. 2021 Jan 21;24(14):4671–4681. doi: 10.1017/S1368980021000276

Table 2.

Summary and characteristics of the fifteen selected observational studies assessing the relationship of maternal dietary diversity and risk of low birth weight

Author(s), year, reference	Country/type of study	Study population	Maternal age (year)/time of data collection	Study location (%)/data collection location	Method of DD assessment	Duration of food intake information	No. of food groups considered/inadequate DDiv	Total no. of LBW infants/no. of LBW infants in low DDS group	%	Covariates adjusted	Findings
Abubakari and colleagues, 2016⁽³³⁾	Ghana/cohort	578 singleton pregnant women and their newborns	≥ 15/second trimester followed until delivery	Urban: 78·20; rural: 21·8/hospital and child welfare clinics	FAO adopted women DDS using FFQ (analysis contained thirty-six food items)	Per week	9/–	162/–	28·0	Gestational age, women with regular antenatal care attendance and without severely ill state included	Mothers with high DDS had reduced risk of LBW infants (OR: 0·10; 95 % CI 0·04, 0·13; P < 0·0001) per sd change in scores
Ahmed and colleagues, 2018⁽³⁴⁾	Ethiopia/case-control	279 singleton live births (93 < 2500 g and 186 births ≥ 2500 g) and their mothers	LBW: 27·3 (sd 5·5) NBW: 26·2 (sd 4·7)/after given birth	Urban: 58·4;rural: 41·6/hospitals and health centres	FAO adopted MDD-W	Based on past 24-h recall	10/MDD-W < 5	93/87	93·5	Potential confounders were controlled Neonates with major congenital anomalies, diabetic mothers and mothers with unknown last menstrual period were excluded	93·5 % of LBW and 62·9 % of NBW neonates were belonged to mothers with inadequate DDS (P < 0·0001) Mothers with inadequate DDS had about seven times higher odds of having LBW babies (OR: 6·65; 95 % CI 2·31, 19·16)
Alemu and Gashu, 2020⁽⁴⁷⁾	Ethiopia/cohort	341 pregnant women	26·4 (sd 4·8)/first 8 weeks of pregnancy followed until delivery	Urban/antenatal care units	FAO adopted MDD-W	Based on past 24-h recall	10/MDD-W < 5	44/–	13·4	Maternal age, parity, educational status, BMI, Fe, folic acid supplementation, serum Zn and Hb concentration	Low dietary diversity was not associated with LBW (crude OR: 1·2; 95 % CI 0·5, 2·5; P = 0·6)
Bekela and colleagues, 2020⁽⁴⁹⁾	Ethiopia/case-control	354 mother–neonate (118 LBW, 236 NBW)	-/-	Urban (n 38); rural (n 80)/public hospitals	FAO adopted MDD-W	Based on past 24-h recall	–	118		Time of ANC initiation, pregnancy-induced hypertension, Fe and folic acid supplementation	Number of mothers with inadequate DD was higher among LBW infants (adjusted OR = 3·75; 95 % CI 1·64, 8·57)
Jamalzehi and colleagues, 2018⁽⁴⁴⁾	Iran/cohort	400 pregnant women	29·69 (sd 2·94)/third trimester	–/health centres	Kant method (based on the number of groups and subgroups of foods)	FFQ (for last 3 months) and 2 d 24-h recall	8/low DDS: < 3	–		–	There was significant negative correlation between mothers DD and infants birth weight (β = −0·370, P = 0·008)
Madlala, 2017⁽⁴⁵⁾	South Africa/cohort	172 black singleton pregnant women	18–41/second and third trimester	Urban/antenatal care settings	FAO adopted DDS	Based on 24-h recall	9/low DDS: ≤ 3; medium DDS: 4–5; high DDS: ≥ 6 food groups	8/1	5		There was significant negative correlation between mothers DD and infants birth weight (r −0·16; P = 0·04)
Manerkar and colleagues, 2017⁽³⁵⁾	India/cohort	121 pregnant women	25·16 (sd 3·61)/second and third trimester	Urban/antenatal clinics	FAO adopted DDS	Based on 24-h recall	9/low DDS ≤ 3 food groups; high DDS ≥ 6 food groups	19/0	15·7	Chronic illness	Mothers DD did not differ between LBW and NBW infants
Nsereko and colleagues, 2020⁽⁴⁸⁾	Rwanda/prospective cohort	367 pregnant women	28·12 (sd 6·01)/9–15 gestational weeks followed until delivery	Urban (n 120); rural (n 247)/health centres	FAO adopted MDD-W	FFQ previous day or night	10/low DDS < 5	7/–	2·1	–	Maternal low MDD-W (OR: 3·36; 95 % CI 1·37, 8·26) was independent determinant of LBW
Quansah and Boateng, 2020⁽³⁶⁾	Ghana/cross-sectional	420 mothers attending postnatal clinic	26·7 (sd 5·7)/post-natal	–/hospital	FAO adopted MDD-W using FFQ	–	10/low DDS ≤ 5	184/88	43·8/60·7	Age, education, employment, marital status, income, birth-order, parity, ANC attendance, smoking, alcohol intake and supplement intake	Maternal low DDS was associated with higher odds of infant LBW (OR: 4·29; 95 % CI 1·24, 6·48)
