Diet in pregnancy is crucial for maternal and child health and pregnancy has been described as a good time for initiating behaviour change.<br />

Evidence from developed countries, however, suggests that dietary intake in pregnant women is inadequate despite food (theoretically) being abundant. There is currently little knowledge on dietary intakes of pregnant women in Germany. A need for furthering theoretical knowledge in the field of nutrition research has also been identified.

This dissertation thus aimed to assess the determinants of diet in pregnancy in developed contexts and their interaction with each other. Based on an initial scoping of the theoretical and empirical literature, a conceptual framework was developed. Pregnancy-related, socio-demographic, individual behavioural and biological responses and environmental determinants were identified as key drivers of diet in pregnancy. Framework ‘fit’ was improved based on findings from a systematic review and application to cross-sectional data from the BaBi birth cohort study.

The initial framework could not be refined into a definitive explanatory model as the evidence on the role of pregnancy-related and environmental factors is inconclusive at this stage and the interaction of the different determinants could not be fully disentangled.<br />

Nevertheless, this dissertation showed that the determinants of diet in pregnancy are very complex and in stark contrast to the notion of pregnancy as a time of ‘heightened awareness’ where behaviour change can easily be implemented. Both a social and behavioural gradient of diet in pregnancy were identified, i.e. women who are less affluent or exhibit health risk behaviours are less likely to exhibit adequate diets in pregnancy. Younger women were also identified as an at-risk group.<br />

Recommendations were made to realise adequate diet in pregnancy for all women. Among these were the improvement of dietary guidelines and communication thereof in Germany and the development of policies to act on the complex determinants of diet. As the field of research advances, clearer and more detailed policy recommendations can be drawn.