Food taboos and perceived misconceptions among pregnant women in a Middle Eastern country

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Design A quantitative cross sectional research design was employed. Methods The study included 395 pregnant women recruited at 8–12 weeks of gestation. The samples were selected through convenient sampling technique. Data were analysed using SPSS 23 with descriptive statistics for frequencies, proportions, means and standard deviations. Data sources The data was collected using demographic data sheet and dietary beliefs questionnaire. Results More than half (56.5%) of the participants reported adhering to food taboos, mainly due to health concerns (88.4%), cultural beliefs (88.4%), and taste preferences (61.0%). Most (44.6%) of the participants avoided food due to lack of knowledge and 63.8% of them avoided food due to lack of physical activity. Few women avoided food due to previous bad obstetric history of gestational diabetes (22.8%), anaemia (14.7%), and abortion (12.2%). Cinnamon (100%), Fenugreek seeds (88.60%), papaya (73.4%), and pineapple (70.4%) were avoided due to the fear of miscarriage and hormonal imbalances. Other foods like grapes and honey are avoided with the fear of getting gestational diabetes mellitus. Meat and butter are avoided with the fear of getting hypertension. Multiparty (AOR = 0.588, p = 0.027) and health-related concerns (AOR = 0.372, p = 0.008) reduced the adherence to food taboos, while taste-driven avoidance to food were commonly found among Omani pregnant women (AOR = 1.659, p = 0.023). Conclusion The study highlights the urgent need for designing educational interventions aimed at increasing the awareness of harmful dietary practices during pregnancy. Implication for practice Addressing cultural beliefs and enhancing nutritional knowledge through community and healthcare-based initiatives can improve maternal and foetal health outcomes. Food taboos Nutritional knowledge Oman Maternal nutrition Dietary restrictions Impact What problem did the study address? The study assessed the food taboos and their related perceived misconceptions among pregnant women. What were the main findings? More than half of the participants reported adhering to food taboos, mainly due to health concerns, cultural beliefs, and taste preferences. Most of the participants avoided food due to lack of knowledge, and lack of physical activity. Few women avoided food due to previous bad obstetric history of gestational diabetes, anaemia and abortion. Cinnamon, Fenugreek seeds, papaya, and pineapple were avoided due to the fear of miscarriage and hormonal imbalances. Other foods like grapes and honey are avoided with the fear of getting gestational diabetes mellitus. Meat and butter are avoided with the fear of getting hypertension. Multiparty and health-related concerns reduced the adherence to food taboos, while taste-driven avoidance to food were commonly found among Omani pregnant women. Where and on whom will the research have an impact? The findings of the study will have a significant impact on the child bearing women and their new-borns. Introduction Nutrition is universally acknowledged as a cornerstone of health, particularly during the transformative period of pregnancy. 1 Adequate maternal nutrition is essential not only for the mother's well-being but also for the optimal development of the foetus. 2 A well-balanced diet during pregnancy can help to prevent a range of health issues, including anemia, gestational diabetes, gestational hypertension, and congenital anomalies . Key nutrients such as folic acid, calcium, iron, and other essential vitamins and micronutrients are crucial for fetal growth, reducing complications, and ensuring healthy birth outcomes. 3 Despite widespread awareness of the importance of proper nutrition, many pregnant women globally face significant challenges in maintaining optimal diet. These challenges are often influenced by socio-economic factors, inadequate knowledge, and improper advice from the public. 4 Further, these practices are deeply rooted in the culture. 5 In numerous societies such as India, Nigeria, Oman and Mexico, traditional beliefs dictate what foods pregnant women should consume or avoid during pregnancy. 6-8 Traditional beliefs govern the dietary choices of pregnant women, often prioritizing generational wisdom over scientific evidence. 9 Food taboos are dietary restrictions due to misconceptions related to certain food items which consequently results in depletion of essential nutrients. 10 These misconceptions arise in the society due to cultural, religious, social and historical beliefs. These food taboos cause a major burden of micronutrient deficiencies, under nutrition and overeating. 11 Every rural and urban society has their own food taboos followed throughout life. In particular, food taboos are followed in women starting from their birth, through menarche, marriage, child birth, motherhood and widowhood. 12 Food taboos have detrimental effect on the pregnant women and the fetus through prohibition of essential nutrients. 10-11 Due to scarcity of data related to food taboos and their misconceptions in the Middle Eastern region, the investigators of the study assessed the food taboos and their misconceptions among pregnant women in Oman. Background Globally, food taboos are considered absolute and should not be violated or ignored, for instance, pregnant women avoid certain foods such as papaya, pineapple, fenugreek, cinnamon, eggs, and honey 13 . Some of these restrictions are based on the belief that these foods could cause miscarriage, negatively affect the baby’s health, or even bring bad luck. 14 While some food taboos have originated from practical observations such as avoiding items that could cause allergic reactions or gastrointestinal discomfort, others are rooted in myths or symbolic beliefs that associate certain foods with negative pregnancy outcomes. 14 Regardless of their origin, these prohibitions can have detrimental effects on maternal nutrition and, consequently, pregnancy outcomes 15-16 . Therefore, addressing food taboos through targeted education and awareness campaigns is essential to enhance maternal nutrition and promote better health outcomes for both the mother and child. In Oman, the prevalence of gestational anemia is 30%, hypertension is 12.5%, gestational diabetes is 9.2% and the abortion rate is 135.3 per 1000 live births. The Ministry of Health (MoH), Oman has embraced numerous strategies to improve the health status of pregnant women including implementation of comprehensive prenatal care programs that provide regular check-ups, screenings, and health education. 17 Key initiatives include promoting adequate nutrition through micronutrient supplementation, such as iron and folic acid, to prevent deficiencies and complications 17 . In addition, public awareness campaigns are designed to empower women with knowledge about the importance of prenatal care and healthy lifestyle choices. 17 Despite the comprehensive strategies to enhance the health status of pregnant women in Oman, pregnancy-related issues continue to rise due to improper dietary practices. Many pregnant women lack awareness of essential nutritional needs and the importance of consuming a balanced diet rich in vitamins and minerals. 18 Factors such as food taboos, cultural beliefs, and limited access to nutritious foods further exacerbate these issues, leading to deficiencies that negatively impact maternal and fetal health. 18 Additionally, misconceptions about certain foods can result in inadequate intake of vital nutrients, increasing the risk of complications such as anemia, gestational diabetes, and low birth weight 19 . Addressing these dietary challenges through targeted education and community support is crucial for improving maternal health outcomes and ensuring the well-being of both mothers and their babies. 