Rammohan and colleagues, 2019⁽³⁷⁾	India/cross-sectional	230 newly delivered women and their babies	–/During 24–48 h after delivery	Urban and rural/hospitals	DD index (based on the intake status of fifty-four food items)	Based on over the last 30 d of pregnancy	DD score range: −1·278– 4·063 Low DD score: < −0·622	/–	51	Women’s pre-pregnancy weight, complications during pregnancy, parity, place of residence, religion, education, type of ration card, type of family, social network with any medical person and income tertile	Women with low DD had significantly higher proportion of LBW babies compared with those in the medium or high DD category (OR: 2·245; 95 % CI 1·107, 4·556; P = 0·025)
Rashid and colleagues, 2018⁽³⁸⁾	Haiti/case-control	Sixty-six infants (thirty-two LBW and thirty-four NBW) and their mothers	LBW: 27·63 (sd 6·3) NBW: 27·6 (sd ± 5·5)/after delivery	Urban/hospital	FAO adopted women’s DDS	Based on past 24-h recall	9/low DD: <5; high DD: ≥5	32/9	28	–	Mean of DDS did not differ between mothers of LBW and NBW infants Number of mothers with DDS <5 was non-significantly higher in LBW infants’ group (28 %) compared with NBW infants’ group (18 %)
Saaka, 2013⁽³⁹⁾	Ghana/cohort	524 singleton pregnant women and their infants	26·7(sd 5·2)/between 34 and 36 weeks of gestation	Urban/hospital	FAO modified DD questionnaire	FFQ based on past 24-h recall	12/low DD: ≤ 7 food groups; high DD: ≥ 8 food groups	89/	17·0	Maternal age, GA, educational level, gender of baby, GWG, uptake of sulphadoxine pyrimethamine, frequency of ANC attendance and anaemia during pregnancy, preterm delivery and household wealth index	There was a significant difference in adjusted mean birth weight between women on low and high diversified diets, F(1, 415) = 8·935, P = 0·003 Maternal high DDS was associated with reduced risk of LBW infants (adjusted OR: 0·43; 95 % CI 0·22, 0·85; P = 0·014) Mothers with low DDS had 2·3 times increased risk of delivery LBW babies compared to those with high DDS (adjusted OR: 2·3; 95 % CI 1·18, 4·78; P = 0·014)
Tela and colleagues, 2019⁽⁴⁰⁾	Ethiopia/cohort	332 singleton pregnant mothers and their infants	Mean 28·5/before delivery	Urban (98·8 %)/private health facilities	Women’s DDS	Based on past 24- h recall	9/low DDS: ≤3; medium DDS: 4–6; high DDS: 7–9	–	–	Women with hearing and speaking difficulty, with pre-existing or current medical conditions and women with twin pregnancy were excluded	Mothers with high DDS had significantly larger babies than those with the low score (P < 0·0001)There was no association between maternal DD and infant birth weight (β: 0·066; 95 % CI −13, 54; P = 0·23)
Vanié and colleagues, 2019⁽⁴⁶⁾	Côte d’Ivoire/retrospective	146 newborns and mothers	28·44 (sd 5·88)/third trimester	–/maternity hospitals	FAO adopted women’s DDS	24-h recall	9/low DDS: ≤3; medium DDS: 4–5; high DDS: ≥6	11	7·6	Education, gestational weight gain, well-being index, alcohol consumption	The mean birth weight of newborns of mothers with medium and high DDS was higher (adjusted OR = 0·386; 95 % CI 0·072, 0·699; P = 0·017 and adjusted OR = 0·233; 95 % CI 0·016, 0·450; P = 0·036)
Zerfu and colleagues, 2016⁽⁴¹⁾	Ethiopia/cohort	374 pregnant women (followed until delivery) and their infants	Low DDS: 25·54 (sd 0·347) Adequate DDS: 24·44 (sd 0·30)/second trimester	Rural/health centres	Women’s DDS	Four 24- h recall	9/inadequate DDS: ≤3 Adequate DDS: ≥4 food groups	34/ 23	9·1/ 67·65	MUAC, level of education, Hb, age, height, GA	Women with inadequate DDS had higher risk of LBW infants (ARR: 2·06; 95 % CI 1·03, 4·11). Mean infants’ birth weight was significantly lower in mothers with low DDS (P < 0·001)

ARR, adjusted relative risk; DDiv, dietary diversity; DDS, dietary diversity score; FFQ, food frequency questionnaire; LBW, low birth weight; NBW, normal birth weight; ANC, antenatal clinic (care); GA, gestational age; GWG, gestational weight gain; OR, odds ratio; FAO, Food and Agriculture Organisation; MDD-W, Minimum Dietary Diversity for Women.