(P10-087-24) Diet Quality and Nutrient Intake During the First Month of Lactation Following Preterm Birth (PTB)

Objectives: Diet quality in lactation after PTB, assessed by the Healthy Eating Index (HEI) and specific nutrient intake, is understudied. This precludes tailoring dietary guidance, such as Dietary Guidelines for Americans (DGA), to augment breast milk quality for infant health in circumstances of PTB. The objective is to report HEI and select nutrient intake in the first month of lactation after PTB.

Methods: This is an interim analysis of a prospective cohort study enrolling 72 mother-preterm infant dyads [Primary group (PG): delivery at 28-31 weeks’, n=42; Reference group (RG): 34-36 weeks’, n=30] at a tertiary care women’s hospital. Study methods include 24-hour dietary recall via USDA 5-step multipass method in lactation weeks 2 and 4 (W2, W4). The interim analysis primary outcome was HEI. Secondary outcomes were intake of: energy; macronutrients; select n-6 and n-3 fatty acids (FA): linoleic (LA), arachidonic (AA), docosahexaenoic (DHA). Standard mean differences (SMD) tested demographics between PG and RG (no difference at < 0.25). Wilcoxon rank sum tests with false discovery rate correction (FDR) assessed intake between groups at W4 and change from W2 to W4. Results are median (IQR).

Results: The 35 lactating women at interim analysis (PG: n=12; RG: n=23) had similar pre-pregnancy BMI between groups yet higher delivery by cesarean in PG (SMD=0.6). PG HEI at W2 was 49.7 (34.7,67.2) and 40.3 (34.7,55.7) at W4. PG W4 HEI was not significantly lower than RG [64.2 (57.9,66)] with FDR. Energy intake (kcal/d) appeared lower than advised by DGA for all (W2: 1886 (1489,2381); W4: 1799 (1456,2157); % of energy as protein, carbohydrate and fat appeared appropriate. W2 LA intake for all was 13.8 g/d (9.6,19.1) and did not differ at W4 yet appeared lower for PG [PG: 9.6 g/d (8.6,16.1); RG: 14.4 (9.4,19.9); p=0.7]. AA intake for all was 0.13 g/d (0.06,0.18) at W2, 0.14 g/d (0.08,0.18) at W4. DHA intake for all was 0.02 g/d (0.0,0.04) at W2, 0.03 (0.01,0.06) at W4. FA were similar between groups at W4 as were changes in HEI and all nutrients over time (all p >0.7).

Conclusions: Emerging patterns in lactating women after PTB raise concern with notably low diet quality in those delivering at 28-31weeks’. Also, n-6 FA intake appears higher for most and n-3 FA much lower than advised by DGA. Completing the study will identify implications of such diet quality on preterm breast milk composition.

Funding Sources: NIH