Greater Ultra-Processed Food Intake during Pregnancy and Postpartum Is Associated with Multiple Aspects of Lower Diet Quality

Low diet quality during pregnancy and postpartum is associated with numerous adverse maternal and infant health outcomes. This study examined relations of ultra-processed food intake with diet quality during pregnancy and postpartum. Using data from 24-h recalls, ultra-processed food intake was operationalized as percent energy intake from NOVA-classified ultra-processed foods; diet quality was measured using Healthy Eating Index 2015 (HEI) total and component scores. Pearson correlations examined associations of ultra-processed food intake with HEI total and component scores, and food group intake was compared across four levels of ultra-processed food intake. On average, ultra-processed food comprised 52.6 +/- 15.1% (mean +/- SD) of energy intake in pregnancy and 50.6 +/- 16.6% in postpartum. Ultra-processed food intake was inversely correlated with HEI total and 8 of 13 component scores. Compared to participants with the highest ultra-processed food intake (>= 60% energy), those with the lowest ultra-processed food intake (<40% energy) had a 17.6-point higher HEI total score and consumed 2-3 times more fruit, vegetables, and seafood and plant proteins, and 11/2 times more total protein. Additionally, they consumed 2/3 as much refined grains and 1/2 as much added sugar. Greater ultra-processed food intake was associated with lower diet quality across most HEI components. Reducing ultra-processed food intake may broadly improve adherence to dietary guidelines in pregnant and postpartum populations.