Food Intake and Diet Quality of Pregnant Women in China During the COVID-19 Pandemic: A National Cross-Sectional Study

Abstract

Background: Between January and April 2020, China implemented differentiated prevention and control strategies across the country, based on the severity of the COVID-19 epidemic/pandemic in different regions. These strategies included lockdowns, social distancing, and the closure of public places. These measures may have affected dietary intake to varying degrees. This study aimed to assess variations in food intake and diet quality among pregnant women according to regional severity and related control measures during the most severe period of COVID-19 restrictions in 2020.

Methods: A total of 3,678 pregnant women from 19 provinces/municipalities in mainland China were analyzed in this nationwide, multi-center study. Food intake data were obtained and assessed using a validated food frequency questionnaire (FFQ). Diet quality was quantified using the Diet Balance Index for Pregnancy (DBI-P), which included high bound score (HBS, excessive dietary intake), low bound score (LBS, insufficient dietary intake), and diet quality distance (DQD, dietary imbalance). Linear trend tests and multivariable regression analyses were performed to examine the association between food intake, DBI-P and the severity of pandemic.

Results: The median daily intake of vegetables, fruit, livestock/poultry meat, dairy, and nuts decreased (p < 0.05) according to low, moderate, and high severity of the pandemic, while no significant differences in cereals/potatoes, eggs, and fish/shrimp intake. The median daily intake of cereals/potatoes exceeded the recommended ranges, and the daily intake of eggs and fish/shrimp was below recommended ranges regardless of the pandemic severity (p < 0.05). Regarding diet quality, HBS decreased (lower excessive consumption) (p = 0.047) and LBS increased (greater insufficient consumption) (p = 0.046) with increased severity of the pandemic. On multivariable analyses, moderate and high pandemic severity were related to lower HBS risk (OR = 0.687, OR = 0.537) and higher LBS risk (β = 1.517, β = 3.020) when compared to low pandemic severity.

Conclusions: Under more severe COVID-19 pandemic conditions, pregnant women consumed less quality food, characterized by reduced consumption of vegetables, fruit, livestock/poultry meat, dairy and nuts, while the quality of the foods that pregnant women consumed in excess tended to improve, but the overconsumption of cereals/potatoes was a problem.

Keywords: COVID-19 pandemic; diet quality; food intake; pregnancy; severity; variations.

Figure 1

Geographic distribution of samples provinces/municipalities. The symbol represents the provinces/municipalities of different COVID-19 pandemic severity. represents the pandemic severity was high. represents the pandemic severity was moderate. represents the pandemic severity was low.

Figure 2

Average daily food intake and diet quality (Diet Balance Index, DBI) for pregnant women according to COVID-19 pandemic severity. (A) The median daily intake of cereals/potatoes, vegetables, fruit and dairy (g/day) for pregnant women according to COVID-19 pandemic severity. (B) The median daily intake of livestock/poultry meat, fish/shrimp, eggs and nuts (g/day) for pregnant women according to COVID-19 pandemic severity. (C) The median of high bound score (HBS), the mean of low bound score (LBS) and diet quality distances (DQD) for pregnant women according to COVID-19 pandemic severity. ^†p < 0.05 (low vs. moderate severity). ^§p < 0.05, ^bp < 0.001 (moderate vs. high severity). ^‡p < 0.05, ^cp < 0.001 (low vs. high severity). *p < 0.05, ^dp < 0.001 (low vs. moderate vs. high severity).

Figure 3

Variation of daily food intake according to COVID-19 pandemic severity. (A) Variation of daily intake of vegetables according to COVID-19 pandemic severity. (B) Variation of daily intake of fruit according to COVID-19 pandemic severity. (C) Variation of daily intake of livestock/poultry meat according to COVID-19 pandemic severity. (D) Variation of daily intake of dairy according to COVID-19 pandemic severity. (E) Variation of daily intake of nuts according to COVID-19 pandemic severity. Daily intake of vegetables, fruit, livestock/poultry meat, dairy and nuts were presented as median (interquartile range, IQR). ^✰Linear trends were statistically significant (p < 0.05).

Figure 4

Variation of diet quality (Diet Balance Index for Pregnancy, DBI-P) according to COVID-19 pandemic severity. (A) Variation of high bound score (HBS) according to COVID-19 pandemic severity. (B) Variation of low bound score (LBS) according to COVID-19 pandemic severity. (C) Variation of diet quality distance (DQD) according to COVID-19 pandemic severity. HBS were presented as median (interquartile range, IQR). LBS and DQD were presented as mean (standard deviation, SD). ^✰Linear trends were statistically significant (p < 0.05).