The Association Between Periconceptional Consumption of Ultra-Processed Food and the Incidence of Adverse Pregnancy Outcomes

<b>Background/Objectives</b>: Increasing popularity, convenience, and access to processed foods are shifting the composition of dietary intake from whole to ultra-processed foods (UPF). This study aimed to assess the association between periconceptional UPF consumption and the incidence of adverse pregnancy outcomes (APOs). <b>Methods</b>: This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). Patients were excluded if they were missing periconceptional diet data or if their pregnancy ended before 20 weeks. Food Frequency Questionnaire items were categorized using the NOVA Scale to calculate the proportion of total energy intake comprised of UPF (% kcal/day). Bivariate and multivariate analyses examined the relationships between UPF intake and preterm birth, hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), small-for-gestational-age (SGA) infants, large-for-gestational-age (LGA) infants, and fetal or neonatal demise. <b>Results</b>: A total of 6693 participants were included in the analysis. The sample was predominantly White (78%) and not Hispanic (84%), and a majority of participants had commercial insurance (76%). UPF accounted for an average of 51.3 ± 12.7% of participants' daily total energy intake. Mean UPF intake was higher among patients who identified as Black or non-Hispanic, patients with public insurance, less than a high school education, a household income below the federal poverty level (all <i>p</i>-values < 0.001), patients with chronic hypertension (<i>p</i> = 0.02), and patients who delivered vaginally (<i>p</i> = 0.002). Patients with preterm birth, HDP, SGA infants, and fetal or neonatal demise all had significantly higher proportions of daily UPF intake compared to patients without these adverse outcomes. After adjusting for potential confounders, higher UPF intake remained significantly associated with preterm birth (AOR 1.11, 95% CI 1.02-1.21) and HDP (AOR 1.05, 95% CI 1.001-1.11). <b>Conclusions</b>: On average, more than half of participants' daily energy intake was from UPF, and higher UPF intake correlated with several adverse pregnancy outcomes. Future efforts should focus on improving nutritional literacy regarding UPF consumption in pregnancy.