19 The study Hence, this study aimed to assess the food taboos and perceived misconceptions among pregnant women attending antenatal clinics of a public hospital in Oman. The findings will provide relevant information about food taboo practices and their perceived misconceptions among Omani pregnant women and the determinants of food taboos that may affect maternal and fetal health outcomes. This baseline data will be useful to the policy makers to design evidence based interventions to mitigate the food taboos and encourage the pregnant women to follow healthy eating practices. Methodology Research design The study utilized a quantitative cross sectional research design to assess the food taboos and their perceived misconceptions among pregnant women. Study Setting The study was conducted at Sultan Qaboos University Hospital (SQUH), a major tertiary care public hospital in Muscat, Oman. This hospital provides comprehensive healthcare services including maternal and child healthcare services. The antenatal outpatient department registers approximately 600 pregnant women monthly, with 300–350 deliveries every month and 10–15 postnatal mothers daily. Sample, Sample Size and Sampling technique The study included 395 pregnant Omani women without chronic medical conditions. Sample size was calculated using the standard formula for estimating a population proportion: n=Z2P (1 − P)/d2n = Z^2 P (1 − P)/d^2n=Z2P (1 − P)/d2, assuming a 50% prevalence (P = 0.5), 5% margin of error (d = 0.05), and 95% confidence level (Z = 1.96), yielding a minimum required sample of 385. To account for attrition, an additional 20% was recruited, bringing the total sample size to 395. When the true prevalence is unknown, a prevalence of 50% is commonly assumed as it yields the maximum required sample size. A margin of error of 5% was selected to ensure adequate precision in estimating proportions. Additionally, a 20% attrition rate was incorporated to account for incomplete responses and potential participant withdrawal. The samples were selected through convenient sampling technique. Criteria for sample selection Inclusion Criteria Participants included pregnant Omani women of any parity, residing in Muscat region, registered at SQUH between 8 to 12 weeks of gestation, and consenting to deliver at the hospital. Early pregnancy (8–12 weeks) is a critical period when women begin to form dietary beliefs and make changes to their eating practices. Assessing food taboos at this stage helps to identify misconceptions early, enabling nutritional guidance and reducing risk of adverse pregnancy outcomes. Exclusion Criteria Women with irregular antenatal visits, those who did not consent to participate, and those with pre-existing conditions such as Type 1 diabetes, Glucose-6-phosphate dehydrogenase (G6PD) deficiency, thalassemia, sickle cell disease, and asthma were excluded. Data collection instruments It included the following; Part 1 Demographic data of the study participants It includes the parity, age in years, education, occupation, family type and social support. Part 2 Dietary beliefs questionnaire A culturally appropriate dietary beliefs questionnaire was developed by the investigators of the study. The questionnaire was prepared based on the suggestions from the subject experts, 2009 Omani Dietary Guidelines 20 , and local dietary beliefs. Suggestions derived from local dietary beliefs were incorporated into the questionnaire through a systematic and context-sensitive process. Initially, commonly held food beliefs and taboos during pregnancy were identified through a review of local literature, informal discussions with pregnant women, and consultations with experienced dietitians, maternal health nurses, and midwives familiar with the community. These beliefs were then translated into questionnaire items using culturally appropriate language. The draft questionnaire was reviewed by subject experts to ensure content relevance and clarity, and pilot tested with a small group pregnant women to assess comprehension and cultural acceptability. Feedback from the pilot testing was used to refine the items before final administration. This process ensured methodological transparency and enhanced the transferability of the approach to similar settings. The tool was pilot-tested and the Content Validity Index (CVI) is 0.76, Cronbach’s alpha is 0.78. A food taboo matrix was used to record the perceived reasons for avoidance of specific foods. It is a structured tool used to systematically document and analyse culturally specific food taboos. It was prepared by the investigators of the study. It organizes complex belief-based information in a clear, compatible format, making it particularly useful in maternal nutrition research. Typically, the matrix is arranged in rows and columns, where rows list specific foods or food groups commonly consumed in the local context. Columns capture key attributes such as whether the food is considered taboo, and the perceived reason for avoidance. Participants were given a list of 24 commonly consumed food items and were asked to rate whether the food items were safe to consume during pregnancy. If avoided, they were further asked to select the perceived reasons to avoid certain foods from a predefined list. Data collection procedure The data was collected from September 2021 to August 2023. Initial contact was made during the pregnant women’s first antenatal visit (8–12 weeks of gestation) and the demographic and dietary beliefs data were collected. Statistical analysis Each response was coded numerically, and the data were organized into a matrix with food items as rows and avoidance reasons as columns. The frequency of each reason per food item was then calculated. A separate column represented the number of participants who indicated that the food was safe to consume. This structure enabled the identification of commonly held beliefs associated with each food taboos and allowed further statistical analysis. Data were analyzed using SPSS 23 with descriptive statistics for frequencies, proportions, means and standard deviations. Ethical considerations Ethical approval was obtained from the Medical Research and Ethics committee of College of Medicine and Health Sciences, Sultan Qaboos University, Oman (Ref. No: SQU-EC/314/2022–2419). Permission was obtained from the Medical Director of the data collection setting to collect the data. Written informed consent was obtained from the study participants. The participants were not forced to participate in the study. None of their identifying information was collected. The collected data was stored in a password protected file and was kept under the custody of the principal investigator of the study. All experiments were performed in accordance with the Declaration of Helsinki. Results Among 395 Omani pregnant women, majority were multiparous (66.8%) and aged 25–30 years (39.0%). Most of them had a graduate degree (54.7%) and were primarily homemakers (39.5%). A larger proportion lived in joint families (54.9%), and 61.8% received social support during pregnancy (Table-1). More than half of the participants (56.5%) adhered to food taboos during pregnancy. Most of the participants (51.4%) slept 7–8 hours daily. Regarding physical activity, 42.3% and 43.0% of them exercised daily and as time permitted respectively. Nutritional information was mainly obtained from family members (76.7%). Cultural beliefs and health concerns were the primary reasons for food avoidance (88.4% each), followed by taste preferences (61.0%), lack of physical activity (63.8%), and insufficient nutritional knowledge (55.4%). In terms of avoidance of food due to previous bad obstetric history, 22.8% reported that they avoided certain foods as they had gestational diabetes in the previous pregnancy, followed by anemia (14.7%), abortion (12.2%), hypertension (8.1%), and infertility (8.1%). Less common reported bad obstetric history includes infections (1.5%), bleeding (0.8%), and small-for-gestational-age births (0.8%) (Table 2). The data regarding perceived misconceptions related to food taboos during pregnancy shows that a significant proportion of women believed papaya (73.4%) and cinnamon (100%) could induce abortion. Similarly, 70.4% of participants associated pineapple with miscarriage. Misconceptions extended to green leafy vegetables, with 15.9% linking them to abortion and 9.1% to allergies. Coffee and tea were considered harmful by few participants, with 6.1% attributing them to adverse fetal outcomes, 2.5% to acidity, and 1.5% to hypertension. Potatoes were believed to be associated with weight gain (8.9%), acidity (10.9%), and hypertension (4.1%). Despite their nutritional value, bananas, meat, fish, butter, ginger, honey, and strawberries were also commonly misconstrued as harmful, with beliefs linking them to allergies, anemia, hormonal imbalance, and excessive weight gain (Table-3). Multivariate logistic regression identified that being multiparous significantly reduced the likelihood of adhering to food taboos (AOR = 0.588, 95% CI: 0.37–0.92, p = 0.027). Avoiding food due to health concerns also lowered the odds of food taboo adherence (AOR = 0.372, 95% CI: 0.17–0.73, p = 0.008). However, avoiding food based on taste was a significant predictor of following food taboos (AOR = 1.659, 95% CI: 1.05–2.62, p = 0.023) (Table-4). Discussion In the present study, most of the pregnant women adhered to food taboos during pregnancy. Consistently, majority (27.5%; 34.22%) of Ethiopian pregnant women followed food taboo practices. 19 , 21 Likewise, in Malysia, 70.2% of pregnant women avoided essential food items due to food taboos. 22 In India, 75% of pregnant women avoided certain foods during pregnancy considering that those foods are unsafe to their fetus. 23 In addition, a systematic review conducted in Sub-Sahara Africa revealed that the food taboo practices among pregnant women in the urban area are 40% and 43% in rural areas. 24 Further, 67.4% of pregnant women in Eastern Ethiopia adhered to food taboos. 