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Letter to the editor: comment on ‘Associations between maternal diet quality in pregnancy and infant feeding practices’

Published online by Cambridge University Press:  19 September 2025

Maria Daniele Teixeira Beltrão de Lemos
Affiliation:
Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-901, Brazil Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-420, Brazil
Raul Manhães de Castro
Affiliation:
Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-901, Brazil Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-420, Brazil
Erika Vanesa Cadena-Burbano
Affiliation:
Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-901, Brazil Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-420, Brazil
Ana Elisa Toscano*
Affiliation:
Graduate Program in Neuropsychiatry and Behavioral Sciences, Center for Medical Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-901, Brazil Studies in Nutrition and Phenotypic Plasticity Unit, Center for Health Sciences, Federal University of Pernambuco, Recife-Pernambuco 50670-420, Brazil Nursing Unit, Vitória Academic Center, Federal University of Pernambuco, Vitória de Santo Antão-Pernambuco 55608-680, Brazil
*
Corresponding author: Ana Elisa Toscano; Email: ana.tmsilva@ufpe.br
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Abstract

Information

Type
Letter to the Editor
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of the Nutrition Society

Dear Editor,

We congratulate Sexton-Dhamu et al. (Reference Sexton-Dhamu, Livingstone and Szymlek-Gay1) on their relevant study exploring the relationship between maternal diet quality in pregnancy and infant feeding practices. An analysis of 469 pregnant women revealed that higher scores on the Dietary Guidelines Index were associated with higher odds of exclusive breastfeeding for at least 6 months, especially among mothers born in Australia. Although no association was observed with the initiation of solid foods, the results reinforce the importance of promoting high-quality maternal nutrition during pregnancy. We congratulate the authors’ contribution, as the study addresses a critical link between maternal nutrition and early childhood health outcomes, and respectfully suggest some improvements.

This study makes a relevant contribution by investigating the association between maternal diet quality during pregnancy and infant feeding practices, using the DGI. The findings indicate that higher Dietary Guidelines Index scores are related to greater chances of exclusive breastfeeding, longer breastfeeding duration and breastfeeding for at least 6 months, especially among mothers born in Australia. These results reinforce the importance of promoting a healthy diet during pregnancy as a strategy for cultivating beneficial feeding practices in early childhood, especially among indigenous Australian women, a group frequently exposed to dietary vulnerabilities(Reference Ward, Coates and Hill2).

However, the study has methodological limitations that deserve consideration. Dietary data collection was performed using a restricted questionnaire (fifteen-item FFQ), adapted from previous research, which may have compromised the accuracy of the information. The lack of assessment of the weight of the ingested portions made it difficult to estimate energy and nutritional intake. The use of more comprehensive methods, such as 24-h records or food diaries, is recommended, in addition to standardisation of portions, as adopted by Aparicio et al. (Reference Cui, Xia and Wu3), allowing accurate calculations of energy and nutrients. Furthermore, altering the Dietary Guidelines Index by excluding important components such as food variety, type of bread, alcohol and salt may compromise the validity of the index and make it difficult to compare it with studies that used its full version, such as that carried out by Ward, Coates and Hill(Reference Aparicio, Jardí and Bedmar4).

From our clinical perspective, the study highlights the importance of maternal diet in promoting breastfeeding, consistent with our prenatal observations. However, the limited dietary assessment and population-based scope may affect applicability in diverse settings. We encourage the use of larger sample sizes and more robust dietary tools in future research to increase clinical relevance.

Author’s contribution

M. D. T. B. d. L.: Writing. R. M. d. C.: Editing and supervision. E. V. C.-B.: Writing. A. E. T.: Editing and supervision.

The authors have no conflicts of interest to report.

References

Sexton-Dhamu, MJ, Livingstone, KM, Szymlek-Gay, EA, et al. (2025) Associations between maternal diet quality in pregnancy and infant feeding practices. Br J Nutr 133, 665673.Google Scholar
Ward, SJ, Coates, AM & Hill, AM (2019) Application of an Australian dietary guideline index to weighed food records. Nutrients 11, 1286.Google Scholar
Cui, Q, Xia, Y, Wu, Q, et al. (2021) A meta-analysis of the reproducibility of food frequency questionnaires in nutritional epidemiological studies. Int J Behav Nutr Phys Act 18, 12.Google Scholar
Aparicio, E, Jardí, C, Bedmar, C, et al. (2020) Nutrient intake during pregnancy and post-partum: ECLIPSES study. Nutrients 12, 1325.Google Scholar