Dietary Diversity and Associated Factors Among Pregnant Women in Central South Africa: The NuEMI Study

Poor dietary diversity (DD) in pregnancy can lead to nutritional deficiencies, resulting in poor maternal and neonatal outcomes. This cross-sectional study assessed the DD of 681 pregnant women in a tertiary hospital in South Africa. DD, household food insecurity and sociodemographic status were assessed using the MDD-W indicator, HFIAS and a questionnaire. 99.4% of participants consumed starchy staples, while only 7.9%, 10.6% and 13.5% consumed pulses; nuts and seeds; and dark green leafy vegetables, respectively. Only 32.9% achieved the MDD-W. Unemployment, having only primary education, severe food insecurity, as well as monthly income of 100-1000 ZAR and 1001-3000 ZAR were associated with 69% (<i>p</i> < .001), 72% (<i>p</i> = .010), 43% (<i>p</i> = .024), 82% (<i>p</i> < .001) and 50% (<i>p</i> = .003) decreased odds of achieving MDD-W, respectively. The findings indicate low DD and likely micronutrient inadequacy among this population of pregnant women. Lower monthly income, lower educational level, unemployment and severe household food insecurity were associated with inadequate DD. Addressing structural barriers, including poverty, unemployment, and food insecurity, is essential to support a more diverse diet during pregnancy.