a more balanced diet. Women who adhered exclusively to the healthy profile had a significantly higher average age compared to other groups. Conversely, women who followed only the Western profile showed a higher prevalence of lower educational levels, unemployment, and economic inactivity (p < 0.001). However, no statistically significant differences were observed in pregnancy outcomes or neonatal outcomes. In a multivariable model, factors significantly associated with the risk of preterm birth included pre-pregnancy BMI (OR = 1.05 for each unit increase; p = 0.013) and educational level, both in the low (OR = 2.71;p=0.015) and medium (OR = 2.24;p=0.021) categories. Conclusions Our findings support the use of PCA as a valuable method for identifying complex dietary patterns and underscore the role of sociodemographic and behavioral factors in shaping maternal and infant health risks. Key messages • Adhering to a Western dietary pattern during pregnancy was strongly associated with lower educational attainment, unemployment, and economic inactivity. • Higher pre-pregnancy BMI and lower educational levels were independently linked to an increased risk of preterm birth, highlighting key social and behavioral health determinants.