Maternal and Child Health Journal

, Volume 16, Issue 7, pp 1468–1483 | Cite as

Validation of a Novel Method for Retrospectively Estimating Nutrient Intake During Pregnancy Using a Semi-Quantitative Food Frequency Questionnaire

  • Fabiola Mejía-Rodríguez
  • Manuela A. Orjuela
  • Armando García-Guerra
  • Amado David Quezada-Sanchez
  • Lynnette M. Neufeld


Case control studies evaluating the relationship between dietary intake of specific nutrients and risk of congenital, neonatal or early childhood disease require the ability to rank relative maternal dietary intake during pregnancy. Such studies are limited by the lack of validated instruments for assessing gestational dietary intake several years post-partum. This study aims to validate a semi-quantitative interview-administered food frequency questionnaire (FFQ) for retrospectively estimating nutrient intake at two critical time points during pregnancy. The FFQ was administered to women (N = 84), who 4–6 years earlier had participated in a prospective study to evaluate dietary intake during pregnancy. The FFQ queried participants about intake during the previous month (FFQ-month). This was then used as a reference point to estimate consumption by trimester (FFQ-pregnancy). The resulting data were compared to data collected during the original study from two 24-h recalls (24 h-original) using Spearman correlation and Wilcoxon sign-rank-test. Total energy intake as estimated by the retrospective and original instruments did not differ and was only weakly correlated in the trimesters (1st and 3rd) as a whole (r = 0.18–32), though more strongly correlated when restricted to the first half of the 1st trimester (r = 0.32) and later half of the 3rd trimester (r = 0.87). After energy adjustment, correlation between the 24hR-original and FFQ-pregnancy in the 3rd trimester were r = 0.25 (P < 0.05) for dietary intake of vitamin A, and r = 0.26 (P < 0.05) for folate, and r = 0.23–0.77 (P < 0.005) for folate, and vitamins A, B6 and B12 in the 1st and 3rd trimester after including vitamin supplement intake. The FFQ-pregnancy provides a consistent estimate of maternal intake of key micronutrients during pregnancy and permits accurate ranking of intake 4–6 years post-partum.


Validation Semi-quantitative food frequency questionnaire Pregnancy Micronutrients Dietary supplements 



This study was funded by NCI grant CA98180 (MAO) and support from ES009089 (MAO). The original RCT was founded by the Thrasher Research Fund, UNICEF, CONACyT Mexico, the Department of International Health, Rollins School of Public Health, Emory University and the Mexican National Institute of Public Health. We are grateful to Dr. Usha Ramakrishnan principal investigator of the RCT for allowing us to use the data for this validation. The authors also thank Ida Suen and Silvia Diaz for assistance with manuscript preparation.


