Feasibility of Egg-Based Diet Interventions and Assessing Perinatal Mental Health

Subjects will be recruited from community sites, such as health clinics and recreation centers. Practitioners and recreation center directors will collaborate by sharing a recruitment flyer with patients and clients. Doctor's clearance is not required for participation, but potential subjects may discuss the study with their physician. Potential subjects will complete an online screening form. Eligible subjects (n=30) will be 18 to 26 weeks pregnant (at study start, mid-July), have access to internet and an electronic devise (phone, tablet, or computer), and be willing to consume eggs and consent to study participation. Eligible subjects will be sent an electronic informed consent and be contacted by study personnel. Study personnel will review the consent either in person, via phone, or via zoom. Those eligible for the study will be randomly assigned to the dietary intervention groups: whole liquid eggs (n=15) or plant-based liquid egg substitute (JUST Egg) (n=15).

After consenting, subjects will complete baseline surveys. Baseline survey data collected will include an online demographic and health history questionnaire, food frequency questionnaire, 24-hour dietary recall, and self-report surveys to assess depressive symptoms, anxiety, perceived stress, and perceived social support. Subjects will complete all assessments online (via Qualtrics) using their own electronic devices, including phone, tablet, or computer, from the comfort of their own home.

Subjects will then be scheduled to come to the Ramsay Research unit (RRU) for fasted blood draw (overnight fast, 8 hours). Subjects will be scheduled between 7:30am and 11am. The RRU is not a CLIA-certified laboratory. It is an approved research laboratory. Blood will be processed at the RRU and sent to the Chen lab on the UI Moscow campus for cortisol analysis and to the University of North Carolina Nutrition Research Institute for choline analysis. At this baseline visit, subjects will also receive the first 30 day supply of the assigned dietary intervention along with a simple recipe book to offer ideas for preparation in case subjects are not familiar with how to prepare liquid eggs and to reduce monotony and palate fatigue. Subjects will also receive a measuring cup and a diet log along with instructions for consuming the intervention food and reporting intake daily via photos and written log. Researchers will answer any questions. Subjects will receive baseline data collection compensation.

Subjects will pick up additional dietary intervention products at the Carmelita Spencer Foods laboratory every 30 days (total of 120 days). Alternatively, research personnel will deliver products to subjects' homes in the Moscow area.

Subjects will be asked to take a photo of each meal that incorporates their assigned dietary intervention food before and after eating. These photos will be sent to the study phone via text message and uploaded to the PI's secure university One Drive account.

Subjects will be asked to complete additional online 24-hour diet recalls at week 9-10 of the intervention (about week 35-36 gestation), and week 18-19 of the intervention (about 4-5 weeks postpartum).

At week 4-6 postpartum, subjects will complete a short survey online describing birth-related outcomes and experience and self-report surveys to assess depressive symptoms, anxiety, perceived stress, and perceived social support.

Also at 4-6 weeks postpartum, subjects will come to the Ramsay Research Unit for fasted blood draw (overnight fast, 8 hours) and to provide a sample of breastmilk. Subjects will be scheduled between 7:30am and 11am. Subjects will be asked to refrain from feeding their infant on one breast for the 2 hours prior to collection. An electronic breast pump will be provided and a lactation specialist will be available to assist in this collection. Subjects will be asked for a full expression from one breast. Blood will be processed as described above. Breastmilk will sent to the UNC Nutrition Research Institute for choline analysis.

This will complete the data collection and subjects will receive study completion compensation.

Inclusion criteria

• 18 to 26 weeks pregnant
• have access to internet and an electronic device (phone, tablet, or computer)
• willing to consume eggs

Exclusion criteria

• score 11 or higher on the Edinburgh Postnatal Depression Scale
• under 19 years of age
• non-English speaking
• pregnant with multiples
• consume a vegan diet
• self-reported use of alcohol or drugs during pregnancy
• have diagnosed egg allergy
• have physical, cognitive, or logistical limitations to being able to follow the study protocol
• do not plan to breastfeed