Researchers validated a new Italian questionnaire called ITpreg-MEDAS that reliably measures how well pregnant women follow the Mediterranean diet. In a study of 116 Italian pregnant women, the tool showed good test-retest reliability (r = 0.756) and acceptable internal consistency (Cronbach’s α = 0.623), according to Gram Research analysis. The average adherence score was 7.2 out of 17, indicating medium adherence to Mediterranean diet patterns. This simple 17-question tool can now help doctors and researchers track whether pregnant women are eating the healthy Mediterranean way.
Researchers created and tested a new questionnaire called ITpreg-MEDAS to measure how well pregnant Italian women follow the Mediterranean diet, a way of eating rich in vegetables, fish, and olive oil. According to Gram Research analysis, the tool was successfully translated from Spanish and adapted for Italian culture. In testing with 116 pregnant women, the questionnaire proved reliable and easy to use. The study shows this simple 17-question tool can help doctors and researchers track whether pregnant women are eating the healthy Mediterranean way, which research shows benefits both mother and baby during pregnancy.
Key Statistics
A 2026 validation study of 116 Italian pregnant women found that the new ITpreg-MEDAS questionnaire demonstrated good test-retest reliability (r = 0.756) and acceptable internal consistency (Cronbach’s α = 0.623), confirming it reliably measures Mediterranean diet adherence during pregnancy.
Italian pregnant women in a 2026 validation study averaged a score of 7.2 out of 17 on the ITpreg-MEDAS questionnaire, indicating medium adherence to Mediterranean diet recommendations during pregnancy.
All 25 Italian pregnant women who participated in pre-testing of the ITpreg-MEDAS questionnaire found the 17-item tool clear and comprehensible, demonstrating its practical usability in clinical settings.
The ITpreg-MEDAS questionnaire required only minor semantic revisions during translation from Spanish to Italian, showing that Mediterranean diet assessment concepts translate effectively across Southern European cultures.
The Quick Take
- What they studied: Whether a new questionnaire could accurately measure how well pregnant women in Italy follow the Mediterranean diet, which is known to be healthy during pregnancy.
- Who participated: Two groups of Italian pregnant women: 25 women who helped test the questionnaire for clarity, and 116 women who participated in the full validation study to confirm it works properly.
- Key finding: The new Italian version of the questionnaire (ITpreg-MEDAS) is reliable and valid. It showed good test-retest reliability (r = 0.756) and acceptable internal consistency (Cronbach’s α = 0.623), meaning it gives consistent results when used repeatedly.
- What it means for you: If you’re pregnant or planning pregnancy, your doctor may soon be able to use this simple 17-question tool to check whether you’re eating a Mediterranean-style diet. The tool is easy to understand and can help identify if dietary changes might benefit your pregnancy. However, this is a validation study, it confirms the tool works, but doesn’t prove the diet itself prevents problems.
The Research Details
Researchers took an existing Spanish questionnaire designed to measure Mediterranean diet adherence in pregnant women and adapted it for Italian pregnant women. The process followed strict international guidelines with six steps: translating it from Spanish to Italian, checking the translation, translating it back to Spanish to verify accuracy, making refinements, testing it with 25 pregnant women to ensure it was clear and understandable, and finally validating it with 116 pregnant women.
The validation phase tested three important qualities: whether the questions were consistent with each other (internal consistency), whether the tool gave the same results when used multiple times (test-retest reliability), and whether it actually measured what it was supposed to measure (construct validity). The questionnaire contains 17 items asking about eating habits typical of the Mediterranean diet, such as olive oil use, fish consumption, and vegetable intake.
This type of study is important because while the Mediterranean diet is known to be beneficial during pregnancy, doctors and researchers need reliable tools to measure how well pregnant women actually follow it. Without a validated tool adapted to different cultures and languages, it’s difficult to study the diet’s effects or help patients track their adherence.
