Dietary protein intake during pregnancy and birth weight among Chinese pregnant women with low intake of protein

BACKGROUND: Previous studies have yielded inconsistent results on the association between maternal dietary protein intake and birth weight. Moreover, little is known about the effects of dietary protein intake from different sources on fetal growth. This study aimed to investigate the associations of different dietary protein sources (total protein, animal protein, plant protein, and major dietary protein sources) during pregnancy with birth weight and the related adverse birth outcomes. METHODS: 7310 women were recruited using a stratified multistage random sampling method at 0–12 months (median: 3; 10–90th percentile: 0–7) after delivery in Shaanxi, China. Maternal diets were gathered by a validated FFQ and other characteristics were collected by a standard questionnaire. Multilevel linear or logistic regression models were used to estimate birth weight changes or ORs (95% CIs) for adverse birth outcomes associated with different dietary protein sources during pregnancy. RESULTS: The mean percentage of energy from total protein was 11.4% (SD 2.2), with only 27.4% of total protein derived from animal protein. Per 3% increase in energy from total protein, animal protein, and dairy protein was associated with birth weight increases of 19.4 g (95% CI 6.0–32.9), 20.6 g (4.8–36.5), and 18.2 g (4.7–31.7), respectively. Per 3% increase in energy from total protein, animal protein, and dairy protein was also associated with lower risks of low birth weight (LBW) (total protein: OR = 0.78, 95% CI 0.64–0.94; animal protein: 0.79, 0.65–0.96; dairy protein: 0.71, 0.56–0.91), small for gestational age (SGA) (total protein: 0.88, 0.79–0.98; animal protein: 0.87, 0.78–0.97; dairy protein: 0.81, 0.68–0.96), and intrauterine growth retardation (IUGR) (total protein: 0.84, 0.72–0.98; animal protein: 0.86, 0.75–0.98; dairy protein: 0.78, 0.66–0.92). We observed no associations of plant protein and other major dietary protein sources with birth weight and the above birth outcomes. The results did not change when maternal protein was substituted for fat or carbohydrate. CONCLUSIONS: Among Chinese pregnant women with low intake of protein, higher intake of dietary protein, in particular animal protein and dairy protein, is associated with higher birth weight and lower risks of LBW, SGA, and IUGR. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12986-022-00678-0.