Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
Am J Clin Nutr. 2020 Sep 1;112(3):695-706. doi: 10.1093/ajcn/nqaa172.
Preterm birth (PTB), 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 aim of this study was to prospectively examine the association of maternal dietary diversity and quality during pregnancy with birth outcomes among women in Dar es Salaam, Tanzania.
We analyzed data from 7553 HIV-negative pregnant women enrolled in a multivitamin trial at 12-27 weeks of gestation. Dietary intake was assessed using 24-h dietary recalls. Dietary diversity scores (DDS; range: 0-10) were computed as the number of food groups consumed by women, using FAO's Minimum Dietary Diversity for Women index. The Prime Diet Quality Score (PDQS; range: 0-42) assessed maternal diet quality based on consumption of 21 healthy and unhealthy food groups. Log binomial regression methods were used to assess associations of DDS and PDQS with PTB, SGA, LBW, and fetal loss.
In the previous 24 h, 99.9% of all women had consumed cereal and staples, 57.9% meats, 4.7% eggs, and 0.5% nuts and seeds. Median DDS was 3.0 (IQR: 2.5-3.5). For the PDQS, all women consumed ≥4 servings/wk of green leafy vegetables and refined grains. Higher DDS was associated with lower risk of SGA (RR highest compared with lowest quintile: 0.74; 95% CI: 0.62, 0.89). Higher PDQS was associated with lower risk of PTB (RR highest compared with lowest quintile: 0.55; 95% CI: 0.46, 0.66), LBW (RR: 0.53; 95% CI: 0.40, 0.70), and fetal loss (RR: 0.53; 95% CI, 0.34, 0.82).
PDQS was inversely associated with PTB, LBW, and fetal loss, and DDS was inversely associated with SGA. These findings suggest that in addition to dietary diversity, diet quality should be considered as important in understanding dietary risk factors for poor birth outcomes.This trial was registered at clinicaltrials.gov as NCT00197548.
早产（PTB）、小于胎龄儿（SGA）和低出生体重（LBW）是婴儿发病和死亡的风险因素。孕妇在孕期摄入高质量的饮食可能有助于预防这些不良的出生结局。
本研究旨在前瞻性地研究坦桑尼亚达累斯萨拉姆妇女在孕期的饮食多样性和质量与出生结局之间的关系。
我们分析了在妊娠 12-27 周期间参加多种维生素试验的 7553 名 HIV 阴性孕妇的数据。采用 24 小时膳食回顾法评估膳食摄入量。使用粮农组织的妇女最低饮食多样性指数，计算出女性所食用食物组的数量，得出饮食多样性评分（DDS；范围：0-10）。基于对 21 种健康和不健康食物组的摄入情况，计算出主要饮食质量评分（PDQS；范围：0-42），以评估母体饮食质量。采用对数二项式回归方法评估 DDS 和 PDQS 与 PTB、SGA、LBW 和胎儿丢失之间的关联。
在过去的 24 小时内，所有女性均食用了 99.9%的谷物和主食、57.9%的肉类、4.7%的蛋类和 0.5%的坚果和种子。中位数 DDS 为 3.0（IQR：2.5-3.5）。对于 PDQS，所有女性每周均摄入≥4 份绿叶蔬菜和精制谷物。DDS 较高与 SGA 风险较低相关（最高五分位比最低五分位的 RR：0.74；95%CI：0.62，0.89）。PDQS 较高与 PTB（RR：0.55；95%CI：0.46，0.66）、LBW（RR：0.53；95%CI：0.40，0.70）和胎儿丢失（RR：0.53；95%CI：0.34，0.82）的风险降低相关。
PDQS 与 PTB、LBW 和胎儿丢失呈负相关，DDS 与 SGA 呈负相关。这些发现表明，除了饮食多样性外，饮食质量也应被视为理解不良饮食与不良出生结局之间关系的重要因素。本试验在 clinicaltrials.gov 注册为 NCT00197548。