25 These findings indicates the need to strengthen the nutritional counseling services to pregnant women and the need to reorient them to the evidence based nutritional benefits during pregnancy. Food taboos are practiced across the world due to various misconceptions related to certain food. 21 In the current study, insufficient nutritional knowledge was the most commonly reported reason for food taboos during pregnancy. Insufficient nutritional knowledge among the participants can be explained by several interrelated factors. First, the heavy reliance on family members as the primary source of nutritional information suggests limited access to, or utilization of, formal nutrition education from healthcare professionals. Family-based advice, while culturally trusted, may be based on traditional beliefs rather than evidence-based guidelines. Second, cultural norms and food taboos may resist open discussion about appropriate dietary practices during pregnancy leading women to follow avoidance behaviors without understanding their nutritional consequences. Third, limited exposure to structured antenatal education counselling-especially in early pregnancy can reduce opportunities to acquire accurate information about balanced diets, nutrient requirements, and the importance of physical activity. Additionally, time constraints, competing household responsibilities, and varying levels of health literacy may further limit women’s ability to seek, understand, and apply nutrition related information. Together, these factors contribute to gaps in nutritional knowledge, reinforcing misconceptions and potentially influencing dietary choices during pregnancy. In line with the current study finding, many other studies have found lack of maternal nutrition knowledge as a determinant of food taboos during pregnancy. 20 , 21 , 22 , 23 , 24 , 25 , 26 Insufficient nutritional knowledge is shown to be a key reason for food taboos during pregnancy. Therefore, community based nutritional education campaigns are to be organized to increase the uptake of healthy and essential nutrition during pregnancy. Perception of wellbeing varies significantly across cultures. Therefore, food taboos during pregnancy should be approached to understand the specific reason in the specific culture to design appropriate culturally relevant nutritional intervention. 27 – 28 In the current study, cultural beliefs were reported as one of the determinant for food taboos during pregnancy. In corroboration with the present study finding, many other studies across the world reported cultural beliefs as a reason for adherence to food taboos during pregnancy. 16 , 17 , 18 , 19 , 24 , 25 , 29 Further, a systematic review have shown that the women in low and middle income countries engage in various cultural food practices during pregnancy. 30 Thus, culturally appropriate nutrition education is essential to improve the nutritional practices during this crucial period. Food preferences are linked to food taboos during pregnancy. 27 Understanding the individual food preferences is critical in developing nutritional interventions during pregnancy. 31 Taste preferences were one of the primary reasons for food avoidance in the current study. Similarly, Placek, Madhivanan & Hagen, (2017) 32 reported that the aversion to staple foods are very common during pregnancy due to taste preferences. Aversion to certain foods is believed that they are harmful to the fetus as these foods could cause toxicity early in the pregnancy. As this information is not true, appropriate evidence based nutritional information should be imparted to the community at the large. Literature originated from Asia and Africa shows food taboos observed during pregnancy leads to detrimental impact on the mother and the fetus. 33 Likewise, limited intake of vegetable and animal protein and micronutrients during pregnancy has long-term consequences on the growth, immunological, and cognitive development of the children and increases the health risk in mothers. 34 In the current study, the pregnant women avoided certain foods such as papaya, cinnamon, pineapple, green leafy vegetables, coffee and tea, potatoes, bananas, meat, fish, butter, honey, ginger, and strawberries. Moreover, the pregnant women believed that these foods could cause abortion, allergy, hypertension, gestational diabetes, anemia, acidity and weight gain. Similar to the current study findings, Ethiopian pregnant women avoided food such as banana, honey, yogurt, and wheat. 19 Further, Bangladeshi pregnant women avoided fish, twin bananas, duck eggs, pineapple, and coconut with a fear that these foods are harmful during pregnancy. 30 In North West Ethiopia, pregnant women avoided honey, milk, meat, cereals and fruits believing that these food items will make the baby fatty. 11 Additionally, Malaysian women avoided eating pineapple, sugar cane drink, hot foods, carbonated drinks, and cold foods. The reason reported for avoiding these food items includes the fear of abortion, fear of excessive bleeding during labor, difficult labor, vomiting, edema, and the fear of baby born with deformities. 21 In South Africa, pregnant women avoided mango, orange, papaya, peach, eggs, sweets, chili and alcohol. 24 Indian pregnant women avoided food such as banana, papaya, jackfruit, coconut, green leafy vegetables, meat, fish and eggs. 32 These findings indicate that food taboos during pregnancy are widespread and deeply rooted across diverse cultural settings, although the specific foods avoided vary by region. Despite these differences, the underlying beliefs show striking similarities, particularly fears related to miscarriage, labor complications, excessive bleeding, fetal deformities, or delivering a large baby. This suggests that food avoidance is largely driven by culturally transmitted perceptions of risk rather than by the nutritional properties of the foods themselves. The avoidance of nutrient-dense foods such as fish, eggs, meat, fruits, and green leafy vegetables is especially concerning, as it may compromise maternal and fetal nutritional status. These patterns reflect the strong influence of traditional knowledge systems and intergenerational advice on dietary practices during pregnancy, often outweighing evidence-based nutritional guidance. Overall, the findings highlight that food taboos are not isolated behaviors but culturally shared practices aimed at protecting the mother and fetus. However, when these beliefs lead to the restriction of essential foods, they may negatively affect pregnancy outcomes. This underscores the need for culturally sensitive and evidence based nutrition educational intervention that acknowledges local beliefs while correcting misconceptions and promoting balanced dietary practices. This will enhance the knowledge of the pregnant women and the community to adopt the best dietary practices, thereby a healthy motherhood and childhood. Strengths of the study The study enabled early identification of food taboos and the related misconceptions during pregnancy. This is the first of this kind of study conducted in Oman. This will help the policy makers to design evidence based culturally appropriate interventions to abolish food taboos during pregnancy. A culturally adapted, expert-informed questionnaire aligned with Omani dietary guidelines ensured contextual relevance and demonstrated good reliability and validity. This tool can be used to assess the dietary beliefs among the pregnant women in the Middle Eastern region. A large, statistically justified sample added robustness to the data. Limitations of the study Data collection using convenience sampling technique and a single urban hospital setting limits generalizability, especially to rural populations. Pregnant women in rural areas or those accessing other healthcare settings may hold distinct dietary beliefs are not captured in this study. The cross-sectional design limits the ability to assess changes in dietary beliefs and behaviors over time. Longitudinal studies would be more informative for understanding how food taboos evolve and whether educational interventions have lasting effects. Reliance on self-reported data introduces potential recall and social desirability biases. The absence of objective dietary intake data also limits the ability to link reported beliefs with actual nutritional deficiencies or health outcomes. In addition, the lack of qualitative data constrains the depth of cultural understanding. While the quantitative approach provides useful prevalence estimates, qualitative methods such as interviews or focus groups could reveal the cultural, emotional, and symbolic meanings underpinning food taboos, thereby informing the design of culturally sensitive interventions. Finally, while the study identifies determinants such as parity, health concerns, and taste preferences, it does not explore other potentially influential factors such as socioeconomic status, religious beliefs, or exposure to health information through media. Inclusion of these variables would provide a more comprehensive view of dietary decision-making during pregnancy. Recommendations Future studies should include diverse settings and populations, especially rural areas, and use qualitative methods to explore the cultural