Having a validated, culturally-adapted tool is crucial for both clinical practice and research. When a questionnaire is properly validated, doctors can trust its results and use it to guide patient care. For researchers, it means they can accurately measure diet adherence across different studies, making results comparable. This study ensures that Italian pregnant women aren’t just answering questions translated word-for-word from Spanish, but questions that make sense in their cultural and linguistic context.
This study followed established international methodological guidelines for translating and validating questionnaires, which strengthens its reliability. The test-retest correlation of 0.756 is considered good, meaning the tool gives consistent results. The Cronbach’s alpha of 0.623 indicates acceptable internal consistency, the questions work together reasonably well. The sample size of 116 for validation is moderate but adequate for this type of study. Published in the European Journal of Nutrition, a peer-reviewed journal, adds credibility. However, the study is relatively recent (2026) and limited to Italian pregnant women, so results may not apply to other populations without further testing.
What the Results Show
The Italian version of the pregnancy-adapted Mediterranean Diet Adherence Screener (ITpreg-MEDAS) was successfully created and validated. The questionnaire required some semantic adjustments during translation to ensure Italian pregnant women understood the questions properly, but all 25 women in the pre-testing phase found it clear and comprehensible.
In the main validation study with 116 Italian pregnant women, the average score was 7.2 out of 17 points, indicating medium adherence to the Mediterranean diet. This means the typical Italian pregnant woman in this study was following about 42% of Mediterranean diet recommendations. The questionnaire demonstrated good test-retest reliability with a correlation of 0.756, meaning when the same women answered the questions again, their scores were very similar. Internal consistency was acceptable with a Cronbach’s alpha of 0.623, indicating the 17 questions work together reasonably well to measure the same concept.
The tool successfully distinguished between different levels of diet adherence and correlated with other markers of diet quality, confirming it measures what it’s supposed to measure. The simplicity of the 17-item format makes it practical for use in busy clinical settings or research studies.
The study demonstrated that the questionnaire is practical and user-friendly. All pregnant women who participated understood the questions without difficulty, suggesting it could be easily implemented in Italian healthcare settings. The tool’s brevity (17 items) compared to longer dietary questionnaires makes it feasible for routine clinical use without burdening patients. The successful cultural adaptation process provides a model that could be used to validate this tool in other languages and cultures.
This study builds on the original Spanish preg-MEDAS questionnaire, which was designed specifically for pregnant women rather than adapting general Mediterranean diet tools. By validating an Italian version, this research extends the tool’s usefulness beyond Spain. The Mediterranean diet has strong evidence supporting its benefits during pregnancy, and having validated measurement tools in multiple languages allows researchers worldwide to study these benefits more rigorously. This work fills a gap identified in previous research, the lack of validated, culturally-adapted tools to assess Mediterranean diet adherence during pregnancy.
The study was conducted only with Italian pregnant women, so results may not apply to pregnant women in other countries or cultures without additional validation. The sample size of 116 for validation is moderate, larger samples would provide more confidence in the results. The study doesn’t measure whether using this questionnaire actually improves pregnancy outcomes; it only confirms the tool works reliably. The average adherence score of 7.2 out of 17 suggests Italian pregnant women in this study weren’t following the Mediterranean diet very closely, but the study doesn’t explain why or test interventions to improve adherence. Finally, this is a validation study published in 2026, so long-term follow-up data on its usefulness in clinical practice isn’t yet available.
The Bottom Line
If you’re pregnant or planning pregnancy, discuss Mediterranean diet patterns with your healthcare provider. The Mediterranean diet, emphasizing vegetables, fruits, whole grains, fish, legumes, and olive oil, has strong evidence supporting benefits during pregnancy. This new Italian questionnaire provides a reliable way for healthcare providers to assess your current diet adherence. Consider asking your doctor if they can use this tool to evaluate your eating patterns and provide personalized guidance. Confidence level: Moderate to High for the tool’s reliability; High for Mediterranean diet benefits in pregnancy based on existing research.
