Dietary diversity in pregnant women is key for maternal health and newborn growth and development. Food insecurity is one of the determinants of poor quality diets and can be measured by several indicators, but evidence of its association with dietary diversity in pregnant women is limited. We assessed the effect of food insecurity measured by the Food Insecurity Experience Scale (FIES) and by the household dietary diversity score (HDDS) on pregnant women's dietary diversity score in four rural areas of South Angola, using the baseline survey data of the MuCCUA trial ("Mother and Child Chronic Undernutrition in Angola" study). We constructed separate estimation models for each food insecurity indicator and adjusted for confounders on the overall sample and by "commune". Among 1379 pregnant women, only 6.7% met the minimum dietary diversity for women, 78.3% of the households experienced moderate/severe food insecurity as measured by FIES and 73.8% showed food insecurity reflected by a low HDDS. Significant negative effects were found between food insecurity measured by low HDDS and pregnant women's dietary diversity after adjusting for confounders, in all the models. Experiencing moderate/severe food insecurity as measured by FIES (FIESmodsev) also had a negative effect on pregnant women's dietary diversity overall, but the effect was only maintained in two communes. Results were similar for severe food insecurity (FIESsev) but effect was lost after adjusting for confounders in three communes. Although low HDDS, FIESmodsev and FIESsev showed similar prevalences of food insecurity, their impact on pregnant women's dietary diversity was different in terms of strength and significance. Addressing food insecurity should be considered when designing multifaceted interventions for improving dietary diversity in pregnant women. Trial registration: Clinical Trials NCT05571280. Registered 7 October 2022.

Keywords: Angola; Food Insecurity Experience Scale (FIES); Household Dietary Diversity Score (HDDS); dietary diversity; food insecurity; pregnant women.

© 2025 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.

孕妇的饮食多样性对母体健康和新生儿生长发育至关重要。食物不安全是导致低质量饮食的一个决定因素，可以通过多种指标进行衡量，但有关其与孕妇饮食多样性的关联证据有限。我们使用了安哥拉“母亲和儿童慢性营养不良”研究（MuCCUA试验）基线调查数据，在南安哥拉的四个农村地区评估了通过食物不安全体验量表（FIES）和家庭饮食多样性得分（HDDS）衡量的食物不安全性对孕妇饮食多样性的得分的影响。我们为每个食物不安全指标分别构建了估计模型，并根据所有样本以及“公社”进行了调整。在1379名孕妇中，只有6.7%的人达到了最低的女性膳食多样性标准；78.3%的家庭通过FIES测量存在中度/重度的食物不安全问题；73.8%的家庭则通过HDDS表现出食物不安全性（得分低）。经过混杂因素调整后，在所有模型中发现，由HDDS衡量的食物不安全与孕妇饮食多样性的显著负向影响。而根据FIES测量的中度/重度食物不安全（FIESmodsev）也对总体上孕妇的饮食多样性产生负面效果，但该效应仅在两个公社内得以维持。对于严重食物不安全（FIESsev），结果类似，但在三个公社中调整混杂因素后影响消失。尽管低HDDS、FIESmodsev和FIESsev显示的食物不安全性流行率相似，它们对孕妇饮食多样性的影响在强度和显著性方面有所不同。因此，在设计用于改善孕妇饮食多样性的多面干预措施时，应考虑解决食物不安全问题。

临床试验注册：ClinicalTrials.gov NCT05571280。注册日期为2022年10月7日。

关键词：安哥拉；食物不安全体验量表（FIES）；家庭饮食多样性得分（HDDS）；饮食多样性；食物不安全性；孕妇。