(P27-045-25) Maternal and Household-Level Determinants of the Global Diet Quality Score During Pregnancy in India

Objectives: The Global Diet Quality Score (GDQS) is a new metric to evaluate diet quality of populations in low-and-middle income countries, but evidence on maternal diets is limited. This study aimed to examine GDQS during pregnancy and factors influencing it in rural Uttar Pradesh, India.

Methods: Data were derived from the Alive & Thrive (A&T) impact evaluation study, a cluster-randomized trial testing the provision of behavior change communication and maternal nutrition interventions delivered through the government antenatal care (ANC) platform. We analyzed quantitative multi-pass 24-hour dietary recalls from two cross-sectional surveys, one at baseline (2017) prior to start of intervention and one at the endline (2019). The GDQS was constructed based on the amount (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 negative such that lower consumption of unhealthy foods resulted in a higher score. Maternal and household factors influencing GDQS examined in a multivariable linear regression model included age, education, parity, nutrition knowledge, ANC exposure, household size, religion, caste, socio-economic status (SES), and food insecurity, adjusted for pregnancy duration, survey time, and A&T intervention cluster.

Results: The mean (SD) scores at baseline and endline were low at 18.3 (3.4) and 18.7 (3.4) for overall GDQS, 7.1 (3.2) and 7.7 (3.1) (out of 32) for GDQS+ (healthy food consumption), and 11.3 (1.6) and 11.1 (1.7) (out of 17) for GDQS- (low consumption of unhealthy foods). In the multivariable model, 4+ ANC visits (β=0.83 and β=0.78), nutrition knowledge (β=0.12 and β=0.13), and SES (β=0.82 and β=0.96) were positively associated (p < 0.05) with both overall GDQS and GDQS+, respectively. Maternal education (β=0.66) and caste (β= -0.66) were also significantly associated with GDQS+.

Conclusions: Poor diet quality during pregnancy was observed in this context, characterized by low consumption of healthy and unhealthy food groups. The findings emphasize that significant inequities persist in accessing a healthy diet and identifies vulnerable sub-groups based on SES, knowledge, education, and ANC exposure.

Funding Sources: Bill & Melinda Gates Foundation through Alive & Thrive (FHI 360)