The “Developmental Origins of Health and Disease” theory posits that early-life nutrition is a key determinant in the development of chronic conditions such as hypertension, diabetes, and cardiovascular disease in adulthood (1). Gestational weight gain (GWG) serves as a direct measure of maternal nutrition and is an independent predictor of both perinatal and long-term health outcomes for both the mother and the infant (2). Studies show that inadequate GWG can raise the risk of infants being small for gestational age and having low birth weight, while excessive GWG may precipitate conditions like pregnancy-induced hypertension syndrome, preeclampsia, gestational diabetes mellitus, large for gestational age, and an increased need for cesarean section (3–5). Furthermore, excessive GWG can have lasting health repercussions, predisposing women to diabetes and cardiovascular diseases later in life and increasing the risk of childhood obesity in their offspring (6–8).

Nutrition during pregnancy is crucial, as it impacts not only the mother’s health but also profoundly influences the growth and development of the fetus (9). A balanced and well-rounded diet is fundamental to controlling GWG and preventing pregnancy-related diseases (10). Analyzing dietary patterns, rather than individual foods or nutrients, provides a more effective approach to evaluating overall dietary status (11). There are various methods to assess dietary patterns: Priori methods, are based on existing dietary guidelines or scientific dietary recommendations and use scores to reflect the degree of adherence, such as index or score analysis (12, 13). Posteriori methods, aim to identify factors that explain variations in dietary patterns or classify individuals into distinct groups. Examples include factor analysis, cluster analysis, and latent profile analysis (LPA) (14–16).

The variations in geography, climate, history, customs, and assessment methods contribute to the diversity in reported dietary patterns across studies. Consequently, the impact of these patterns on GWG is a subject of inconsistent findings. A recent Danish study highlighted the advantages of a high-protein, low-glycemic index diet, particularly in reducing GWG and associated complications, such as a decreased rate cesarean deliveries among overweight or obese women (17). A retrospective study identified a negative association between GWG and adherence to the Mediterranean dietary pattern, which is characterized by a high consumption of vegetables, whole cereals, nuts, fish, and olive oil and a low consumption of refined cereals, snacks, and desserts (18). Additionally, a prospective cohort study from central China revealed that a dietary pattern rich in beans and vegetables is beneficial for managing GWG effectively and for promoting higher birth weight in newborns (19).

Recent studies have sought to explore the potential correlations between specific tastes preference, dietary habits, and obesity. A systematic review, which meticulously examined 19 articles, revealed a possible association between obesity and taste preferences, particularly a moderate inclination toward salty, bitter, and fatty flavors, as well as a heightened preference for sour flavors (20). However, there remains a significant gap in the literature concerning the relationship between taste preference and GWG.

In Chongqing, southwest China, the distinctive Mala flavor is a cornerstone of local cuisine. This flavor, characterized by its “numbing” and “spicy” qualities, is typically achieved by the addition of Chinese prickly ash, known for its tingling effect, and chili peppers to a variety of dishes including fish, poultry, meat, and soy products (21). Originating from Sichuan cuisine, the Mala taste has transcended regional boundaries, becoming a beloved seasoning across China and gaining international recognition for its unique sensory experience. However, the impact of this flavor profile on body weight remains largely unexplored in scientific literature. Furthermore, research on the connection between diet and GWG in Chongqing is scarce, which poses a challenge for the development of tailored nutritional intervention. In light of these gaps, our study aims to investigate the correlation between dietary habits, including taste preferences and dietary patterns, and GWG among pregnant women in Chongqing.

GWG surpassing the recommended levels in approximately half of pregnancies is often attributed to unhealthy lifestyles and unbalanced diets (26). Excessive GWG is linked to an increased risk of adverse maternal and neonatal outcomes (27, 28). Data from China indicate that 30–50% of women experience excessive GWG (29). Multiple interventions, including diet, physical activity, and combinations, have been proposed to address this issue (30). A meta-analysis showed that dietary interventions are associated with reduced GWG and exert a more significant effect than physical activity alone does (31). Strategies for dietary interventions in weight management should focus on reducing energy intake and consider dietary patterns related to differences in food accessibility, eating behaviors, taste preferences, and cultural background (32). A comprehensive understanding of regional dietary intake elements is crucial for devising targeted dietary interventions to prevent excessive GWG.

In this study, we evaluated dietary intake and taste preference among pregnant women in Chongqing and their impacts on GWG. Our results showed that food intake during pregnancy was notably inadequate, except for cereals, meats/poultries, and eggs, with less than 70% of the recommended minimum intake based on the CBDP being consumed. This is consistent with the 2018 Chongqing Residents’ Health Status report (33). An unbalanced diet heavily laden with carbohydrates has been reported to be associated with weight gain and obesity in Asia (34). This explains why, despite inadequate dietary intake, there are still quite a few cases of excessive GWG in Chongqing (30.3%). We identified three dietary patterns: HCD, LND, and MND by using the LPA method, and found that women adhering to HCD pattern, characterized by a high intake of cereals, had an increased risk of excessive GWG. Our findings align with those of a 2022 Danish study, which demonstrated that a low glycemic index diet was associated with reduced GWG (17). In a similar vein, a 2019 randomized controlled trial established a link between healthy eating practices, including lower carbohydrate intake, and decreased GWG (35). Additionally, a substantial longitudinal study among Korean adults bolsters our conclusions, showing that a diet rich in noodle or rice consumption was inversely related to reductions in waist circumference (36). It is noteworthy that compared to the LND, adhering to a MND pattern did not significantly increase the risk of excessive GWG. This suggests that a balanced diet is a more advantageous approach to ensure the intake of essential nutrients and to manage weight gain during pregnancy effectively.

