Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Nutrition and Health (including climate and ecological aspects)

Association of plant-based dietary patterns in first trimester of pregnancy with gestational weight gain: results from a prospective birth cohort



Plant-based dietary patterns are becoming more popular worldwide. We aimed to examine the relationship between plant-based dietary patterns and the risk of inadequate or excessive gestational weight gain (GWG) in Iranian pregnant women.


We prospectively followed 657 pregnant women in Iran. Adherence to the plant-based diet, represented by plant-based (PDI), healthy (hPDI) and unhealthy plant-based (uPDI) dietary indexes was evaluated by applying a 90-item food frequency questionnaire during the first trimester of pregnancy. Multivariable-adjusted Cox proportional-hazards regression model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) across quartiles of plant-based diet scores.


Over 25,562 person-weeks of follow-up, we documented 106 and 294 participants with inadequate and excessive GWG, respectively. We found a strong inverse association between adherence to the PDI and inadequate GWG after adjustment for demographic and confounding variables. Women in the highest quartile of the PDI had 50% lower risk of inadequate GWG than those in the lowest quartile (adjusted HR: 0.50; 95%CI 0.29, 0.89; P = 0.02). No significant association was found between hPDI and uPDI and inadequate GWG. There was no association between PDI, hPDI, and uPDI and the risk of excessive GWG.


Greater adherence to a plant-based diet during the first trimester of pregnancy may be associated with a lower risk of inadequate GWG. This finding needs to be confirmed in larger cohort studies, considering other pregnancy outcomes such as birth weight and the potential changes across the trimester in terms of food types and quantity.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. Herring SJ, Rose MZ, Skouteris H, Oken E. Optimizing weight gain in pregnancy to prevent obesity in women and children. Diabetes Obes Metab. 2012;14:195–203.

    Article  CAS  PubMed  Google Scholar 

  2. Dietz PM, Callaghan WM, Cogswell ME, Morrow B, Ferre C, Schieve LA. Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery. Epidemiology. 2006;17:170–7.

    Article  PubMed  Google Scholar 

  3. Li C, Liu Y, Zhang W. Joint and independent associations of gestational weight gain and pre-pregnancy body mass index with outcomes of pregnancy in Chinese women: a retrospective cohort study. PloS One. 2015;10:e0136850.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Guan P, Tang F, Sun G, Ren W. Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population. J Int Med Res. 2019;47:4397–412.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Su W-j, Chen Y-l, Huang P-y, Shi X-l, Yan F-f, Chen Z, et al. Effects of prepregnancy body mass index, weight gain, and gestational diabetes mellitus on pregnancy outcomes: a population-based study in Xiamen, China, 2011–2018. Ann Nutr Metab. 2019;75:31–38.

    Article  CAS  PubMed  Google Scholar 

  6. Pregnancy as a window to future health: Excessive gestational weight gain and obesity. Semin Perinatol. Elsevier, 2015.

  7. Hoorsan H, Majd HA, Chaichian S, Mehdizadehkashi A, Hoorsan R, Akhlaqghdoust M, et al. Maternal anthropometric characteristics and adverse pregnancy outcomes in iranian women: a confirmation analysis. Arch Iran Med. 2018;21:61–66.

    PubMed  Google Scholar 

  8. Lagiou P, Tamimi R, Mucci L, Adami H, Hsieh C, Trichopoulos D. Diet during pregnancy in relation to maternal weight gain and birth size. Eur J Clin Nutr. 2004;58:231–7.

    Article  CAS  PubMed  Google Scholar 

  9. Reyes NR, Klotz AA, Herring SJ. A qualitative study of motivators and barriers to healthy eating in pregnancy for low-income, overweight, African-American mothers. J Acad Nutr Diet. 2013;113:1175–81.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tielemans MJ, Garcia AH, Peralta Santos A, Bramer WM, Luksa N, Luvizotto MJ, et al. Macronutrient composition and gestational weight gain: a systematic review. Am J Clin Nutr. 2015;103:83–99.

    Article  PubMed  Google Scholar 

  11. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.

    Article  CAS  PubMed  Google Scholar 

  12. Melina V, Craig W, Levin S. Position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116:1970–80.

    Article  PubMed  Google Scholar 

  13. Gaskin IM. Spiritual midwifery, Book Publishing Company, 2010.

  14. Carter JP, Furman T, Hutcheson HR. Preeclampsia and reproductive performance in a community of vegans. South Med J. 1987;80:692–7.

