Self-Identified Vegetarian Pregnant Women in India Have Better Diets Than Self-Identified Non-Vegetarian Women Because of the Intersections of Caste and Economic Status

Abstract

Abstract Objectives Poor dietary intake during pregnancy remains a significant public health concern affecting the health of the mother and fetus. This study examines the adequacy of energy, macronutrient and micronutrient intakes among vegetarian and non-vegetarian pregnant women. Methods We analyzed dietary data from 627 pregnant women enrolled at baseline from an Alive &Thrive maternal nutrition program in Uttar Pradesh, India. Dietary intake was assessed using a multiple-pass 24-hour diet recall. We compared differences between vegetarian and non-vegetarian women in dietary diversity (calculated using the minimum dietary diversity for women guidelines), probability of adequacy, and mean probability of adequacy (MPA) for 11 micronutrients. Results Women who identified themselves as vegetarians (∼47%) were more likely to have higher education and socioeconomic status, and belong to upper caste groups than non-vegetarians. Average dietary diversity score was 4 out of 10 food groups for both groups. Vegetarian women were more likely to meet the MDD-W cutoff of five or more food groups compared to non-vegetarian women (39.2% compared to 32.4% respectively) (P < 0.05). Average MPA for vegetarians was 20% (SD:15.3) compared to 17% (SD:13.7) for non-vegetarian group (P = 0.02). In both groups, median intake of 9 out of 11 micronutrients was below the Estimated Average Requirement (EAR). Only zinc and thiamin had a median intake slightly above EAR. Starchy staple foods accounted for 62.4% of total energy for vegetarians and 69.1% for non-vegetarians. Dairy foods were an important source of fat, calcium, and vitamin B12 for both groups. Among non-vegetarian women, consumption of animal source foods was low (<8%). Conclusions Vegetarian women were more likely to have probability of nutrient adequacy and diet diversity during pregnancy than non-vegetarian women, but these differences are likely confounded by socio-economic and caste status. Since diets are poor for both groups, a range of policies and interventions that address the food environment, nutrition counseling during pregnancy, behavior change, and supplementation are needed in order to achieve adequate nutrient intake for pregnant women in this population. Funding Sources Bill and Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360.