Maternal Dietary Intake and Associated Pregnancy Outcomes in the United Arab Emirates - The Dietary Subcohort of the Mutaba’ah Study

Abstract

This thesis aimed to assess dietary intake and its associations with pregnancy outcomes in the United Arab Emirates (UAE). Within the Mutaba’ah Study, 1556 pregnant women were recruited into a dietary subcohort. Data collection using a semi-quantitative food frequency questionnaire (FFQ) was performed during antenatal care visits throughout the pregnancy. The relative validity of the FFQ was assessed using a 24-hour dietary recall as a reference method. Adherence to dietary patterns (Alternate Healthy Eating Index for Pregnancy [AHEI-P], Alternate Mediterranean Diet [aMED], Dietary Approaches to Stop Hypertension [DASH]) were identified, and ultra-processed food (UPF) intake was assessed. Gestational weight gain (GWG) was calculated as the difference in weight between the first and the last recorded weight, and excessive GWG (EGWG) was defined according to the Institute of Medicine guidelines, based on the first trimester body mass index. Gestational diabetes mellitus (GDM) diagnosis was based on the National Institute for Health and Clinical Excellence criteria. Paper Ⅰ showed that the FFQ overestimated intake of most nutrients and food groups but could be used to rank the pregnant women based on some aspects of their dietary intake. Paper Ⅱ showed that the three dietary indices (AHEI-P, aMED, DASH) were moderately correlated. Some differences were observed in what distinct aspects of dietary intakes they captured. In paper Ⅲ, the prevalence of EGWG was 29%. No associations were found between aMED and GWG or EGWG. However, intake of some aMED components (fruit, vegetables, ratio of monounsaturated fatty acids to saturated fatty acids) showed associations with GWG and/or EGWG. In paper Ⅳ, UPF intake was associated with lower diet quality but not with GDM. Further, no association was found between aMED and GDM. These findings show that the FFQ estimates intakes of nutrients and food groups with poor to acceptable validity. Adherence to healthy dietary patterns was associated with a favorable intake of nutrients and food groups, while high UPF intake was associated with poorer intake. Further research is needed to clarify the role of dietary intake in pregnancy outcomes.