Taste influences nutritional status and health. A systematic review was carried out in 2023 on the relationship between weight status and the perception of and preference for four common tastes (sweet, salty, fatty, bitter, and sour) by reviewing observational and interventional studies (37). The findings indicated that adults who were overweight and obese exhibited decreased perceptions of the four tastes and that preferences for sweetness and fat increased with weight gain (37). There is no consensus in the literature regarding the effects of food spiciness on obesity. One 2017 prospective study from China suggests that a high intake of spicy foods is positively associated with energy intake but inversely associated with the risk of overweight or obesity (38). A 2023 review of the literature indicated that both pepper extract and capsaicin have shown promising effects in aiding weight reduction (39). However, a meta-analysis of cross-sectional studies in the same year showed that spiciness may adversely affect overweight or obesity (40).

Regarding taste preference during pregnancy, only sugar consumption has been reported in 2019 to contribute to increased GWG and the development of pregnancy complications (41). In the present study, we investigated three taste preferences of pregnant women, namely, fatty, salty, spicy, and Mala flavors, and found that pregnant women who preferred the Mala flavor (but not fatty or salty flavor) had a higher risk of excessive GWG, compared with those who did not. Further analysis showed that the positive effect of consuming foods with a Mala flavor on excessive GWG was mediated by HCD patterns. Unlike the straightforward spiciness found in other regional Chinese cuisines, Sichuan cuisine is distinguished by a unique numbing sensation in its Mala flavor, which is derived from Chinese prickly ash. The numbing compounds in Chinese prickly ash, known as sanshool-based amides, activate sensory neurons in the mouth by targeting TRPV1, a chemically sensitive member of the transient receptor potential (TRP) channels (42, 43). This activation can influence appetite by modulating appetite hormone levels or by regulating gastrointestinal vagal afferent signaling (44). Mala sauce is a staple in Sichuan cooking, used extensively in dishes made with poultry, livestock, fresh fish, beans, and bean products, such as Boiled Meat Slices, Mapo Tofu, Spicy Beef Shreds, Spicy Chicken Slices, and more. Consequently, as our research indicates, the appetite-stimulating effect of Mala flavors lead to increased food intake among pregnant women who prefer this taste, particularly in cereals, and accordingly, a heightened risk of excessive GWG, which is mediated by HCD pattern.

Our study provides an innovative analysis of the effect of preference for the unique Mala taste of Sichuan cuisine on GWG. However, this study has some limitations. First, our FFQ only dealt with food categories, not specific foods, therefore, it was not possible to assess energy and nutrient intake. However, it was effective for collecting the frequency and amount of food category intake and analyzing dietary patterns. Second, the reliability and validity of the FFQ were not evaluated. Nonetheless, this version of the FFQ was an enhancement of the 2014 edition, which had demonstrated good reproducibility and correlations with 24 h dietary recall 2014 (23). And the results of food category intake in our study were consistent with those of the Chongqing Residents’ Health Status Report, which reflects the validity of the FFQ to some extent. Moreover, the FFQ showed good reproducibility. The Spearman and intra-class correlation coefficients between the two FFQ measurements 3 months apart ranged from 0.22 to 0.66 and from 0.22 to 0.60, respectively (Supplementary Table 1). The proportion of women classified into the same or adjacent quartiles by both FFQ measurements ranged from 72 to 85%, whereas the rate of misclassification into opposite quartiles was <9% (Supplementary Table 2). Third, we did not adjust for food intake when analyzing the relationship between taste preferences and GWG, which could potentially introduce bias into the results. However, in the subsequent mediation analysis, dietary patterns extracted on the basis of food category intake were included and adjusted in the model. Another significant limitation is the absence of external validation for our results, which means we cannot confirm the applicability of our findings to other populations. Consequently, it is imperative to approach the interpretation of our findings with caution.

The current study conducted a thorough evaluation of the dietary intake and taste preferences on GWG in the Southwest China region. Our results indicate that a preference for the Mala flavor, a distinctive characteristic of Sichuan cuisine, is positively associated with GWG, with this relationship being mediated by HCD patterns that feature high glycemic indexes cereals. It is recommended that pregnant women in the Chongqing region consider adjusting their preference for Mala flavors and reducing their consumption of high glycemic index cereals to manage GWG effectively and keep it within a healthy range. However, giving the exploratory nature of this study, caution is advised in interpreting these results. Future research with larger sample sizes is essential to validate our findings and to elucidate the underlying mechanisms, potentially incorporating relevant biomarkers into the analysis.