Dietary Diversity Score during Pregnancy is Associated with Neonatal Low Apgar Score: A Hospital-Based Cross-Sectional Study


  • Dan Yedu Quansah Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast
  • Daniel Boateng School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi
  • Louis Boafo Kwantwi Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi
  • Anthony Owusu-Sekyere Department of Agricultural Science, University of Helsinki
  • A. Kofi Amegah Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast



Dietary diversity score, Apgar score, Pregnancy, Cape Coast Metropolitan Hospital, Neonate.


Background: Apgar score is an established index of neonatal well-being and development. Nutrition during pregnancy is an accepted risk factor for neonatal low Apgar score.

Objective: To investigate the association between dietary diversity score and low Apgar score.

Methods: This was a hospital based cross-sectional study. The study participants were 420 mothers who delivered and were attending the postnatal clinic at the Cape Coast Metropolitan Hospital. Mothers’ dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the FAOs women’s Dietary Diversity Score (DDS), the subjects were categorized into low, medium or high DDS. The primary outcome was Apgar score. Apgar scores < 5 were classified as low.

Results: The mean age (± standard deviation, SD) of subjects was 26.7 ± 5.7 years with a range of 17 to 45 years. The prevalence of low Apgar score among the study population was 16.9%. Majority of the study participants had a low DDS in relation to low Apgar score whereas 7.5% had high DDS. After adjusting for potential confounding factors, the odds of low Apgar score in the low DDS group was three times higher than those who had high DDS (Adjusted odds ratio, AOR= 3.10, 95% confidence interval, CI=1.23-4.48).

Conclusion: Dietary diversity score during pregnancy was associated with a low Apgar score in the study area. The results of this study reinforce the significance of adequate nutrition during pregnancy in the study area.


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