Preconceptional diet quality is associated with birth outcomes among low socioeconomic status minority women in a high-income country



Studies of the association between maternal nutrition and birth outcomes have investigated differing nutrients, maternal socioeconomic conditions, and timing within the reproductive cycle; and have produced inconsistent results. We evaluated the association of preconceptional maternal dietary intake with birth outcomes among low socioeconomic status ethnic minority women in a high-income country.


In this prospective cohort study, habitual preconceptional dietary intake was assessed among pregnant Bedouin Arab women in Israel (n = 384), using a short culturally specific, targeted food frequency questionnaire. Multiple nutrients (protein, lysine, calcium, iron, zinc, folate, omega-3 fatty acids) were evaluated simultaneously via a diet quality score derived from principal component analysis. Multivariable logistic regression was used to test associations between the diet quality score and a composite adverse birth outcomes variable, including preterm birth, low birth weight and small for gestational age.


Sixty-nine women (18%) had adverse birth outcomes. Women with low preconceptional diet quality scores had low intakes of nutrient-rich plant foods, bioavailable micronutrients, and complete proteins. In multivariable analysis, a woman at the 10th percentile of the diet quality score had a 2.97 higher odds (95% CI 1.28–6.86) of an adverse birth outcome than a woman at the 90th percentile.


Low diet quality during the preconceptional period was associated with adverse birth outcomes among low socioeconomic status minority women in a high-income country. The results have implications for the development of appropriate intervention strategies to prevent adverse birth outcomes, and the promotion of adequate nutrition throughout the child-bearing years.

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We would like to thank the women who participated in the DEPOSIT cohort, the study staff of the S. Daniel Abraham Center for Health and Nutrition at Ben-Gurion University of the Negev, and the staff of the Maternal and Child Health and High Risk Pregnancy clinics. We would also like to thank Dr. Ilya Novikov for conducting the power analysis. This work was supported by a grant from the Israel National Institute for Health Policy and Health Services Research [Grant Number: 2003/136/A]. The funding agency had no role in the design, conduct or analysis of the study; or in the preparation, review, or approval of the manuscript.

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KA-S and DF conceived of and procured the funding for study, and KA-S was responsible for the project administration. KA-S, DF and LSF planned and conducted the analysis, with input from VK-S and IB, KA-S prepared the initial manuscript draft. All authors critically reviewed the manuscript for important intellectual content; and gave final approval of the version to be submitted.

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Correspondence to Kathleen Abu-Saad.

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The authors declare no conflict of interest.

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Abu-Saad, K., Kaufman-Shriqui, V., Freedman, L.S. et al. Preconceptional diet quality is associated with birth outcomes among low socioeconomic status minority women in a high-income country. Eur J Nutr 60, 65–77 (2021).

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  • Preconceptional maternal diet
  • Diet quality
  • Adverse birth outcomes
  • Ethnic minority
  • Low socioeconomic status
  • Principal component analysis