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The observed dietary under-reporting bias in this study, as well as the biases introduced by the exclusion of dietary mis-reporters or the adjustment of their reported dietary intakes based exclusively on quantitative energy correction equations may generate misleading associations between dietary and nutrient intakes and obstetric outcome. The increased incidence of under- reporting in overweight and obese women in particular, may result in erroneous conclusions regarding the nutritional intake, status and risk profile of these women. The assessment of body composition allowed us investigate the association between body fat levels in early pregnancy and the likelihood of under-reporting, which as far as we are aware has not been investigated in any previous studies in pregnancy.
Women experiencing relative deprivation may be at particular risk of nutritional deficiencies. Maternal diet and nutritional status can be modified before conception, and given the importance of maternal diet in fetal programming and lifelong health, the associations between nutritional intake and status and gestational outcome need to be clearly and accurately articulated. On the basis of these findings, all women who are planning pregnancy or who may be at risk of nutritional deficiencies or excesses during pregnancy, need to be accurately
identified so that effective interventions can be implemented. Development of specialised dietary assessment techniques for overweight and obese women in pregnancy may also be needed to ensure the collection of more robust nutritional intake data from these women.
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59 Chapter 4
Dietary Assessment Methods
4.0 Introduction
This chapter was based on the publication (Appendix 6):
Mullaney L, O’Higgins AC, Cawley S, Kennedy R, McCartney D, Turner MJ (2016) Use of a
Web-Based Dietary Assessment Tool in Early Pregnancy. Ir J Med Sci DOI: 10.1007/s11845- 016-1430-x [Epub ahead of print].
The Ph.D. candidate’s contribution was data collection, data preparation, statistical analysis, and
preparation and finalisation of the manuscript.