Old question revisited: Are high-protein diets safe in pregnancy?

Þórhallur Ingi Halldórsson*, Bryndís Eva Birgisdóttir, Anne Lise Brantsæter, Helle Margrete Meltzer, Margaretha Haugen, Inga Þórsdóttir, Anna Sigríður Ólafsdóttir, Sjurdur F. Olsen

*Corresponding author for this work

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Abstract

BACKGROUND: A previous randomized dietary intervention in pregnant women from the 1970s, the Harlem Trial, reported retarded fetal growth and excesses of very early preterm births and neonatal deaths among those receiving high-protein supplementation. Due to ethical challenges, these findings have not been addressed in intervention settings. Exploring these findings in an observational setting requires large statistical power due to the low prevalence of these outcomes. The aim of this study was to investigate if the findings on high protein intake could be replicated in an observational setting by combining data from two large birth cohorts.

METHODS: Individual participant data on singleton pregnancies from the Danish National Birth Cohort (DNBC) ( n = 60,141) and the Norwegian Mother, Father and Child Cohort Study (MoBa) ( n = 66,302) were merged after a thorough harmonization process. Diet was recorded in mid-pregnancy and information on birth outcomes was extracted from national birth registries.

RESULTS: The prevalence of preterm delivery, low birth weight and fetal and neonatal deaths was 4.77%, 2.93%, 0.28% and 0.17%, respectively. Mean protein intake (standard deviation) was 89 g/day (23). Overall high protein intake (>100 g/day) was neither associated with low birth weight nor fetal or neonatal death. Mean birth weight was essentially unchanged at high protein intakes. A modest increased risk of preterm delivery [odds ratio (OR): 1.10 (95% confidence interval (CI): 1.01, 1.19)] was observed for high (>100 g/day) compared to moderate protein intake (80-90 g/day). This estimate was driven by late preterm deliveries (weeks 34 to <37) and greater risk was not observed at more extreme intakes. Very low (<60 g/day) compared to moderate protein intake was associated with higher risk of having low-birth weight infants [OR: 1.59 (95%CI: 1.25, 2.03)].

CONCLUSIONS: High protein intake was weakly associated with preterm delivery. Contrary to the results from the Harlem Trial, no indications of deleterious effects on fetal growth or perinatal mortality were observed.

Original languageEnglish
Article number440
Pages (from-to)1-12
Number of pages12
JournalNutrients
Volume13
Issue number2
DOIs
Publication statusPublished - 29 Jan 2021

Bibliographical note

Funding Information:
Funding: The Norwegian Mother, Father and Child Cohort Study is supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research. The Danish National Birth Cohort Study has been supported by the March of Dimes Birth Defects Foundation (6-FY-96-0240, 6-FY97-0553, 6-FY97-0521, 6-FY00-407), the Danish Heart Association, Danish Medical Research Council, Sygekassernes Helsefond and the Danish National Research Foundation. This coordinated analysis has been supported by Innovation Fund Denmark (grant No 09-067124, Centre for Fetal Programming) and Kræftens Bekæmpelse (R204-A12638).

Funding Information:
The Norwegian Mother, Father and Child Cohort Study is supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research. The Danish National Birth Cohort Study has been supported by the March of Dimes Birth Defects Foundation (6-FY-96-0240, 6-FY97-0553, 6-FY97-0521, 6-FY00-407), the Danish Heart Association, Danish Medical Research Council, Sygekassernes Helsefond and the Danish National Research Foundation. This coordinated analysis has been supported by Innovation Fund Denmark (grant No 09-067124, Centre for Fetal Programming) and Kr?ftens Bek?mpelse (R204-A12638).

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Other keywords

  • Complications
  • Diet
  • DNBC
  • Fetal growth
  • MoBa
  • Perinatal mortality
  • Pregnancy
  • Preterm birth
  • Protein
  • Maternal Nutritional Physiological Phenomena
  • Prevalence
  • Prospective Studies
  • Diet Surveys
  • Humans
  • Diet, High-Protein/adverse effects
  • Young Adult
  • Perinatal Mortality
  • Adult
  • Female
  • Odds Ratio
  • Prenatal Care/methods
  • Infant, Newborn
  • Infant, Low Birth Weight
  • Norway/epidemiology
  • Risk Factors
  • Denmark/epidemiology
  • Dietary Proteins/adverse effects
  • Premature Birth/epidemiology
  • Dietary Supplements
  • Pregnancy Outcome

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