This tool is most relevant for Italian pregnant women and their healthcare providers. It’s also valuable for researchers studying nutrition during pregnancy in Italian populations. Healthcare systems in Italy can use this tool in prenatal clinics to screen and counsel pregnant women about diet. Women planning pregnancy may also benefit from understanding Mediterranean diet principles. This tool is less immediately relevant for non-Italian populations, though the validation process could serve as a model for other countries.
The questionnaire provides immediate feedback: you can complete it in a few minutes and get a score showing your current Mediterranean diet adherence. If you make dietary changes based on the results, you might notice improvements in energy levels and digestion within 2-4 weeks. Benefits to pregnancy outcomes (if they exist) would likely develop over weeks to months of consistent adherence. The tool can be used repeatedly throughout pregnancy to track changes in diet adherence over time.
Frequently Asked Questions
What is the Mediterranean diet and why is it important during pregnancy?
The Mediterranean diet emphasizes vegetables, fruits, whole grains, fish, legumes, and olive oil while limiting red meat and processed foods. Research shows this eating pattern supports healthy pregnancy outcomes and fetal development. The diet provides essential nutrients like omega-3 fatty acids, folate, and fiber that benefit both mother and baby.
How does the ITpreg-MEDAS questionnaire work and how long does it take?
The ITpreg-MEDAS is a 17-question tool that asks about your typical eating habits related to Mediterranean diet foods. You answer questions about olive oil use, fish consumption, vegetable intake, and other dietary patterns. It takes just a few minutes to complete and produces a score from 0-17 indicating your adherence level.
Can I use this questionnaire if I’m not Italian or don’t live in Italy?
This specific version was validated only for Italian pregnant women. However, the original Spanish version (preg-MEDAS) exists, and the validation process could be adapted for other languages and cultures. Talk to your healthcare provider about Mediterranean diet assessment tools available in your region.
What should I do if my ITpreg-MEDAS score is low?
A low score means you’re not following Mediterranean diet patterns closely. Work with your healthcare provider or a dietitian to identify which foods to add, typically more fish, vegetables, legumes, and olive oil. Small, gradual changes are more sustainable than trying to overhaul your diet overnight.
Is the Mediterranean diet safe for all pregnant women?
The Mediterranean diet is generally considered safe and beneficial during pregnancy. However, pregnant women should avoid high-mercury fish and ensure adequate iron and calcium intake. Always discuss dietary changes with your healthcare provider, especially if you have gestational diabetes, food allergies, or other pregnancy complications.
Want to Apply This Research?
- Use the 17-item ITpreg-MEDAS questionnaire monthly during pregnancy to track your Mediterranean diet adherence score. Record your score (0-17) and note which specific items you scored lowest on, this identifies which dietary habits need improvement, such as olive oil use, fish consumption, or vegetable intake.
- Based on your lowest-scoring items, set one specific dietary goal each week. For example: ‘This week, I’ll use olive oil in salads three times’ or ‘I’ll eat fish twice this week.’ Use the app to log when you complete these goals and retake the questionnaire monthly to see if your overall score improves.
- Create a dashboard showing your ITpreg-MEDAS score trend across pregnancy trimesters. Link specific food logging to the questionnaire items, track olive oil servings, fish meals, vegetable portions, and legume intake separately. Set reminders for monthly questionnaire completion and share results with your healthcare provider to enable personalized nutrition counseling throughout pregnancy.
This research validates a measurement tool but does not constitute medical advice. The Mediterranean diet is generally considered beneficial during pregnancy based on existing research, but individual dietary needs vary. Pregnant women should consult with their healthcare provider or a registered dietitian before making significant dietary changes, especially if they have gestational diabetes, food allergies, or other pregnancy-related conditions. This study was conducted in Italian pregnant women and may not apply to other populations. The questionnaire is a screening tool to assess diet patterns: it does not diagnose nutritional deficiencies or predict pregnancy outcomes. Always seek personalized medical guidance from qualified healthcare professionals regarding nutrition during pregnancy.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.
