Associations between the Planetary Health Diet in Late Pregnancy and Pregnancy Outcomes in Women with a Raised BMI: Insights from the PEARS Study.

Background: Diet quality in pregnancy is a modifiable factor with important implications for maternal and neonatal outcomes. The Planetary Health Diet (PHD), designed to promote both human health and environmental sustainability, has not been comprehensively evaluated in high-risk obstetric populations. Objectives: This study aimed to examine the PHD in a pregnant cohort with a raised body mass index (BMI) and its associations with pregnancy outcomes, hypothesizing that greater adherence is associated with more favorable pregnancy outcomes. Methods: This was a secondary analysis of data from the pregnancy exercise and nutrition research study with smartphone application support study. Pregnant women ( Results: In adjusted models, a "High" PHDI score was associated with a lower odds of preeclampsia and/or pregnancy-induced hypertension [adjusted odds ratio (OR): 0.21; 95% confidence interval (CI): 0.06, 0.68; Conclusions: : This diet is associated with lower odds of hypertensive outcomes among pregnant women with a raised BMI, while promoting more sustainable food choices. Greater adherence to the PHD is also associated with a lower risk of delivering an infant born SGA and higher breastfeeding initiation rates, highlighting its potential benefits beyond pregnancy.