Examining the Influence of Maternal and Household-Level Factors on the Global Diet Quality Score During Pregnancy in...

Adequate nutrition during pregnancy is critical for mothers and newborns, but few studies have characterized maternal diets. The Global Diet Quality Score (GDQS) is a new metric to evaluate population diets. This study examined GDQS during pregnancy and its influencing factors in rural Uttar Pradesh, India. Data were from the Alive & Thrive (A&T) impact evaluation study, a cluster-randomized trial testing behavior change communication delivered through the antenatal care (ANC) platform. We analyzed multi-pass 24-h dietary recalls combined from two cross-sectional surveys, at baseline (2017, n = 660) prior to intervention and endline (2019, n = 674). The GDQS was constructed based on grams/day of 25 food groups consumed (range 0-49); for 16 healthy food groups (GDQS+), higher scores indicated higher consumption, whereas for 9 unhealthy food groups (GDQS-), scoring was reversed with higher scores reflecting lower consumption. Maternal and household factors influencing GDQS examined in a multivariable linear regression model included age, education, parity, nutrition knowledge, ANC visits, household size, religion, caste, socio-economic status (SES), and food insecurity, adjusted for pregnancy duration, survey time, and A&T intervention. The mean (SD) at 18.5 (3.4) for overall GDQS, 7.3 (3.2) for GDQS+, and 11.2 (1.6) for GDQS- was low. Factors positively associated with overall GDQS and GDQS+ were 4+ ANC visits (β = 0.83 and 0.78), nutrition knowledge (β = 0.12 and 0.13), and SES (β = 0.82 and 0.96). Maternal education (β = 0.66) and caste (β = -0.66) were significantly associated with GDQS+ while no factors were associated with GDQS-. This study highlights poor diet quality during pregnancy in this context.