influences on food beliefs. This will provide a broader understanding of food taboos across socio-demographic groups. Culturally sensitive nutrition education should be integrated into antenatal care. Public health campaigns, involving community and religious leaders, can help reshape traditional nutritional beliefs. Longitudinal follow-up is needed to link evolving dietary beliefs to maternal and neonatal outcomes. Implications for Practice The high prevalence of food taboos highlights the need for culturally tailored nutrition counseling in antenatal care. Training healthcare providers to address harmful beliefs early can help prevent nutrient deficiencies and adverse outcomes in the mothers and their newborns. Public health messages should reflect cultural contexts, and community influencers can support myth-busting efforts. Findings support targeted interventions to improve maternal and fetal health outcomes Declarations Ethics approval and consent to participate Ethical approval was obtained from the Medical Research and Ethics committee of College of Medicine and Health Sciences, Sultan Qaboos University, Oman (Ref. No: SQU-EC/314/2022-2419). Permission was obtained from the Medical Director of the data collection setting to collect the data. Written informed consent was obtained from the study participants. Consent for publication Not Applicable Availability of data and materials The data will be available upon request from the authors. Corresponding author may be contacted to receive the raw data. Competing interests The authors declare that they don’t have any conflict of interest in publishing this manuscript. Funding The study did not receive any funding from any organizations. Reporting Method The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting observational studies was used. Patient or Public Contribution The antenatal women attending to the public hospital in Oman were recruited as study participants. The data were collected from the antenatal women who fulfilled the inclusion criteria. Authors' contributions Sophia Cyril VINCENT: Conceptualization, Ideas; formulation or evolution of overarching research goals and aims, Methodology, Writing - Original Draft Development or design of methodology; creation of models Judie ARULAPPAN: Conceptualization, Methodology, Writing - Original Draft, Supervision, Writing - Review & Editing Preeja PRABHAKARAN: Investigation, Conducting a research and investigation process, specifically performing the experiments, or data/evidence collection, Review & Editing Iman Al HASHMI: Review & Editing Maha Al-DUGHAISHI: Investigation, Conducting a research and investigation process, specifically performing the experiments, or data/evidence collection, Review & Editing Acknowledgements The authors acknowledge the study participants. References Marshall NE, Abrams B, Barbour LA, Catalano P, Christian P, Friedman JE, Hay WW Jr, Hernandez TL, Krebs NF, Oken E, Purnell JQ. 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Food taboos, health beliefs, and gender: understanding household food choice and nutrition in rural Tajikistan. J Health Popul Nutr. 2019;38(1):17. Lekey A, Masumo RM, Jumbe T, Ezekiel M, Daudi Z, Mchome NJ, David G, Onesmo W, Leyna GH. Food taboos and preferences among adolescent girls, pregnant women, breastfeeding mothers, and children aged 6–23 months in Mainland Tanzania: A qualitative study. PLOS Global Public Health. 2024;4(8):e0003598. Maggiulli O, Rufo F, Johns SE, Wells JC. Food taboos during pregnancy: meta-analysis on cross cultural differences suggests specific, diet-related pressures on childbirth among agriculturalists. PeerJ. 2022;10:e13633. Rahaman A, Afrin M, Mondal S. Dietary intake with food taboos among pregnant women attending antenatal checkups at a hospital in Narayanganj city, Bangladesh. Population Medicine. 2023;5(Supplement). Olajide BR, Van Der Pligt P, McKay FH. Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low-and middle-income countries residing in high income countries: A systematic review. PLoS ONE. 2024;19(5):e0303185. Placek CD, Madhivanan P, Hagen EH. Innate food aversions and culturally transmitted food taboos in pregnant women in rural southwest India: Separate systems to protect the fetus? Evol Hum Behav. 2017;38(6):714–28. Ramenzoni VC. Taboos, food avoidances, and diseases: Local epistemologies of health among Coastal Endenese in Eastern Indonesia. Front Sustainable Food Syst. 2023;7:977694. Iradukunda F. Food taboos during pregnancy. Health Care Women Int. 2020;41(2):159–68. Tables Table 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tablesdated11.04.2026.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 12 May, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviewers invited by journal 17 Apr, 2026 Editor assigned by journal 17 Apr, 2026 Editor invited by journal 14 Apr, 2026 Submission checks completed at journal 14 Apr, 2026 First submitted to journal 14 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9325333","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627785203,"identity":"ffe80fed-8607-4654-b0e9-86c3f604335b","order_by":0,"name":"Sophia Cyril VINCENT","email":"","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":false,"prefix":"","firstName":"Sophia","middleName":"Cyril","lastName":"VINCENT","suffix":""},{"id":627785204,"identity":"9a3903b4-85f4-47c0-a4b4-1d7cc6fd5911","order_by":1,"name":"Judie ARULAPPAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYBACxgYGgwMMFRCOBAlazpCiBQgMGBjbSNHCPCN544GP8+pkNxxgPnibh8EmmrDDZqQVHJy57bDxhgNsydY8DGm5DYS15Bgc5t12IHHDAR4zaR6Gw0Rq+TunDqiF/xsJWhgbmEG2sBGppedZwcGeY4eNZx5mM7acY0CEXwzbkzd/+FFTJ9t3vPnhjTcVNkRogaoAug1EGRBSDwTyMAcSNHwUjIJRMApGLgAAxkhBeU8+qvYAAAAASUVORK5CYII=","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":true,"prefix":"","firstName":"Judie","middleName":"","lastName":"ARULAPPAN","suffix":""},{"id":627785205,"identity":"54c991aa-5d94-4c7c-9515-eb9e116f3ddc","order_by":2,"name":"Preeja PRABHAKARAN","email":"","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":false,"prefix":"","firstName":"Preeja","middleName":"","lastName":"PRABHAKARAN","suffix":""},{"id":627785206,"identity":"ca77f6ca-8464-4c6a-ae66-fd232fd3da7f","order_by":3,"name":"Iman Al HASHMI","email":"","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":false,"prefix":"","firstName":"Iman","middleName":"Al","lastName":"HASHMI","suffix":""},{"id":627785207,"identity":"da830e13-b39b-4e64-a5ad-c0e045db03fb","order_by":4,"name":"Maha Al-DUGHAISHI","email":"","orcid":"","institution":"Sultan Qaboos University","correspondingAuthor":false,"prefix":"","firstName":"Maha","middleName":"","lastName":"Al-DUGHAISHI","suffix":""}],"badges":[],"createdAt":"2026-04-05 09:38:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9325333/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9325333/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107707627,"identity":"f1421464-ef50-43b7-a607-8e6483b689ec","added_by":"auto","created_at":"2026-04-24 09:20:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":237026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9325333/v1/2ffee1e6-a31d-4511-92be-b284c25314a6.pdf"},{"id":107699285,"identity":"16501d0d-5960-44b0-9641-fb3dc1a8dbbe","added_by":"auto","created_at":"2026-04-24 07:46:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":36121,"visible":true,"origin":"","legend":"","description":"","filename":"Tablesdated11.04.2026.docx","url":"https://assets-eu.researchsquare.com/files/rs-9325333/v1/9db874415fff11c7c7008504.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFood taboos and perceived misconceptions among pregnant women in a Middle Eastern country\u003c/p\u003e","fulltext":[{"header":"Impact","content":"\u003cp\u003e\u003cem\u003eWhat problem did the study address?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study assessed the food taboos and their related perceived misconceptions among pregnant women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat were the main findings?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMore than half of the participants reported adhering to food taboos, mainly due to health concerns, cultural beliefs, and taste preferences. Most of the participants avoided food due to lack of knowledge, and lack of physical activity. Few women avoided food due to previous bad obstetric history of gestational diabetes, anaemia and abortion. Cinnamon, Fenugreek seeds, papaya, and pineapple were avoided due to the fear of miscarriage and hormonal imbalances. \u0026nbsp;Other foods like grapes and honey are avoided with the fear of getting gestational diabetes mellitus. Meat and butter are avoided with the fear of getting hypertension. \u0026nbsp; Multiparty and health-related concerns reduced the adherence to food taboos, while taste-driven avoidance to food were commonly found among Omani pregnant women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhere and on whom will the research have an impact?\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of the study will have a significant impact on the child bearing women and their new-borns.