Table 4: Summary of systematic review and meta-analyses studies on burden of malnutrition/disease associated with diet during pregnancy

|Author (Year)|Study Type &|Participants|Diet Assessed|Nutrition, health|Key findings|
|---|---|---|---|---|---|
||Location|||outcomes assessed||
|Maternal nutrition out|<br>comes,includinganem|ia or other nutrient defi|ciencies|||
|Seid et al. (2023)|SRM of 22<br>observational<br>studies in Africa (11<br>cross-sectional, 6<br>cohort, 5 case-<br>control)|9,696 pregnant<br>women|Dietary diversityduring<br>pregnancy<br>_(note: studies used_<br>_different cutoffs for_<br>_‘inadequate DD’,_<br>_including <5/10 (n=9)_<br>_and≤4/9(n=2))_|Maternal anemia, low<br>birthweight|Low diet diversity associated with maternal<br>anemia (OR 2.15;95% CI 1.66, 2.65; 13<br>studies)<br>Low diet diversity associated with LBW (OR<br>2.04;1.45, 2.63; 9 studies)|
|Geta, Gebremedhin,<br>and Omigbodun<br>(2022)|SRM of 60 studies<br>(53 cross-<br>sectional, 5 case-<br>control, 2 cohort)<br>from Ethiopia|Pregnant women,<br>Ethiopia|Dietary diversity(low,<br>medium, high) assessed<br>in 10 studies|Anemia (Hb <11 g/dL)|Low diet diversity associated with higher risk<br>of anemia (RR 2.61; 1.85, 3.68)|
|J. Zhang et al. (2022)|SRM of 51 studies<br>(42 cross-<br>sectional, 6 case-<br>control, 3 cohort),<br>all in LMICs (36 in<br>Ethiopia)|Pregnant women 15-<br>49 y (n=73,919)|Model tested for 8<br>dietary habit exposures,<br>including frequency of<br>eating vegetables (n=10)<br>or meat (n=11), DDS<br>(n=7)|Anemia (Hb <11 g/DL)|Risk factors for anemia included frequency<br>of eating meat≤1 time per week (OR 2.02;<br>1.55, 2.50), eating vegetables≤3 times per<br>week (OR 2.97; 95% CI 1.59, 4.34), diet<br>diversity score≤3 (OR 2.38; 1.55, 3.21)|
|Getaneh et al.<br>(2021)|SRM of 24 studies<br>(22 cross-<br>sectional, 1 cohort,<br>1 case-control) in<br>Ethiopia|Pregnant women<br>15–49 y (n=12,893)|Dietary diversity<br>(DDS <5 food groups)<br>assessed in 5 studies|Undernutrition,<br>assessed as MUAC<br><21 (n=6), <22 (n=9) or<br><23 cm (n=6);<br>BMI <18.5 kg/m<sup>2</sup>(n=3)|Pooled prevalence of undernutrition was<br>29.2% (MUAC) and 27.9% (BMI).<br>Low diet diversity associated with risk of<br>undernutrition during pregnancy (effect size<br>2.89;95% CI 1.28,6.53)|
|Berhe, Gebrearegay,<br>and Gebremariam<br>(2019)|SRM of 7 studies,<br>Ethiopia|N=2371 pregnant<br>women|ASF intake, diet diversity|Zinc deficiency<br>(plasma or serum Zn<br>concentration)|Pooled prevalence of zinc deficiency 59.9%<br>(95% CI 51.9, 67.7)<br>Dietary risk factors associated with Zn<br>deficiency (n=4 studies):<br>low intake of ASF (OR 2.57; 1.80, 3.66),<br>low diet diversity (OR 2.12;1.28,3.53)|
|Health outcomes,incl|uding gestational diab|etes,hypertension, pre-|eclampsia and birth outcom|es||
|Beyene et al. (2023)|SRM of 10 studies<br>(8 cross-sectional,<br>1 cohort, 1 case-<br>control)|N=6525|Diet diversity(2 studies)<br>_(no info on how_<br>_assessed or cutoffs_<br>_used)_|GDM|Risk factors for GDM included inadequate<br>diet diversity (effect size 1.51; 1.25, 1.83)<br>and high BMI≥25 (2.24; 2.07, 2.42)|
|Cui et al. (2023)|SRM of 65 studies<br>(63 cohort and 2<br>case-control),|Pregnant women<br>18+ y (n=831,798)|Dietary intake, pre-<br>pregnancy (foods or|GDM, neonatal<br>outcomes, preterm<br>birth,SGA|GDM positively associated with pre-<br>pregnancy intake of fried food (pooledRR<br>1.59;1.08,2.34),fast food(RR 1.93;1.27,|

27