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Thus far, few factors with a causal relation to preterm birth have been identified. Many studies have focused on the woman's diet, but most have been discouraging. The aim of the present study was to examine if maternal intake of a Mediterranean-type diet (MD) is associated with reduced risk of preterm birth.The Danish National Birth Cohort assessed diet in mid-pregnancy by food frequency questionnaires (FFQ). Women consuming MD were those who ate fish twice a week or more, used olive or rape seed oil, consumed 5+ fruits and vegetables a day, ate meat (other than poultry and fish) at most twice a week, and drank at most 2 cups of coffee a day.Of 35,530 non-smoking women, 1,137 (3.2%) fulfilled all MD criteria, and 540 (1.5%) none. Odds ratios for preterm birth and early preterm birth were 0.61 (95% Confidence Interval (CI): 0.35-1.05) and 0.28 (0.11-0.76), respectively, in MD women compared to women fulfilling none of the MD criteria.Shifting towards a MD during pregnancy may reduce the risk of early delivery in Danish women.

BACKGROUND: Cow milk contains many potentially growth-promoting factors. OBJECTIVE: The objective was to examine whether milk consumption during pregnancy is associated with greater infant size at birth. DESIGN: During 1996-2002, the Danish National Birth Cohort collected data on midpregnancy diet through questionnaires and on covariates through telephone interviews and ascertained birth outcomes through registry linkages. Findings were adjusted for mother's parity, age, height, prepregnant BMI, gestational weight gain, smoking status, and total energy intake; father's height; and family's socioeconomic status The analyses included data from 50,117 mother-infant pairs. RESULTS: Mean (+/-SD) consumption of milk was 3.1 +/- 2.0 glasses/d. Milk consumption was inversely associated with the risk of small-for gestational age (SGA) birth and directly with both large-for-gestational age (LGA) birth and mean birth weight (P for trend < 0.001). In a comparison of women drinking >or=6 glasses/d with those drinking 0 glasses/d, the odds ratio for SGA was 0.51 (95% CI: 0.39, 0.65) and for LGA was 1.59 (1.16, 2.16); the increment in mean birth weight was 108 g (74, 143 g). We also found graded relations (P < 0.001) for abdominal circumference (0.52 cm; 0.35, 0.69 cm), placental weight (26 g; 15, 38 g), birth length (increment: 0.31 cm; 0.15, 0.46 cm), and head circumference (0.13 cm; 0.04, 0.25 cm). Birth weight was related to intake of protein, but not of fat, derived from milk. CONCLUSION: Milk intake in pregnancy was associated with higher birth weight for gestational age, lower risk of SGA, and higher risk of LGA. Udgivelsesdato: 2007-Oct

Objective: To examine whether fruit and vegetable consumption in pregnancy is associated with birth weight in a Western population. Design: Prospective cohort study based on telephone interviews, a food frequency questionnaire (FFQ), and extractions of birth characteristics from national health registries. Subjects and setting: The 43,585 Danish women from the Danish National Birth Cohort who had completed the FFQ in mid-pregnancy and on whom information about birth outcome was available. The exposures were frequency of green leafy vegetable (GLV) intake and quantified intake of fruit, fruit and vegetables, and fruit and vegetables and juice. The outcomes were birth weight and z-score for expected birth weight adjusted for sex and gestation week. Information on maternal height, weight, smoking, and other potential confounders was obtained through telephone interviews. Results: Significant associations were found for all exposures to fruit and vegetable intake with birth weight and most with z-score. The strongest association was found for fruit intake in which case birth weight increased by 10.7 g (95% CI 7.3—14.2) per quintile. All associations were stronger among lean women (BMI

Dietary glycaemic index and glycaemic load (GL) have been related to obesity and other health outcomes. The objective of the present study was to examine the associations between maternal dietary GL and gestational weight gain, birth weight, the risk of giving birth to a child large-for-gestational age (LGA) or small-for-gestational age and postpartum weight retention (PPWR). Data were derived from the Danish National Birth Cohort (1996–2002), including data on gestational and lifestyle factors in pregnancy and 18 months postpartum. Dietary data were collected using a validated FFQ. Information on birth outcome was obtained through registers. A total of 47 003 women were included. The associations between the GL and birth outcome, gestational weight gain, assessed between weeks 12 and 30 of gestation, and PPWR were analysed by linear and logistic regression. Birth weight increased by 36 g from the lowest to highest GL quintile (95 % CI 19, 53 g), and an increased risk of LGA of 14 % was detected in the highest GL quintile compared with the lowest GL quintile. Among normal-weight and overweight women, higher gestational weight gain rates were detected in the highest GL quintile (26 g/week (95 % CI 19, 34) and 30 g/week (95 % CI 13, 46), respectively). The association between the GL and PPWR was most pronounced among pre-pregnant obese women, with an increase in weight retention of 1·3 (95 % CI 0·2, 2·8) kg from the lowest to highest GL quintile. The GL may play a role for excessive gestational weight gain and PPWR, which may be more pronounced among overweight and obese women.

