*2.2. Maternal Dietary Assessment*

All participants received assistance in installing an image-based dietary assessment application on their smartphones (Cofit Pro version 1.0.0, Taipei, Taiwan). We previously proved the validity and reliability of this image-based dietary assessment application for assessing macronutrients and micronutrients [16]. Registered dietitians taught the participants to use the application on-site for 20–30 min. Participants used their smartphones to take photos of all the food that they consumed for ≥3 days. Dietary records from three matching days (two weekdays and one weekend day) were used for this analysis. Dietary variables were calculated as individual means of the 3-day dietary records. After food record collection, trained dietitians disaggregated the foods into their constituent ingredients, including macronutrients (measured in grams) and micronutrients (measured in milligrams). The macronutrients included carbohydrates and dietary fiber, fats, proteins, and fluids. The micronutrients included vitamins and minerals.

Fruits and vegetables contribute the most to dietary fiber intake in the Taiwanese population; therefore, the 2018 Dietary Guidelines of Taiwan for pregnant women recommend the consumption of 5–9 cups of fruits and vegetables per day. More than 80% of women in our cohort consumed fewer fruits and vegetables than this recommendation during pregnancy. On average, they consumed 4.9 g/day of dietary fiber, well below the recommended 25 g/day. The mean cups of fruits and vegetables were estimated as follows: five cups of fruits and vegetables (the minimum recommended), multiplied by 20% (derived from the average 4.9 g/day divided by the recommended 25 g/day of dietary fiber). The high or low consumption of vegetables and fruit was determined based on more than one cup of fruits and more than one cup of vegetables per day.