  1. 1.
    Basch, C. E., Shea, S., & Zybert, P. (1994). The reproducibility of data from a Food Frequency Questionnaire among low-income Latina mothers and their children. American Journal of Public Health, 84(5), 861–864.PubMedCrossRefGoogle Scholar
  2. 2.
    Brown, J. E., et al. (1996). A food frequency questionnaire can detect pregnancy-related changes in diet. Journal of the American Dietetic Association, 96(3), 262–266.PubMedCrossRefGoogle Scholar
  3. 3.
    Cheng, Y., et al. (2008). Validity and reproducibility of a semi-quantitative food frequency questionnaire for use among pregnant women in rural China. Asia Pacific Journal of Clinical Nutrition, 17(1), 166–177.PubMedGoogle Scholar
  4. 4.
    De Vriese, S. R., et al. (2001). Estimation of dietary fat intake of Belgian pregnant women. Comparison of two methods. Annals of Nutrition and Metabolism, 45(6), 273–278.PubMedCrossRefGoogle Scholar
  5. 5.
    Erkkola, M., et al. (2001). Validity and reproducibility of a food frequency questionnaire for pregnant Finnish women. American Journal of Epidemiology, 154(5), 466–476.PubMedCrossRefGoogle Scholar
  6. 6.
    Greeley, S., Storbakken, L., & Magel, R. (1992). Use of a modified food frequency questionnaire during pregnancy. Journal of the American College of Nutrition, 11(6), 728–734.PubMedGoogle Scholar
  7. 7.
    Kristal, A. R., et al. (1997). Associations of race/ethnicity, education, and dietary intervention with the validity and reliability of a food frequency questionnaire: The Women’s Health Trial Feasibility Study in Minority Populations. American Journal of Epidemiology, 146(10), 856–869.PubMedCrossRefGoogle Scholar
  8. 8.
    Robinson, S., et al. (1996). Evaluation of a food frequency questionnaire used to assess nutrient intakes in pregnant women. European Journal of Clinical Nutrition, 50(5), 302–308.PubMedGoogle Scholar
  9. 9.
    Suitor, C. J., Gardner, J., & Willett, W. C. (1989). A comparison of food frequency and diet recall methods in studies of nutrient intake of low-income pregnant women. Journal of the American Dietetic Association, 89(12), 1786–1794.PubMedGoogle Scholar
  10. 10.
    Wei, E. K., et al. (1999). Validity of a food frequency questionnaire in assessing nutrient intakes of low-income pregnant women. Maternal and Child Health Journal, 3(4), 241–246.PubMedCrossRefGoogle Scholar
  11. 11.
    Bunin, G. R., et al. (2001). Recall of diet during a past pregnancy. American Journal of Epidemiology, 154(12), 1136–1142.PubMedCrossRefGoogle Scholar
  12. 12.
    House, J. D., et al. (2006). Improvements in the status of folate and cobalamin in pregnant Newfoundland women are consistent with observed reductions in the incidence of neural tube defects. Canadian Journal of Public Health, 97(2), 132–135.Google Scholar
  13. 13.
    Iqbal, M. M. (1999). Birth defects: prevention of neural tube defects by periconceptional use of folic acid and screening. Journal of Preventive and Social Medicine, 18(1), 52–65.PubMedGoogle Scholar
  14. 14.
    La Merrill, M. et al. (2011). The association between first trimester micronutrient intake, MTHFR genotypes, and global DNA methylation in pregnant women. The Journal of Maternal-Fetal & Neonatal Medicine.Google Scholar
  15. 15.
    Ma, A. G., et al. (2009). Micronutrient status in anemic and non-anemic Chinese women in the third trimester of pregnancy. Asia Pacific Journal of Clinical Nutrition, 18(1), 41–47.PubMedGoogle Scholar
  16. 16.
    Painter, R. C., Roseboom, T. J., & Bleker, O. P. (2005). Prenatal exposure to the Dutch famine and disease in later life: An overview. Reproductive Toxicology, 20(3), 345–352.PubMedCrossRefGoogle Scholar
  17. 17.
    Strobel, M., Tinz, J., & Biesalski, H. K. (2007). The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. European Journal of Nutrition, 46(Suppl 1), I1–I20.PubMedCrossRefGoogle Scholar
  18. 18.
    de Lourdes Flores, M., et al. (2007). Multiple micronutrient supplementation and dietary energy intake in pregnant women. Salud Publica de Mexico, 49(3), 190–198.PubMedGoogle Scholar
  19. 19.
    Ramakrishnan, U., et al. (2003). Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: A randomized controlled trial in a semirural community in Mexico. American Journal of Clinical Nutrition, 77(3), 720–725.PubMedGoogle Scholar
  20. 20.
    Ramakrishnan, U., et al. (2005). Effect of prenatal multiple micronutrient supplements on maternal weight and skinfold changes: A randomized double-blind clinical trial in Mexico. Food and Nutrition Bulletin, 26(3), 273–280.PubMedGoogle Scholar
  21. 21.