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eNutrition is universally acknowledged as a cornerstone of health, particularly during the transformative period of pregnancy.\u003csup\u003e1\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/sup\u003eAdequate maternal nutrition is essential not only for the mother\u0026apos;s well-being but also for the optimal development of the foetus.\u003csup\u003e2\u003c/sup\u003e A well-balanced diet during pregnancy can help to prevent a range of health issues, including anemia, gestational diabetes, gestational hypertension, and congenital anomalies . Key nutrients such as folic acid, calcium, iron, and other essential vitamins and micronutrients are crucial for fetal growth, reducing complications, and ensuring healthy birth outcomes.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eDespite widespread awareness of the importance of proper nutrition, many pregnant women globally face significant challenges in maintaining optimal diet. These challenges are often influenced by socio-economic factors, inadequate knowledge, and improper advice from the public.\u003csup\u003e4\u0026nbsp;\u003c/sup\u003eFurther, these practices are deeply rooted in the culture. \u003csup\u003e5\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/sup\u003eIn numerous societies such as\u0026nbsp;India, Nigeria, Oman and Mexico, traditional beliefs dictate what foods pregnant women should consume or avoid during pregnancy.\u003csup\u003e6-8\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/sup\u003eTraditional beliefs govern the dietary choices of pregnant women, often prioritizing generational wisdom over scientific evidence.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eFood taboos are dietary restrictions due to misconceptions related to certain food items which consequently results in depletion of essential nutrients.\u003csup\u003e10\u003c/sup\u003e These misconceptions arise in the society due to cultural, religious, social and historical beliefs. These food taboos cause a major burden of micronutrient deficiencies, under nutrition and overeating.\u003csup\u003e11\u003c/sup\u003e Every rural and urban society has their own food taboos followed throughout life. In particular, food taboos are followed in women starting from their birth, through menarche, marriage, child birth, motherhood and widowhood.\u003csup\u003e12\u003c/sup\u003e Food taboos have detrimental effect on the pregnant women and the fetus through prohibition of essential nutrients.\u003csup\u003e10-11\u003c/sup\u003e Due to scarcity of data related to food taboos and their misconceptions in the Middle Eastern region, the investigators of the study assessed the food taboos and their misconceptions among pregnant women in Oman.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, food taboos are considered absolute and should not be violated or ignored, for instance, pregnant women avoid certain foods such as papaya, pineapple, fenugreek, cinnamon, eggs, and honey\u003csup\u003e13\u003c/sup\u003e. Some of these restrictions are based on the belief that these foods could cause miscarriage, negatively affect the baby\u0026rsquo;s health, or even bring bad luck.\u003cstrong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e14\u003c/sup\u003e While some food taboos have originated from practical observations such as avoiding items that could cause allergic reactions or gastrointestinal discomfort, others are rooted in myths or symbolic beliefs that associate certain foods with negative pregnancy outcomes.\u003csup\u003e14\u003c/sup\u003e Regardless of their origin, these prohibitions can have detrimental effects on maternal nutrition and, consequently, pregnancy outcomes\u003csup\u003e15-16\u003c/sup\u003e. Therefore, addressing food taboos through targeted education and awareness campaigns is essential to enhance maternal nutrition and promote better health outcomes for both the mother and child.\u003c/p\u003e\n\u003cp\u003eIn Oman, the prevalence of gestational anemia is 30%, hypertension is 12.5%, gestational diabetes is 9.2% and the abortion rate is 135.3 per 1000 live births. The Ministry of Health (MoH), Oman has embraced numerous strategies to improve the health status of pregnant women including\u0026nbsp;implementation of comprehensive prenatal care programs that provide regular check-ups, screenings, and health education.\u003csup\u003e17\u003c/sup\u003e Key initiatives include promoting adequate nutrition through micronutrient supplementation, such as iron and folic acid, to prevent deficiencies and complications\u003csup\u003e17\u003c/sup\u003e. In addition, public awareness campaigns are designed to empower women with knowledge about the importance of prenatal care and healthy lifestyle choices.\u003cstrong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eDespite the comprehensive strategies to enhance the health status of pregnant women in Oman, pregnancy-related issues continue to rise due to improper dietary practices. Many pregnant women lack awareness of essential nutritional needs and the importance of consuming a balanced diet rich in vitamins and minerals.\u003cstrong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e18\u0026nbsp;\u003c/sup\u003eFactors such as food taboos, cultural beliefs, and limited access to nutritious foods further exacerbate these issues, leading to deficiencies that negatively impact maternal and fetal health.\u003csup\u003e18\u003c/sup\u003e Additionally, misconceptions about certain foods can result in inadequate intake of vital nutrients, increasing the risk of complications such as anemia, gestational diabetes, and low birth weight\u003csup\u003e19\u003c/sup\u003e. Addressing these dietary challenges through targeted education and community support is crucial for improving maternal health outcomes and ensuring the well-being of both mothers and their babies.\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHence, this study aimed to assess the food taboos and perceived misconceptions among pregnant women attending antenatal clinics of a public hospital in Oman. The findings will provide relevant information about food taboo practices and their perceived misconceptions among Omani pregnant women and the \u0026nbsp; determinants of food taboos that may affect maternal and fetal health outcomes. This baseline data will be useful to the policy makers to design evidence based interventions to mitigate the food taboos and encourage the pregnant women to follow healthy eating practices.\u0026nbsp;\u003c/p\u003e"},{"header":"Methodology","content":"\u003ch2\u003eResearch design\u003c/h2\u003e\u003cp\u003eThe study utilized a quantitative cross sectional research design to assess the food taboos and their perceived misconceptions among pregnant women.\u003c/p\u003e\u003ch3\u003eStudy Setting\u003c/h3\u003e\u003cp\u003e The study was conducted at Sultan Qaboos University Hospital (SQUH), a major tertiary care public hospital in Muscat, Oman. This hospital provides comprehensive healthcare services including maternal and child healthcare services. The antenatal outpatient department registers approximately 600 pregnant women monthly, with 300–350 deliveries every month and 10–15 postnatal mothers daily.\u003c/p\u003e\u003ch3\u003eSample, Sample Size and Sampling technique\u003c/h3\u003e\u003cp\u003eThe study included 395 pregnant Omani women without chronic medical conditions. Sample size was calculated using the standard formula for estimating a population proportion: n=Z2P (1 − P)/d2n = Z^2 P (1 − P)/d^2n=Z2P (1 − P)/d2, assuming a 50% prevalence (P = 0.5), 5% margin of error (d = 0.05), and 95% confidence level (Z = 1.96), yielding a minimum required sample of 385. To account for attrition, an additional 20% was recruited, bringing the total sample size to 395. When the true prevalence is unknown, a prevalence of 50% is commonly assumed as it yields the maximum required sample size. A margin of error of 5% was selected to ensure adequate precision in estimating proportions. Additionally, a 20% attrition rate was incorporated to account for incomplete responses and potential participant withdrawal. The samples were selected through convenient sampling technique.\u003c/p\u003e\u003ch3\u003eCriteria for sample selection\u003c/h3\u003e\u003ch2\u003eInclusion Criteria\u003c/h2\u003e\u003cp\u003eParticipants included pregnant Omani women of any parity, residing in Muscat region, registered at SQUH between 8 to 12 weeks of gestation, and consenting to deliver at the hospital. Early pregnancy (8–12 weeks) is a critical period when women begin to form dietary beliefs and make changes to their eating practices. Assessing food taboos at this stage helps to identify misconceptions early, enabling nutritional guidance and reducing risk of adverse pregnancy outcomes.\u003c/p\u003e\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\u003cp\u003eWomen with irregular antenatal visits, those who did not consent to participate, and those with pre-existing conditions such as Type 1 diabetes, Glucose-6-phosphate dehydrogenase (G6PD) deficiency, thalassemia, sickle cell disease, and asthma were excluded.