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Maternal and pediatric nutrition

Maternal dietary diversity during pregnancy and congenital heart defects: a case-control study



Maternal diet is critical to fetal development. This study aimed to explore the association between maternal dietary diversity during pregnancy and congenital heart defects (CHD) in Chinese population.


A hospital-based case-control study was conducted including 474 cases and 948 controls in Northwest China. We recruited eligible women waiting for delivery in the hospital and gathered their diets during the whole pregnancy by a validated food frequency questionnaire. According to the FAO Minimum Dietary Diversity for Women (MDD-W) guideline, the participants were categorized into “inadequate dietary diversity score (DDS)” (DDS < 5) and “adequate DDS” (DDS ≥ 5) groups. The association between dietary diversity and CHD was estimated using the mixed logistic regression models.


Case mothers had a lower DDS during pregnancy than the controls (P < 0.001). The proportions of women consuming all the ten defined food groups were lower in the inadequate DDS group than in the adequate DDS group among both cases and controls (all P < 0.001). The prevalence of inadequate micronutrient intake was higher in the inadequate DDS group than in the adequate DDS group among both cases and controls (all P < 0.05). Women in the adequate DDS group had reduced risks of having fetuses with total CHD (OR = 0.62, 95% CI = 0.45–0.84) and ventricular septal defects (OR = 0.58, 95% CI = 0.38–0.88).


Adequate DDS during pregnancy might be associated with a lower risk of CHD in offspring. Efforts to promote dietary diversity during pregnancy need to be strengthened to reduce the prevalence of CHD in Chinese population.

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Fig. 1: Distribution of maternal dietary diversity score (DDS) and prevalence of adequate and inadequate DDS during pregnancy among cases and controls.
Fig. 2: Proportion of women consuming food groups during pregnancy by maternal dietary diversity score (DDS) category among cases and controls.
Fig. 3: Prevalence of inadequate micronutrient intakes (below the Estimated Average Requirements for pregnant women in China) during pregnancy by maternal dietary diversity score (DDS) category among cases and controls.


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The authors are grateful to all medical staff involved in the study for recruiting the participants. The authors are also grateful to all mothers and infants who participated in the study and all investigators who contributed to data collection.


This research was supported by the National Natural Science Foundation of China (81230016), the Shaanxi Health and Family Planning Commission (Sxwsjswzfcght2016-013), the National Key R&D Program of China (2017YFC0907200, 2017YFC0907201), the China Postdoctoral Science Foundation (2019M663751), and the China Scholarship Council (201906285048).

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JY, SD, and HY designed the study; JY analysed and interpreted the data and wrote the paper; JY, YC, and LZ contributed to data analysis and data interpretation; JY, SD, and HY provided critical revision of the paper; SD and HY had primary responsibility for the final content. All the authors read and approved the final version of the paper.

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Correspondence to Shaonong Dang or Hong Yan.

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Yang, J., Cheng, Y., Zeng, L. et al. Maternal dietary diversity during pregnancy and congenital heart defects: a case-control study. Eur J Clin Nutr 75, 355–363 (2021).

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