(689) Development of Pre-Pregnancy Diet Quality Index and Its Association with Adverse Pregnancy Outcomes

This was a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Mothers-to-Be (nuMoM2b), which assessed preconception dietary habits using food frequency questionnaires. PPDQI was developed using Dietary Guidelines for Americans, 2020-2025, and included 22 adequacy components and 4 moderation components, each scored from 0-5. Adequacy components received higher scores for greater intake; moderation components for lower intake. The total score was weighted 60% for adequacy and 40% for moderation. The primary outcome was a composite of APOs: preterm births < 37 weeks, hypertensive disorders of pregnancy, small for gestational age (< 5th percentile), gestational diabetes mellitus, and stillbirths. Modified Poisson regression was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI) for APOs across PPDQI quartiles and per interquartile range (IQR) increase, adjusting for confounders.

Results:

Of the 7,551, 1,819 (24%) had APO. The mean PPDQI score was 66.03 ± 9.44 (range:36.56-91.00). Higher PPDQI quartiles were associated with older age, non-Black race, higher education, income, body mass index, and energy intake (Table 1). Compared to Q1, individuals in Q4 had a lower risk of APO (aRR: 0.77; 95% CI: 0.66-0.89), preterm births (aRR:0.75; 95% CI: 0.56-0.99), and hypertensive disorders of pregnancy (aRR: 0.77; 95% CI: 0.63-0.95) (Table 2). One-IQR increase in PPDQI was associated with lower risk of APO (aRR: 0.89; 95% CI: 0.83-0.95), hypertensive disorders of pregnancy (aRR:0.89; 95%CI:0.80-0.98), preterm births (aRR: 0.86; 95% CI: 0.74-1.00), and stillbirths (aRR: 0.43; 95% 0.20- 0.94).

Conclusion:

Higher PPDQI scores were associated with lower risk of APOs, particularly preterm birth and hypertensive disorders. This supports incorporating dietary assessment and counseling into preconception care.