Consumption of dairy, fruits and dark green leafy vegetables is associated with lower risk of adverse pregnancy outcomes (APO): a prospective cohort study in rural Ethiopia

Background: Poor maternal nutrition during pregnancy is a leading modifiable risk factor associated with risks of adverse pregnancy outcomes (APO). Nevertheless, there is paucity of evidence if consumption of some food groups is associated with lower risk of APO, particularly in low-income settings. We aimed to determine whether consumption of some food groups is associated with lower risk of APOs such as: preterm birth (PTB), low-birth weight (LBW), and stillbirth in rural Central Ethiopia. Methods: A multi-center (8 health centers) prospective cohort study, enrolling 432 pregnant women during their initial antenatal care visit, was employed. All mothers were then followed monthly (for a total of four visits) from enrollment to delivery. Midwives in respective health centers assessed dietary diversity using the Women's individual dietary diversity score and evaluated birth outcomes following standard procedures. Logistic regression models were run to predict association of food groups with the APO. Findings: Out of the 374 pregnant women who completed the study, one in five [74 (19.8%)] experienced at least one of the APO: 34 (9.1%) gave birth to LBW babies, 51(13.6%) had PTB and 17 (4.5%) experienced stillbirth. Poor or inconsistent consumption (<3/4 assessments) of dark green leafy vegetables (adjusted odds ratio (AOR) = 2.01; 95% confidence interval (CI): 1.04-3.87), dairy products (AOR = 2.64; 95% CI: 1.11-6.30), and fruits and vegetables (AOR = 2.92; 95% CI: 1.49-5.67) were independently associated with higher APO risks. Whereas, being nonanemic at term (AOR = 0.24; 95% CI: 0.12-0.48) was independently associated with lower APO risks. Conclusions: Poor or inconsistent consumption of dairy, dark green leafy vegetables and fruits were associated with higher risk of APOs. While community-based trials and mechanistic studies are needed to substantiate these findings, efforts to promote dietary diversity through increased consumption of fruits, vegetables and dairy may be beneficial in this and similar settings.