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Am J Perinatol
DOI: 10.1055/a-2712-5518
Original Article

Nutrition Pattern and Adverse Pregnancy Outcomes in Nulliparous Individuals: A Cluster Analysis

Authors

  • Tetsuya Kawakita 

    1   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States

  • Yara H. Diab

    1   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States

  • Kazuma Onishi 

    1   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States

  • George Saade

    1   Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, United States

Funding Information nuMoM2b specimen and data collection were supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): grant nos.: U10 HD063036; U10 HD063072; U10 HD063047; U10 HD063037; U10 HD063041; U10 HD063020; U10 HD063046; U10 HD063048; and U10 HD063053.
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Abstract

Objective

This study aimed to develop a k-means clustering algorithm to identify distinct food intake patterns through cluster analysis.

Study Design

This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), including nulliparous individuals with singleton pregnancies. Dietary intake data from the 3 months preceding pregnancy were collected using a validated questionnaire. The primary outcome was a composite measure including preterm birth, stillbirth, preeclampsia, eclampsia, gestational diabetes, and small for gestational age. Clusters were formed using a k-means clustering algorithm with Euclidean distance, based on 335 dietary variables. The association between dietary clusters and adverse pregnancy outcomes (APOs) was assessed. Relative risks with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for predefined confounders. A random forest model was also employed to identify features predictive of cluster allocation.

Results

The analysis included 7,599 participants, distributed across three clusters: Cluster 1 (n = 4,243, 55.8%), Cluster 2 (n = 2,768, 36.4%), and Cluster 3 (n = 588, 7.7%). Cluster 2, which serves as the referent cluster, is characterized by a higher intake of vitamin E as α-tocopherol, vitamin A retinol activity equivalents, vegetables, and fruits, aligning most closely with a healthy diet pattern. Compared with Cluster 2, Cluster 1, characterized by a lower intake of the same nutrients, did not show a significant association with increased odds of APOs (22.7 vs. 25.4%; adjusted relative risk [aRR], 1.07 [95% CI: 0.98–1.18]). In contrast, Cluster 3, characterized by higher intake of trans fats, dietary polyunsaturated fatty acids 20:4, red meat, and sugary beverages, was significantly associated with APOs compared with Cluster 2 (31.0 vs. 22.7%; aRR, 1.19 [95% CI: 1.01–1.39]).

Conclusion

A dietary pattern characterized by a high intake of trans fats, polyunsaturated fatty acids, red meat, and sugary beverages is significantly associated with an increased risk of APOs.

Key Points

  • Diets high in trans fats, polyunsaturated fatty acids, red meat, and sugary beverages are associated with increased APOs.

  • Diets rich in vitamin E, vitamin A, vegetables, and green salads are linked to a lower risk of these outcomes.

  • This study underscores the significant role of nutrition in influencing APOs.

Keywords

nutrition - nulliparous women - adverse pregnancy outcomes - diet

Supplementary Material



Publication History

Received: 28 April 2025

Accepted: 28 September 2025

Accepted Manuscript online:
29 September 2025

Article published online:
10 October 2025

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