\u003c/p\u003e\u003ch3\u003eData collection instruments\u003c/h3\u003e\u003cp\u003eIt included the following;\u003c/p\u003e\u003ch2\u003ePart 1\u003c/h2\u003e\u003ch2\u003eDemographic data of the study participants\u003c/h2\u003e\u003cp\u003eIt includes the parity, age in years, education, occupation, family type and social support.\u003c/p\u003e\u003ch2\u003ePart 2\u003c/h2\u003e\u003ch2\u003eDietary beliefs questionnaire\u003c/h2\u003e\u003cp\u003eA culturally appropriate dietary beliefs questionnaire was developed by the investigators of the study. The questionnaire was prepared based on the suggestions from the subject experts, 2009 Omani Dietary Guidelines\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, and local dietary beliefs. Suggestions derived from local dietary beliefs were incorporated into the questionnaire through a systematic and context-sensitive process. Initially, commonly held food beliefs and taboos during pregnancy were identified through a review of local literature, informal discussions with pregnant women, and consultations with experienced dietitians, maternal health nurses, and midwives familiar with the community. These beliefs were then translated into questionnaire items using culturally appropriate language. The draft questionnaire was reviewed by subject experts to ensure content relevance and clarity, and pilot tested with a small group pregnant women to assess comprehension and cultural acceptability. Feedback from the pilot testing was used to refine the items before final administration. This process ensured methodological transparency and enhanced the transferability of the approach to similar settings. The tool was pilot-tested and the Content Validity Index (CVI) is 0.76, Cronbach’s alpha is 0.78.\u003c/p\u003e\u003cp\u003eA food taboo matrix was used to record the perceived reasons for avoidance of specific foods. It is a structured tool used to systematically document and analyse culturally specific food taboos. It was prepared by the investigators of the study. It organizes complex belief-based information in a clear, compatible format, making it particularly useful in maternal nutrition research. Typically, the matrix is arranged in rows and columns, where rows list specific foods or food groups commonly consumed in the local context. Columns capture key attributes such as whether the food is considered taboo, and the perceived reason for avoidance. Participants were given a list of 24 commonly consumed food items and were asked to rate whether the food items were safe to consume during pregnancy. If avoided, they were further asked to select the perceived reasons to avoid certain foods from a predefined list.\u003c/p\u003e\u003ch2\u003eData collection procedure\u003c/h2\u003e\u003cp\u003eThe data was collected from September 2021 to August 2023. Initial contact was made during the pregnant women’s first antenatal visit (8–12 weeks of gestation) and the demographic and dietary beliefs data were collected.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eEach response was coded numerically, and the data were organized into a matrix with food items as rows and avoidance reasons as columns. The frequency of each reason per food item was then calculated. A separate column represented the number of participants who indicated that the food was safe to consume. This structure enabled the identification of commonly held beliefs associated with each food taboos and allowed further statistical analysis. Data were analyzed using SPSS 23 with descriptive statistics for frequencies, proportions, means and standard deviations.\u003c/p\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003e \u003cstrong\u003e\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eEthical approval was obtained from the Medical Research and Ethics committee of College of Medicine and Health Sciences, Sultan Qaboos University, Oman (Ref. No: SQU-EC/314/2022–2419). Permission was obtained from the Medical Director of the data collection setting to collect the data. Written informed consent was obtained from the study participants. The participants were not forced to participate in the study. None of their identifying information was collected. The collected data was stored in a password protected file and was kept under the custody of the principal investigator of the study. All experiments were performed in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 395 Omani pregnant women, majority were multiparous (66.8%) and aged 25\u0026ndash;30 years (39.0%). Most of them had a graduate degree (54.7%) and were primarily homemakers (39.5%). A larger proportion lived in joint families (54.9%), and 61.8% received social support during pregnancy (Table-1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore than half of the participants (56.5%) adhered to food taboos during pregnancy. Most of the participants (51.4%) slept 7\u0026ndash;8 hours daily. Regarding physical activity, 42.3% and 43.0% of them exercised daily and as time permitted respectively. Nutritional information was mainly obtained from family members (76.7%). Cultural beliefs and health concerns were the primary reasons for food avoidance (88.4% each), followed by taste preferences (61.0%), lack of physical activity (63.8%), and insufficient nutritional knowledge (55.4%). In terms of avoidance of food due to previous bad obstetric history, 22.8% reported that they avoided certain foods as they had gestational diabetes in the previous pregnancy, followed by anemia (14.7%), abortion (12.2%), hypertension (8.1%), and infertility (8.1%). Less common reported bad obstetric history includes infections (1.5%), bleeding (0.8%), and small-for-gestational-age births (0.8%) (Table 2).\u003c/p\u003e\n\u003cp\u003eThe data regarding perceived misconceptions related to food taboos during pregnancy shows that a significant proportion of women believed papaya (73.4%) and cinnamon (100%) could induce abortion. Similarly, 70.4% of participants associated pineapple with miscarriage. Misconceptions extended to green leafy vegetables, with 15.9% linking them to abortion and 9.1% to allergies. Coffee and tea were considered harmful by few participants, with 6.1% attributing them to adverse fetal outcomes, 2.5% to acidity, and 1.5% to hypertension. Potatoes were believed to be associated with weight gain (8.9%), acidity (10.9%), and hypertension (4.1%). Despite their nutritional value, bananas, meat, fish, butter, ginger, honey, and strawberries were also commonly misconstrued as harmful, with beliefs linking them to allergies, anemia, hormonal imbalance, and excessive weight gain (Table-3).\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression identified that being multiparous significantly reduced the likelihood of adhering to food taboos (AOR = 0.588, 95% CI: 0.37\u0026ndash;0.92, p = 0.027). Avoiding food due to health concerns also lowered the odds of food taboo adherence (AOR = 0.372, 95% CI: 0.17\u0026ndash;0.73, p = 0.008). However, avoiding food based on taste was a significant predictor of following food taboos (AOR = 1.659, 95% CI: 1.05\u0026ndash;2.62, p = 0.023) (Table-4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, most of the pregnant women adhered to food taboos during pregnancy. Consistently, majority (27.5%; 34.22%) of Ethiopian pregnant women followed food taboo practices.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Likewise, in Malysia, 70.2% of pregnant women avoided essential food items due to food taboos.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e In India, 75% of pregnant women avoided certain foods during pregnancy considering that those foods are unsafe to their fetus.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In addition, a systematic review conducted in Sub-Sahara Africa revealed that the food taboo practices among pregnant women in the urban area are 40% and 43% in rural areas.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Further, 67.4% of pregnant women in Eastern Ethiopia adhered to food taboos.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e These findings indicates the need to strengthen the nutritional counseling services to pregnant women and the need to reorient them to the evidence based nutritional benefits during pregnancy.\u003c/p\u003e \u003cp\u003eFood taboos are practiced across the world due to various misconceptions related to certain food.