Maternal Dietary Diversity and Dietary Quality Scores in Relation to Adverse Birth Outcomes in Tanzanian Women

Abstract

Abstract Objectives Preterm birth, small for gestational age (SGA) and low birth weight (LBW) are risk factors for morbidity and mortality among infants. High-quality maternal diets during pregnancy may protect against these adverse birth outcomes. The objective of this research is to prospectively examine the association of maternal dietary diversity and quality during pregnancy with birth outcomes among women in Dar es Salaam, Tanzania. Methods We analyzed data from 7553 HIV-negative pregnant women enrolled in a multivitamin trial at 12–27 weeks gestation. Dietary intake was assessed using 24-hour dietary recalls. Log binomial regression methods were used to assess associations of Minimum Dietary Diversity for Women (MDD-W) and Prime Diet Quality Score (PDQS) with preterm, SGA, LBW, fetal loss, very preterm, severe SGA and very low birth weight (VLBW). Results In the previous 24 hours, 99.9% of women reported consuming grains, roots and tubers, 57.9% meats, 4.7% eggs and 0.5% nuts and seeds. Median MDD-W score was 3.0 ± 1.0. For the PDQS, women consumed at least 4 servings/week of green leafy vegetables (100%) and other vegetables (64.7%) and consumption of refined grains was high (99.6%). Higher MDD-W scores were associated with lower risk of SGA (RR highest vs. lowest quintile 0.74, 95% CI: 0.62, 0.89). Higher PDQS scores were associated with lower risk of preterm birth (RR: 0.55, 95% CI: 0.46, 0.67); LBW (RR: 0.53, 95% CI: 0.40, 0.71); fetal loss (RR: 0.53, 95% CI: 0.34,0.82), very preterm (RR: 0.33, 95% CI: 0.17, 0.64) and VLBW (RR: 0.49, 95% CI: 0.26, 0.92) comparing women in highest vs. lowest quintiles. Conclusions PDQS was inversely associated with preterm, very preterm, LBW, VLBW and fetal loss, and MDD-W was inversely associated with SGA. These findings suggest that in addition to diet diversity, diet quality should be considered as important in understanding dietary risk factors for poor birth outcomes. Funding Sources This work has been supported by the National Institutes of Child Health and Human Development. Co-authors were supported by a grant from the National Institute of Child Health and Human Development and the National Institutes of Health.