(P23-04-26) Dietary Diversity in Early and Late Pregnancy and Its Associations With Maternal- and Household-Level Factors in Rural Bangladesh

Objectives: Examine the associations between individual- and household-level risk factors and dietary diversity in early and late pregnancy in rural Bangladesh.

Methods: Dietary intake was assessed in early and late pregnancy using a 7-day food frequency questionnaire among women enrolled in the Target-BEP cluster-randomized trial in rural northwestern Bangladesh. A modified dietary diversity score (DDS; range 0–10) was constructed, based on the food groups defined by the Minimum Dietary Diversity for Women indicator (MDD-W). Adequate dietary diversity (ADD) was defined as consumption of ≥5 food groups, for ≥4 times in a 7-day period. Cluster-adjusted multivariable logistic regression models using generalized estimating equations were used to identify determinants of ADD at each time point.

Results: Dietary data were available among pregnant women enrolled in the trial in early (n=3390) and late (n=2811) pregnancy. The proportion of women meeting ADD was 44.0% in early pregnancy and increased to 57.3% in late pregnancy (p < 0.001), with mean DDS increasing from 4.35 (SD: 1.60) to 4.93 (SD: 1.71). In adjusted analyses, higher socioeconomic status (SES), household food security, women's employment, seasonality, and maternal height were independently associated with achieving ADD in early pregnancy. In late pregnancy, higher SES, household food security, women's employment, maternal age, parity, and sanitation were independently associated with achieving ADD. Women in the highest SES quartile had greater odds of meeting ADD in both early pregnancy (aOR: 1.54; 95% CI: 1.20, 1.97) and late pregnancy (aOR: 1.70; 95% CI: 1.29, 2.24) compared with women in the lowest SES quartile. Similarly, women from food-secure households had greater odds of meeting ADD in early pregnancy (aOR: 1.54; 95% CI: 1.07, 2.20) and late pregnancy (aOR: 1.83; 95% CI: 1.15, 2.91) compared with women from moderately or severely food-insecure households, although food insecurity was low in this setting.

Conclusions: Although diets improved from early to late pregnancy, a substantial proportion of women did not meet the minimum dietary diversity in late pregnancy. These findings highlight the importance of addressing food insecurity and broader socioeconomic constraints to improve maternal diet quality and identify early pregnancy as a critical window for nutrition interventions.

Funding Sources: This work was supported by the Gates Foundation.