Objective To examine the association between physical activity in early pregnancy and risk of pre-eclampsia. Design Prospective cohort. Setting Denmark. Population A total of 85 139 pregnant Danish women, recruited between 1996 and 2002. Methods The authors assessed leisure time physical activity in first trimester by a telephone interview and categorised women a priori into seven groups: 0 (reference), 1–44, 45–74, 75–149, 150–269, 270–419 and 420+ minutes/week. Pre-eclampsia diagnoses were extracted from the Danish National Patient Registry. A number of potential confounders were adjusted for by logistic regression. Main outcome measures Pre-eclampsia and severe pre-eclampsia. Results The two highest physical activity levels were associated with increased risk of severe pre-eclampsia compared with the nonexercising group, with adjusted odds ratios of 1.65 (95% CI: 1.11–2.43) and 1.78 (95% CI: 1.07–2.95), whereas more moderate levels of physical activity (1–270 minutes/week) had no statistically significant association with risk of pre-eclampsia (total n = 85 139). Conclusions We were unable to document a protective effect of leisure time physical activity against pre-eclampsia. Our data even suggest that leisure time physical activity exceeding 270 minutes/week in first trimester may increase risk of severe pre-eclampsia.

Evidence from controlled trials suggests that ingestion of 0.4 mg of folic acid per day in the periconceptional period is effective in preventing neural tube defects (NTD). For this reason, most countries recommend that women planning pregnancy take folic acid supplements in the periconceptional period, and some countries even fortify stable foods with folic acid. Denmark exemplifies a country with a relatively conservative attitude with respect to taking action in these matters. In 1999, a national information campaign was launched that recommended women planning pregnancy take 0.4 mg of folic acid periconceptionally, but with the moderation that women who eat a healthy diet do not need to take folic acid supplement. The campaign was repeated during 2001. The results of the latter campaign were evaluated by using data from a national survey among pregnant women conducted simultaneously with the campaign by the Danish National Birth Cohort. An increase in the proportion of folic acid users took place concomitantly with the launching of the information events, but the increase was limited. Among women who did not plan their pregnancy, a small proportion had taken folic acid supplements periconceptionally, and this proportion did not change concomitantly with the campaign. Young age and low education were factors associated with low likelihood of taking folic acid. It seems that different and more efficient actions are needed if a more substantial proportion of Danish women and their fetuses are going to benefit from the knowledge that folic acid supplementation in the periconceptional period can prevent NTD.

ObjectivesTo evaluate compliance with the national recommendation on supplemental iron to all pregnant women in Denmark and to explore differences between compliers and non-compliers with respect to dietary habits and other lifestyle factors.DesignIntake of supplemental iron from pure iron supplements and from multivitamin and mineral preparations was estimated in mid-pregnancy.SettingNationwide cohort study, the Danish National Birth Cohort (DNBC), comprising more than 100 000 women recruited in early pregnancy.SubjectsInformation on diet and dietary supplements was available for 54 371 women. Of these, information on lifestyle factors was available for 50 902 women.ResultsA high compliance with the recommendation was found, as approximately 77% of the women reported use of iron supplements during pregnancy. However, many of the compliers did not obtain the recommended doses of iron, which can partly be explained by the lack of iron preparations of appropriate doses available on the Danish market. Compliance with the recommendation was associated with age above 20 years, primiparity, body mass index − 2, non-smoking and long education. No major differences were seen in dietary intake between compliers and non-compliers.ConclusionOverall, a high compliance rate was found among participants of the DNBC but a clarification on daily dose is needed, and more concern should be paid to vulnerable groups such as young, smoking women and women with no or short education.

To investigate possible associations between maternal diet during pregnancy and fetal growth. Factor analysis was used to explore dietary patterns among pregnant women. The association between maternal dietary patterns and fetal growth (in terms of small for gestational age, SGA) was investigated by logistic regression. Prospective cohort study, including information on 44 612 women in Denmark. Two major dietary patterns were defined: the first pattern was characterized by red and processed meat, high-fat dairy, and the second pattern was characterized by intake of vegetables, fruits, poultry and fish. Women were classified into three classes according to their diet: the first class had high intake of foods of the first dietary pattern, and was classified as ‘the Western diet’, the second class preferred foods of the second pattern and was classified as the ‘Health Conscious’; and the third one had eaten foods of both patterns, and was classified as the ‘Intermediate’. The odds ratio of having a small for gestational-age infant (with a birth weight below the 2.5th percentile for gestational age and gender) was 0.74 (95% CI 0.64–0.86) for women in the Health Conscious class compared with women in the Western Diet class. The analyses were adjusted for parity, maternal smoking, age, height, pre-pregnancy weight and father's height. Our results indicated that a diet in pregnancy, based on red and processed meat and high-fat diary, was associated with increased risk for SGA. Further studies are warranted to identify specific macro-, or micronutrients that may be underlying these associations.