    Article  CAS  PubMed  Google Scholar 

  15. Zhang C, Liu S, Solomon CG, Hu FB. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care. 2006;29:2223–30.

    Article  CAS  PubMed  Google Scholar 

  16. Frederick IO, Williams MA, Dashow E, Kestin M, Zhang C, Leisenring WM. Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia. J Reprod Med. 2005;50:332–44.

    PubMed  Google Scholar 

  17. Pistollato F, Sumalla Cano S, Elio I, et al. Plant-based and plant-rich diet patterns during gestation: beneficial effects and possible shortcomings. Adv Nut. 2015;6:581–91.

    Article  CAS  Google Scholar 

  18. Zulyniak MA, de Souza RJ, Shaikh M, Desai D, Lefebvre DL, Gupta M, et al. Does the impact of a plant-based diet during pregnancy on birth weight differ by ethnicity? A dietary pattern analysis from a prospective Canadian birth cohort alliance. BMJ Open. 2017;7:e017753.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zare Sakhvidi MJ, Danaei N, Dadvand P, Mehrparvar AH, Heidari-Beni M, Nouripour S, et al. The prospective epidemiological research studies in IrAN (PERSIAN) birth cohort protocol: Rationale, design and methodology. Longitud Life Course Stud. 2021;12:241–62.

    Article  Google Scholar 

  20. Martínez-González MA, Sánchez-Tainta A, Corella D, Salas-Salvadó J, Ros E, Arós F, et al. A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study. Am J Clin Nutr. 2014;100:320s–328s.

    Article  PubMed  Google Scholar 

  21. Satija A, Bhupathiraju SN, Rimm EB, Spiegelman D, Chiuve SE, Borgi L, et al. Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med. 2016;13:e1002039.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Medicine Io, Status IoMSoN, Pregnancy WGd, Pregnancy CoNSD, Lactation, Intake IoMSoD et al. Nutrition during pregnancy: Part I: weight gain, Part II: nutrient supplements, National Academy Press, 1990.

  23. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    Article  PubMed  Google Scholar 

  24. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Tudor-Locke C, et al. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43:1575–81.

    Article  PubMed  Google Scholar 

  25. Kaiser L, Allen LH. American Dietetic Association. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108:553–61.

  26. Streuling I, Beyerlein A, Rosenfeld E, Schukat B, von Kries R. Weight gain and dietary intake during pregnancy in industrialized countries–a systematic review of observational studies. J Perinat Med. 2011;39:123–9.

    Article  PubMed  Google Scholar 

  27. Stuebe AM, Oken E, Gillman MW. Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol. 2009;201:58.e51–58.e588.

    Article  Google Scholar 

  28. Kesary Y, Avital K, Hiersch L. Maternal plant-based diet during gestation and pregnancy outcomes. Arch Gynecol Obstet. 2020;302:887–98.

    Article  CAS  PubMed  Google Scholar 

  29. Cano-Ibáñez N, Martínez-Galiano JM, Luque-Fernández MA, Martín-Peláez S, Bueno-Cavanillas A, Delgado-Rodríguez M. Maternal dietary patterns during pregnancy and their association with gestational weight gain and nutrient adequacy. Int J Environ Res Public Health. 2020;17:7908.

  30. Parker HW, Vadiveloo MK. Diet quality of vegetarian diets compared with nonvegetarian diets: a systematic review. Nutr Rev. 2019;77:144–60.

    Article  PubMed  Google Scholar 

  31. Hargreaves SM, Araújo WMC, Nakano EY, Zandonadi RP. Brazilian vegetarians diet quality markers and comparison with the general population: a nationwide cross-sectional study. PLOS One. 2020;15:e0232954.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Aminianfar A, Soltani S, Hajianfar H, Azadbakht L, Shahshahan Z, Esmaillzadeh A. The association between dietary glycemic index and load and risk of gestational diabetes mellitus: a prospective study. Diabetes Res Clin Pract. 2020;170:108469.

    Article  CAS  PubMed  Google Scholar 

  33. Daneshzad E, Tehrani H, Bellissimo N, Azadbakht L. Dietary total antioxidant capacity and gestational diabetes mellitus: a case-control study. Oxid Med Cell Longev. 2020;2020:5471316–5471316.

