Development and validation of a food frequency questionnaire for iron intake among pregnant women (P-FeFFQ)

Background: Iron deficiency anaemia is common among pregnant women in Malaysia, posing risks to both maternal and foetal health. This study aimed to develop and validate a Food Frequency Questionnaire (FFQ) to assess iron intake among pregnant Malaysian women. Method: The Pregnancy-Focused Iron Food Frequency Questionnaire (P-FeFFQ) was created using data from 24-hour dietary recalls and literature reviews on iron-rich foods. An expert panel reviewed an initial list of 74 food items, which was refined to 63 based on content validity index (I-CVI) scores and feedback. Validation was performed against three-day dietary records from 21 pregnant women. Descriptive statistics summarised sociodemographic data and iron intake, while Pearson’s correlation and Bland-Altman plot analyses assessed validity. Results: Participants had mean age of 29.8 years and prepregnancy body mass index (BMI) of 26.0 kg/m². P-FeFFQ showed excellent content validity (I-CVI score of 0.93) and was culturally relevant. Mean iron intake estimated by P-FeFFQ was 14.09 mg/day compared to 12.38 mg/day from dietary records. Pearson’s correlation coefficient was 0.648 (p=0.001), indicating moderate positive relationship. Bland-Altman analysis showed mean difference of 1.71 mg/day, with most data points within the limits of agreement, suggesting reasonable accuracy. Conclusion: P-FeFFQ is a valid tool for assessing dietary iron intake among pregnant women in Malaysia.