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In the current study, insufficient nutritional knowledge was the most commonly reported reason for food taboos during pregnancy. Insufficient nutritional knowledge among the participants can be explained by several interrelated factors. First, the heavy reliance on family members as the primary source of nutritional information suggests limited access to, or utilization of, formal nutrition education from healthcare professionals. Family-based advice, while culturally trusted, may be based on traditional beliefs rather than evidence-based guidelines. Second, cultural norms and food taboos may resist open discussion about appropriate dietary practices during pregnancy leading women to follow avoidance behaviors without understanding their nutritional consequences. Third, limited exposure to structured antenatal education counselling-especially in early pregnancy can reduce opportunities to acquire accurate information about balanced diets, nutrient requirements, and the importance of physical activity. Additionally, time constraints, competing household responsibilities, and varying levels of health literacy may further limit women\u0026rsquo;s ability to seek, understand, and apply nutrition related information. Together, these factors contribute to gaps in nutritional knowledge, reinforcing misconceptions and potentially influencing dietary choices during pregnancy. In line with the current study finding, many other studies have found lack of maternal nutrition knowledge as a determinant of food taboos during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Insufficient nutritional knowledge is shown to be a key reason for food taboos during pregnancy. Therefore, community based nutritional education campaigns are to be organized to increase the uptake of healthy and essential nutrition during pregnancy.\u003c/p\u003e \u003cp\u003ePerception of wellbeing varies significantly across cultures. Therefore, food taboos during pregnancy should be approached to understand the specific reason in the specific culture to design appropriate culturally relevant nutritional intervention.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e In the current study, cultural beliefs were reported as one of the determinant for food taboos during pregnancy. In corroboration with the present study finding, many other studies across the world reported cultural beliefs as a reason for adherence to food taboos during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Further, a systematic review have shown that the women in low and middle income countries engage in various cultural food practices during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Thus, culturally appropriate nutrition education is essential to improve the nutritional practices during this crucial period.\u003c/p\u003e \u003cp\u003eFood preferences are linked to food taboos during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Understanding the individual food preferences is critical in developing nutritional interventions during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Taste preferences were one of the primary reasons for food avoidance in the current study. Similarly, Placek, Madhivanan \u0026amp; Hagen, (2017)\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e reported that the aversion to staple foods are very common during pregnancy due to taste preferences. Aversion to certain foods is believed that they are harmful to the fetus as these foods could cause toxicity early in the pregnancy. As this information is not true, appropriate evidence based nutritional information should be imparted to the community at the large.\u003c/p\u003e \u003cp\u003eLiterature originated from Asia and Africa shows food taboos observed during pregnancy leads to detrimental impact on the mother and the fetus.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Likewise, limited intake of vegetable and animal protein and micronutrients during pregnancy has long-term consequences on the growth, immunological, and cognitive development of the children and increases the health risk in mothers.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e In the current study, the pregnant women avoided certain foods such as papaya, cinnamon, pineapple, green leafy vegetables, coffee and tea, potatoes, bananas, meat, fish, butter, honey, ginger, and strawberries. Moreover, the pregnant women believed that these foods could cause abortion, allergy, hypertension, gestational diabetes, anemia, acidity and weight gain. Similar to the current study findings, Ethiopian pregnant women avoided food such as banana, honey, yogurt, and wheat.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurther, Bangladeshi pregnant women avoided fish, twin bananas, duck eggs, pineapple, and coconut with a fear that these foods are harmful during pregnancy.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e In North West Ethiopia, pregnant women avoided honey, milk, meat, cereals and fruits believing that these food items will make the baby fatty.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Additionally, Malaysian women avoided eating pineapple, sugar cane drink, hot foods, carbonated drinks, and cold foods. The reason reported for avoiding these food items includes the fear of abortion, fear of excessive bleeding during labor, difficult labor, vomiting, edema, and the fear of baby born with deformities.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In South Africa, pregnant women avoided mango, orange, papaya, peach, eggs, sweets, chili and alcohol.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Indian pregnant women avoided food such as banana, papaya, jackfruit, coconut, green leafy vegetables, meat, fish and eggs.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese findings indicate that food taboos during pregnancy are widespread and deeply rooted across diverse cultural settings, although the specific foods avoided vary by region. Despite these differences, the underlying beliefs show striking similarities, particularly fears related to miscarriage, labor complications, excessive bleeding, fetal deformities, or delivering a large baby. This suggests that food avoidance is largely driven by culturally transmitted perceptions of risk rather than by the nutritional properties of the foods themselves. The avoidance of nutrient-dense foods such as fish, eggs, meat, fruits, and green leafy vegetables is especially concerning, as it may compromise maternal and fetal nutritional status. These patterns reflect the strong influence of traditional knowledge systems and intergenerational advice on dietary practices during pregnancy, often outweighing evidence-based nutritional guidance.\u003c/p\u003e \u003cp\u003eOverall, the findings highlight that food taboos are not isolated behaviors but culturally shared practices aimed at protecting the mother and fetus. However, when these beliefs lead to the restriction of essential foods, they may negatively affect pregnancy outcomes. This underscores the need for culturally sensitive and evidence based nutrition educational intervention that acknowledges local beliefs while correcting misconceptions and promoting balanced dietary practices. This will enhance the knowledge of the pregnant women and the community to adopt the best dietary practices, thereby a healthy motherhood and childhood.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStrengths of the study\u003c/h2\u003e \u003cp\u003eThe study enabled early identification of food taboos and the related misconceptions during pregnancy. This is the first of this kind of study conducted in Oman. This will help the policy makers to design evidence based culturally appropriate interventions to abolish food taboos during pregnancy. A culturally adapted, expert-informed questionnaire aligned with Omani dietary guidelines ensured contextual relevance and demonstrated good reliability and validity. This tool can be used to assess the dietary beliefs among the pregnant women in the Middle Eastern region. A large, statistically justified sample added robustness to the data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eData collection using convenience sampling technique and a single urban hospital setting limits generalizability, especially to rural populations. Pregnant women in rural areas or those accessing other healthcare settings may hold distinct dietary beliefs are not captured in this study. The cross-sectional design limits the ability to assess changes in dietary beliefs and behaviors over time. Longitudinal studies would be more informative for understanding how food taboos evolve and whether educational interventions have lasting effects. Reliance on self-reported data introduces potential recall and social desirability biases. The absence of objective dietary intake data also limits the ability to link reported beliefs with actual nutritional deficiencies or health outcomes. In addition, the lack of qualitative data constrains the depth of cultural understanding. While the quantitative approach provides useful prevalence estimates, qualitative methods such as interviews or focus groups could reveal the cultural, emotional, and symbolic meanings underpinning food taboos, thereby informing the design of culturally sensitive interventions. Finally, while the study identifies determinants such as parity, health concerns, and taste preferences, it does not explore other potentially influential factors such as socioeconomic status, religious beliefs, or exposure to health information through media. Inclusion of these variables would provide a more comprehensive view of dietary decision-making during pregnancy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eFuture studies should include diverse settings and populations, especially rural areas, and use qualitative methods to explore the cultural influences on food beliefs. This will provide a broader understanding of food taboos across socio-demographic groups. Culturally sensitive nutrition education should be integrated into antenatal care. Public health campaigns, involving community and religious leaders, can help reshape traditional nutritional beliefs. Longitudinal follow-up is needed to link evolving dietary beliefs to maternal and neonatal outcomes.