Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics. SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs. RESULTS: Three DPs were identified at each time point and designated DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), DP 7-9 (second trimester) and DP 10-12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11. CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.