    Ramakrishnan, U., et al. (2004). Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico. Journal of Nutrition, 134(4), 898–903.PubMedGoogle Scholar
  22. 22.
    Hernandez-Avila, M., et al. (1998). Validity and reproducibility of a food frequency questionnaire to assess dietary intake of women living in Mexico City. Salud Publica de Mexico, 40(2), 133–140.PubMedCrossRefGoogle Scholar
  23. 23.
    Rivera-Dommarco, J. et al. (2001). Estado Nutricio en Niños y Mujeres en México. Encuesta Nacional de Nutrición 1999. Cuernavaca, Morelos: Instituto Nacional de Salud Pública.Google Scholar
  24. 24.
    Rodriguez-Ramirez, S., et al. (2009). Methodology for the analysis of dietary data from the Mexican National Health and Nutrition Survey 2006. Salud Publica de Mexico, 51(Suppl 4), S523–S529.PubMedGoogle Scholar
  25. 25.
    Safdie, M., et al. (2004). Bases de datos de valor nutritivo de los alimentos. Complied by Instituto Nacional de Salud Pública. Cuernavaca, Morelos: Instituto Nacional de Salud Pública.Google Scholar
  26. 26.
    Mejia-Rodriguez, F., et al. (2007). Use of nutritional supplements among Mexican women and the estimated impact on dietary intakes below the EAR and above the UL. Journal of the American College of Nutrition, 26(1), 16–23.PubMedGoogle Scholar
  27. 27.
    Lohman, T. G., Roche, A. F., & Martorell, R. (1988). Anthropometric standardization reference manual. Human Kinetics Books.Google Scholar
  28. 28.
    Organization, W. H. (1995). Physical status: The use and interpretation of anthropometry. Geneva: World Health Organization.Google Scholar
  29. 29.
    Bronfman, M., et al. (1988). Strategies for improving the therapeutic patterns used in acute diarrhea in primary medical care units. II. The measurement of inequality: a methodologic strategy, analysis of the socioeconomic features of the sample. Archivos de Investigación Médica (Mex), 19(4), 351–360.Google Scholar
  30. 30.
    Willett, W. (1990). Nutritional epidemiology. Oxford: Oxford University Press.Google Scholar
  31. 31.
    Willett, W. C., Howe, G. R., & Kushi, L. H. (1997). Adjustment for total energy intake in epidemiologic studies. The American journal of clinical nutrition, 65(4 Suppl): 1220S–1228S (discussion 1229S–1231S).Google Scholar
  32. 32.
    Bland, J. M., & Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1(8476), 307–310.PubMedCrossRefGoogle Scholar
  33. 33.
    Bland, J. M., & Altman, D. G. (1999). Measuring agreement in method comparison studies. Statistical Methods in Medical Research, 8(2), 135–160.PubMedCrossRefGoogle Scholar
  34. 34.
    Rosner, B., & Willett, W. C. (1988). Interval estimates for correlation coefficients corrected for within-person variation: Implications for study design and hypothesis testing. American Journal of Epidemiology, 127(2), 377–386.PubMedGoogle Scholar
  35. 35.
    Zar, J. H. (1972). Significance testing of the Spearman rank correlation coefficient. Journal of the American Statistical Association, 67(339), 578–580.CrossRefGoogle Scholar
  36. 36.
    Block, G., et al. (2006). Validation of a food frequency questionnaire for Hispanics. Preventing Chronic Disease, 3(3), A77.PubMedGoogle Scholar
  37. 37.
    Gibson, R. S. (2005). Principles of nutritional assessment. Oxford: Oxford University Press.Google Scholar
  38. 38.
    Romieu, I., et al. (1999). Questionnaire assessment of antioxidants and retinol intakes in Mexican women. Archives of Medical Research, 30(3), 224–239.PubMedCrossRefGoogle Scholar
  39. 39.
    Smith, A. F., Jobe, J. B., & Mingay, D. J. (1991). Retrieval from memory of dietary information. Applied Cognitive Psychology, 5(3), 269–296.CrossRefGoogle Scholar
  40. 40.
    Ocke, M. C., et al. (1997). The Dutch EPIC food frequency questionnaire. II. Relative validity and reproducibility for nutrients. International Journal of Epidemiology, 26(Suppl 1), S49–S58.PubMedCrossRefGoogle Scholar
  41. 41.
    Kabagambe, E. K., et al. (2001). Application of the method of triads to evaluate the performance of food frequency questionnaires and biomarkers as indicators of long-term dietary intake. American Journal of Epidemiology, 154(12), 1126–1135.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Fabiola Mejía-Rodríguez
    • 1
  • Manuela A. Orjuela
    • 2
  • Armando García-Guerra
    • 1
  • Amado David Quezada-Sanchez
    • 1
  • Lynnette M. Neufeld
    • 3
  1. 1.Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP)CuernavacaMexico
  2. 2.Department of Pediatrics (Oncology), and in Environmental Health Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Micronutrient InitiativeOttawaCanada

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