    Article  PubMed  PubMed Central  Google Scholar 

  34. De La Rosa VY, Hoover J, Du R, Jimenez EY, MacKenzie D, Team NS, et al. Diet quality among pregnant women in the Navajo Birth Cohort Study. Matern Child Nutr. 2020;16:e12961–e12961.

    PubMed  Google Scholar 

  35. Miller V, Yusuf S, Chow CK, Dehghan M, Corsi DJ, Lock K, et al. Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet Glob Health. 2016;4:e695–703.

    Article  PubMed  Google Scholar 

  36. Esteghamati A, Noshad S, Nazeri A, Khalilzadeh O, Khalili M, Nakhjavani M. Patterns of fruit and vegetable consumption among Iranian adults: a SuRFNCD-2007 study. Br J Nutr. 2012;108:177–81.

    Article  CAS  PubMed  Google Scholar 

  37. Craig WJ, Mangels AR. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009;109:1266–82.

    Article  CAS  PubMed  Google Scholar 

  38. McGuire S. U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, January 2011. Adv Nutr. 2011;2:293–4.

    Article  Google Scholar 

  39. Piccoli GB, Clari R, Vigotti FN, Leone F, Attini R, Cabiddu G, et al. Vegan–vegetarian diets in pregnancy: danger or panacea? A systematic narrative review. BJOG: Int J Obstet Gynaecol. 2015;122:623–33.

    Article  CAS  Google Scholar 

  40. Cullum-Dugan D, Pawlak R. Removed: position of the academy of nutrition and dietetics: vegetarian diets. J Acad Nutr Diet. 2015;115:801–10.

    Article  PubMed  Google Scholar 

  41. Mousavi SM, Shayanfar M, Rigi S, Mohammad-Shirazi M, Sharifi G, Esmaillzadeh A. Adherence to plant-based dietary patterns in relation to glioma: a case–control study. Sci Rep. 2021;11:1–11.

    Article  Google Scholar 

  42. Hull HR, Herman A, Gibbs H, Gajewski B, Krase K, Carlson SE, et al. The effect of high dietary fiber intake on gestational weight gain, fat accrual, and postpartum weight retention: a randomized clinical trial. BMC Preg Childbirth. 2020;20:319.

    Article  CAS  Google Scholar 

  43. Turner TF, Nance LM, Strickland WD, Malcolm RJ, Pechon S, O’Neil PM. Dietary adherence and satisfaction with a bean-based high-fiber weight loss diet: a pilot study. Int Sch Res Not. 2013;2013:915415.

  44. Paul HA, Bomhof MR, Vogel HJ, Reimer RA. Diet-induced changes in maternal gut microbiota and metabolomic profiles influence programming of offspring obesity risk in rats. Sci Rep. 2016;6:1–14.

    Article  Google Scholar 

  45. Cotillard A, Kennedy SP, Kong LC, Prifti E, Pons N, Le Chatelier E, et al. Dietary intervention impact on gut microbial gene richness. Nature. 2013;500:585–8.

    Article  CAS  PubMed  Google Scholar 

  46. Mokkala K, Röytiö H, Munukka E, Pietilä S, Ekblad U, Rönnemaa T, et al. Gut microbiota richness and composition and dietary intake of overweight pregnant women are related to serum zonulin concentration, a marker for intestinal permeability. J Nutr. 2016;146:1694–1700.

    Article  CAS  PubMed  Google Scholar 

Download references


This study was supported by Semnan University of Medical Sciences (Grant number: 1908).

Author information

Authors and Affiliations



AJ, SS-B, and MMK conceived and designed th study, SZM, HM and AE contributed to the data gathering, SZM and AJ analyzed the data, SZM, HM, AE, and AJ wrote the first draft of the manuscript, SS-B and MMK critically revised the manuscript. All authors have read and approved the final manuscript. SS-B had primary responsibility for final content.

Corresponding author

Correspondence to Sakineh Shab-Bidar.

Ethics declarations

Competing interests

All authors declare no conflict of interest.

Ethics approval and consent to participate

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the ethics committee of Semnan University of Medical Sciences. Written informed consent was obtained from all subjects/patients.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jayedi, A., Zeraattalab-Motlagh, S., Moosavi, H. et al. Association of plant-based dietary patterns in first trimester of pregnancy with gestational weight gain: results from a prospective birth cohort. Eur J Clin Nutr (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links