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dietary quality, distress, pregnancy



  1. Fowles, Eileen R.
  2. Bryant, Miranda
  3. Kim, SungHun
  4. Walker, Lorraine O.
  5. Ruiz, Roberta Jeanne
  6. Timmerman, Gayle M.
  7. Brown, Adama


Background: Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester.


Objective: The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women.


Method: A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy.


Results: The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits ([beta] = .36) and a direct ([beta] = -.23) and indirect effect on dietary quality ([beta] = -.30). Poor eating habits had a direct effect on dietary quality ([beta] = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education ([beta] = .39) and nutritional knowledge ([beta] = .18) and an indirect effect on dietary quality (total effect, [beta] = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables.


Discussion: Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.