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eThe high prevalence of food taboos highlights the need for culturally tailored nutrition counseling in antenatal care. Training healthcare providers to address harmful beliefs early can help prevent nutrient deficiencies and adverse outcomes in the mothers and their newborns. Public health messages should reflect cultural contexts, and community influencers can support myth-busting efforts. Findings support targeted interventions to improve maternal and fetal health outcomes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Medical Research and Ethics committee of College of Medicine and Health Sciences, Sultan Qaboos University, Oman (Ref. No: SQU-EC/314/2022-2419). Permission was obtained from the Medical Director of the data collection setting to collect the data. Written informed consent was obtained from the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data will be available upon request from the authors. Corresponding author may be contacted to receive the raw data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they don\u0026rsquo;t have any conflict of interest in publishing this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study did not receive any funding from any organizations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReporting Method\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting observational studies was used.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatient or Public Contribution\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe antenatal women attending to the public hospital in Oman were recruited as study participants. The data were collected from the antenatal women who fulfilled the inclusion criteria. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSophia Cyril VINCENT:\u0026nbsp;\u003c/strong\u003e Conceptualization, Ideas; formulation or evolution of overarching research goals and aims, Methodology, Writing - Original Draft\u003c/p\u003e\n\u003cp\u003eDevelopment or design of methodology; creation of models\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJudie ARULAPPAN:\u0026nbsp;\u003c/strong\u003e\u0026nbsp; Conceptualization, Methodology, Writing - Original Draft, Supervision, Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreeja PRABHAKARAN:\u003c/strong\u003e Investigation, Conducting a research and investigation process, specifically performing the experiments, or data/evidence collection, Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIman Al HASHMI:\u0026nbsp;\u003c/strong\u003eReview \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaha Al-DUGHAISHI:\u0026nbsp;\u003c/strong\u003eInvestigation, Conducting a research and investigation process, specifically performing the experiments, or data/evidence collection, Review \u0026amp; Editing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the study participants.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMarshall NE, Abrams B, Barbour LA, Catalano P, Christian P, Friedman JE, Hay WW Jr, Hernandez TL, Krebs NF, Oken E, Purnell JQ. 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PLOS Global Public Health. 2024;4(8):e0003598.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaggiulli O, Rufo F, Johns SE, Wells JC. Food taboos during pregnancy: meta-analysis on cross cultural differences suggests specific, diet-related pressures on childbirth among agriculturalists. PeerJ. 2022;10:e13633.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahaman A, Afrin M, Mondal S. Dietary intake with food taboos among pregnant women attending antenatal checkups at a hospital in Narayanganj city, Bangladesh. Population Medicine. 2023;5(Supplement).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlajide BR, Van Der Pligt P, McKay FH. Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low-and middle-income countries residing in high income countries: A systematic review. PLoS ONE. 2024;19(5):e0303185.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlacek CD, Madhivanan P, Hagen EH. Innate food aversions and culturally transmitted food taboos in pregnant women in rural southwest India: Separate systems to protect the fetus? Evol Hum Behav. 2017;38(6):714\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamenzoni VC. Taboos, food avoidances, and diseases: Local epistemologies of health among Coastal Endenese in Eastern Indonesia. Front Sustainable Food Syst. 2023;7:977694.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIradukunda F. Food taboos during pregnancy. Health Care Women Int. 2020;41(2):159\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Food taboos, Nutritional knowledge, Oman, Maternal nutrition, Dietary restrictions","lastPublishedDoi":"10.21203/rs.3.rs-9325333/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9325333/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe study examined the food taboos and perceived misconceptions among pregnant women.\u003c/p\u003e\u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA quantitative cross sectional research design was employed.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study included 395 pregnant women recruited at 8\u0026ndash;12 weeks of gestation. The samples were selected through convenient sampling technique. Data were analysed using SPSS 23 with descriptive statistics for frequencies, proportions, means and standard deviations.\u003c/p\u003e\u003ch2\u003eData sources\u003c/h2\u003e \u003cp\u003eThe data was collected using demographic data sheet and dietary beliefs questionnaire.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMore than half (56.5%) of the participants reported adhering to food taboos, mainly due to health concerns (88.4%), cultural beliefs (88.4%), and taste preferences (61.0%). Most (44.6%) of the participants avoided food due to lack of knowledge and 63.8% of them avoided food due to lack of physical activity. Few women avoided food due to previous bad obstetric history of gestational diabetes (22.8%), anaemia (14.7%), and abortion (12.2%). Cinnamon (100%), Fenugreek seeds (88.60%), papaya (73.4%), and pineapple (70.4%) were avoided due to the fear of miscarriage and hormonal imbalances. Other foods like grapes and honey are avoided with the fear of getting gestational diabetes mellitus. Meat and butter are avoided with the fear of getting hypertension. Multiparty (AOR\u0026thinsp;=\u0026thinsp;0.588, p\u0026thinsp;=\u0026thinsp;0.027) and health-related concerns (AOR\u0026thinsp;=\u0026thinsp;0.372, p\u0026thinsp;=\u0026thinsp;0.008) reduced the adherence to food taboos, while taste-driven avoidance to food were commonly found among Omani pregnant women (AOR\u0026thinsp;=\u0026thinsp;1.659, p\u0026thinsp;=\u0026thinsp;0.023).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study highlights the urgent need for designing educational interventions aimed at increasing the awareness of harmful dietary practices during pregnancy.\u003c/p\u003e\u003ch2\u003eImplication for practice\u003c/h2\u003e \u003cp\u003eAddressing cultural beliefs and enhancing nutritional knowledge through community and healthcare-based initiatives can improve maternal and foetal health outcomes.\u003c/p\u003e","manuscriptTitle":"Food taboos and perceived misconceptions among pregnant women in a Middle Eastern country","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 07:46:31","doi":"10.21203/rs.3.rs-9325333/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-12T17:44:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217759945385037780024403459590903330234","date":"2026-04-22T13:11:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-17T10:16:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-17T10:13:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-14T11:36:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T08:56:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-04-14T08:27:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ec9646fe-bd11-4c60-89e1-abb18c743363","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-12T17:44:18+00:00","index":29,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T07:46:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 07:46:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9325333","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9325333","identity":"rs-9325333","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}