title: Dietary diversity during pregnancy is associated with reduced risk of maternal anemia, preterm delivery, and low birth weight in a prospective cohort study in rural Ethiopia.
abstract: Anemia during pregnancy is a leading nutritional disorder with serious short- and long-term consequences for both the mother and the fetus.
  
  
  
  The objective was to investigate the association between dietary diversity during pregnancy and maternal anemia, low birth weight (LBW), preterm birth (PTB), and stillbirth in rural Ethiopia.
  
  
  
  We conducted a prospective cohort study and enrolled 432 pregnant women in their first antenatal care visit (24-28 gestational weeks); 374 women completed the follow-up. By using the FAO Women's Dietary Diversity Scores (WDDSs), subjects were categorized into "inadequate" (WDDS <4) and "adequate" (WDDS ≥4) groups and were followed until delivery. Primary outcomes were maternal anemia, birth weight, term delivery, and stillbirth.
  
  
  
  The attrition rate was 13.7% and was balanced across the 2 groups. The proportion of women consuming dairy, animal-source foods, fruits, and vegetables including vitamin A-rich ones was higher in the adequate than in the inadequate WDDS group (P < 0.05). The overall incidence of maternal anemia increased from 28.6% to 32.4% during the follow-up period. The overall proportion of LBW, PTB, and stillbirth were 9.1%, 13.6%, and 4.5%, respectively. After control for baseline differences, women in the inadequate group had a higher risk of anemia [adjusted RR (ARR: 2.29; 95% CI: 1.62, 3.24], LBW (ARR: 2.06; 95% CI: 1.03, 4.11), and PTB (ARR: 4.61; 95% CI: 2.31, 9.19) but not of stillbirth (ARR: 2.71; 95% CI: 0.88, 8.36) than women in the adequate group (P < 0.05).
  
  
  
  A WDDS of ≥4 food groups during pregnancy was shown to be associated with lower risk of maternal anemia, LBW, and PTB. Population-based controlled trials of various options to improve dietary diversity are needed before conclusive recommendations can be made. This trial was registered at clinicaltrials.gov as NCT02620943.
authors.affiliation: Center for Food Science and Nutrition, College of Natural Sciences and College of Medicine and Health Sciences and Referral Hospital, Dilla University, Gedeo, Ethiopia tadal2005@yahoo.com kaleabbaye@gmail.com.
authors.forename: Taddese A
authors.initials: TA
authors.lastname: Zerfu
authors.affiliation: Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; and.
authors.forename: Melaku
authors.initials: M
authors.lastname: Umeta
authors.affiliation: Center for Food Science and Nutrition, College of Natural Sciences and tadal2005@yahoo.com kaleabbaye@gmail.com.
authors.forename: Kaleab
authors.initials: K
authors.lastname: Baye
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D000818:Animals; D001724:Birth Weight; D015331:Cohort Studies; D003611:Dairy Products; D004032:Diet; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005638:Fruit; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology* / Q000517:prevention & control; D047928:Premature Birth / Q000453:epidemiology*; D011295:Prenatal Care; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D050497:Stillbirth / Q000453:epidemiology; D014675:Vegetables; D014801:Vitamin A / Q000008:administration & dosage
chemical_list: D014801:Vitamin A
keywords: anemia; dietary diversity; low birth weight; pregnancy outcome; preterm; stillbirth