Recent research suggests that the diet consumed in, or shortly before, pregnancy can potentially lead to maldevelopment and diseases in the offspring, which may become apparent at any time from the embryonic stage until old age. For example, maternal diet may affect the chance of twinning (and associated complications), malformation risk, brain development, and the offspring's fecundity and risk of contracting cardiovascular diseases and cancer in adult life. Prospectively designed longitudinal studies with sufficient size and data quality are much needed to substantiate or refute these hypotheses. At present, the Danish National Birth Cohort is likely to be the largest epidemiological database containing extensive information on maternal dietary exposures. By October 2002, 100 000 women had been recruited in early pregnancy, for long-term follow-up of themselves and their offspring. The present paper details the information available in the database on early nutritional exposures with emphasis on maternal dietary intake. We also present distributions of selected nutritional exposures. Udgivelsesdato: 2007-Jan

This study examines the association between oral clefts and first trimester maternal lifestyle factors based on prospective data from the Danish National Birth Cohort. The cohort includes approximately 100,000 pregnancies. In total 192 mothers gave birth to child with an oral cleft during 1997-2003. Information on risk factors such as smoking, alcohol consumption, tea, coffee, cola, and food supplements was obtained during pregnancy for these and 828 randomly selected controls. We found that first trimester maternal smoking was associated with an increased risk of oral clefts (odds ratio (OR): 1.50; 95% confidence interval (CIs): 1.05, 2.14). Although not statistically significant, we also saw associations with first trimester consumption of alcohol (OR: 1.11; CIs: 0.79, 1.55), tea (OR: 1.31; CIs: 0.93, 1.86), and drinking more than 1 l of cola per week (OR: 1.40; CIs: 0.92, 2.12). Furthermore supplementation with > or =400 mcg folic acid daily during the entire first trimester (OR: 0.75; CIs: 0.46, 1.22) suggested an inverse associated with oral clefts, similar to our results on coffee drinking. No effects were found for smaller doses of folic acid, vitamin A, B6 or B12 in this study. The present study found an association between oral clefts and smoking and, although not conclusive, supports an association of oral cleft with alcohol. Udgivelsesdato: 2007

To test the earlier suggested hypothesis that intake of long-chain n-3 fatty acids from fish oil may delay the timing of spontaneous delivery and to test if alpha-linolenic acid, provided as flax oil capsules, shows the same effect.Randomised controlled trial including women reporting low dietary fish intake. The women were allocated in the proportions of 1:1:1:1:1:1:2 into six treatment groups and a control group, respectively, from week 17-27 of gestation. The treatment groups received fish oil, in various doses, or flax oil, and the control group did not receive any treatment.The Danish National Birth Cohort.A total of 3098 women allocated into six treatment groups and one control group.The six intervention groups were offered fish oil capsules in doses of 0.1, 0.3, 0.7, 1.4 and 2.8 g of eicosapentaenoic acid and docosahexaenoic acid per day or 2.2 g of alpha-linolenic acid (ALA) per day from week 17-27 of gestation until delivery.Timing of spontaneous delivery.No differences in timing of spontaneous delivery was detected in the fish oil groups or the flax oil group, compared with the control group. The difference in timing of spontaneous delivery in the group receiving the highest fish oil dose compared with the control group was 0.8 days (95% CI: -2.3 to 1.0). Only a minority of the women in the intervention groups took capsules until delivery.Possible explanations for these findings include no true effect of n-3 fatty acids on spontaneous delivery or a quick-acting effect not detectable in this trial.

It has been suggested that vitamin C, alone or in combination with vitamin E, may protect against pre-eclampsia, whereas the safety of high-dose vitamin E supplements has been questioned. We investigated dietary intakes of vitamins C and E to see if they correlated with the incidence of pre-eclampsia.Prospective cohort study.The Danish National Birth Cohort; a population-based pregnancy cohort; analyses were based on 57 346 pregnancies.Vitamin intake was estimated from a food frequency questionnaire completed in gestational week 25, recording intake from diet and supplements during the previous four weeks. Pre-eclampsia diagnoses were obtained from the Danish National Patient Registry; we worked with two entities, 'pre-eclampsia (all types)' and 'severe pre-eclampsia/eclampsia/HELLP'. We adjusted for confounding factors by logistic regression.A small increase in the incidence of severe disease was also seen in the group of women (64, n = 49 373) with a high intake of vitamin E from supplements and dietary sources.The incidence of 'pre-eclampsia (all types)' did not correlate with dietary vitamin C and E intake. There was a decreasing trend (P = 0.01) in the incidence of 'severe pre-eclampsia/eclampsia/HELLP' with increasing dietary vitamin C intake; with an intake of 130-170 mg/day as reference, odds ratios ranged from 1.21 (95% confidence interval 0.83 to 1.75) for an intake below 70 mg/day to 0.70 (0.40 to 1.23) for an intake exceeding 275 mg/day (total n = 57 346). For vitamin E intake aggregated from diet and supplements (n = 49 373), with an intake of 10.5-13.5 mg/day as reference, the 'severe pre-eclampsia/eclampsia/HELLP' odds ratio was 1.46 (1.02 to 2.09) for an intake exceeding 18 mg/day.Low dietary intake of vitamin C was associated with a trend towards an increased incidence of either severe pre-eclampsia, eclampsia or HELLP. A small increase in the incidence of severe disease was also seen in the group of women with a high intake of vitamin E from supplements and dietary sources.