Dietary Diversity in Pregnant Women and Its Association With Household Food Security in Rural Southern Angola

Dietary diversity in pregnant women is key for maternal health and newborn growth and development. Food insecurity is one of the determinants of poor quality diets and can be measured by several indicators, but evidence of its association with dietary diversity in pregnant women is limited. We assessed the effect of food insecurity measured by the Food Insecurity Experience Scale (FIES) and by the household dietary diversity score (HDDS) on pregnant women's dietary diversity score in four rural areas of South Angola, using the baseline survey data of the MuCCUA trial ("Mother and Child Chronic Undernutrition in Angola" study). We constructed separate estimation models for each food insecurity indicator and adjusted for confounders on the overall sample and by "commune". Among 1379 pregnant women, only 6.7% met the minimum dietary diversity for women, 78.3% of the households experienced moderate/severe food insecurity as measured by FIES and 73.8% showed food insecurity reflected by a low HDDS. Significant negative effects were found between food insecurity measured by low HDDS and pregnant women's dietary diversity after adjusting for confounders, in all the models. Experiencing moderate/severe food insecurity as measured by FIES (FIESmodsev) also had a negative effect on pregnant women's dietary diversity overall, but the effect was only maintained in two communes. Results were similar for severe food insecurity (FIESsev) but effect was lost after adjusting for confounders in three communes. Although low HDDS, FIESmodsev and FIESsev showed similar prevalences of food insecurity, their impact on pregnant women's dietary diversity was different in terms of strength and significance. Addressing food insecurity should be considered when designing multifaceted interventions for improving dietary diversity in pregnant women. Trial registration: Clinical Trials NCT05571280. Registered 7 October 2022.