Trimester-specific associations of diet quality and macronutrient intake with cardiometabolic health among healthy pregnant Korean women

Purpose: Evidence on trimester-specific associations between dietary intake and cardiometabolic health remains limited among metabolically healthy pregnant women.This study examined the associations of diet quality and macronutrient intake with cardiometabolic health across pregnancy trimesters in metabolically normal Korean women.Methods: Normotensive normoglycemic pregnant women (n = 299) from the Korea National Health and Nutrition Examination Survey 2009-2023 stratified according to trimester.Diet quality was assessed using the Korean Healthy Eating Index (KHEI) score and macronutrient intakes were quantified.Cardiometabolic health measures, including systolic blood pressure, diastolic blood pressure (DBP), fasting serum glucose, and lipid profiles, were measured.Results: Diet quality was not associated with any cardiometabolic measures during the first trimester.In women in their second trimester, elevated DBP was associated with lower adherence to the KHEI (β, -0.147; 95% CI, -0.274 to -0.021).During the third trimester, DBP was inversely associated with the proportion of energy from total protein intake (β, -0.617; 95% CI, -1.041 to -0.193), especially with protein from fish and seafood sources (β, -0.901; 95% CI, -1.450 to -0.352).In addition, among those with total and animal protein intakes below 14% and 8% of energy intake, respectively, protein intakes were inversely associated with triglycerides (TG) during the third trimester (p overall = 0.02 for total protein; p overall = 0.02 for animal protein).Proportions of energy intake from carbohydrate or fat were not associated with any cardiometabolic health measure throughout pregnancy.Conclusion: Lower diet quality and inadequate protein intake during the second and third trimesters were associated with higher DBP and TG.Nevertheless, further prospective research is needed to determine whether trimester-specific dietary guidelines are warranted for managing cardiometabolic health during pregnancy.