2026-04-242026-04-242026-02-19https://repositorio.bc.ufg.br/tede/handle/tede/15294Introduction: Maternal diet during pregnancy plays a fundamental role in maternal–fetal health and appropriate gestational weight gain. Among high-risk pregnant women, assessing diet quality becomes even more relevant for the prevention of adverse outcomes. Objective:To evaluate the diet quality of high-risk pregnant women using different diet quality assessment instruments, and to investigate their association with and discriminatory ability regarding maternal and perinatal outcomes.  Methods:This cross-sectional study included high-risk pregnant women receiving care at a high-complexity public hospital in the Central-West region of Brazil. Maternal and clinical data were collected using a standardized structured questionnaire. Dietary intake was assessed through 24-hour dietary recalls, and diet quality was evaluated using the IQDAG and the Nova24hScreener. Gestational weight gain was calculated based on self-reported pre-pregnancy weight and classified according to Brazilian reference curves. Perinatal outcomes were collected after delivery. Association analyses and evaluations of the discriminatory performance of the instruments were conducted.Results: A high prevalence of excessive gestational weight gain was observed. The overall IQDAG score was not associated with gestational weight gain or perinatal outcomes. However, higher consumption of ultra-processed foods was associated with excessive gestational weight gain, with an 8% increase in the odds of excessive weight gain for each one-percentage-point increase in the contribution of these foods to total dietary intake. Regarding perinatal outcomes, higher Nova-WPB scores were associated with a 43% reduction in the odds of small-for-gestational-age newborns, indicating a protective effect of the consumption of unprocessed and minimally processed foods, with significant inverse discrimination observed in the ROC curve for this outcome. No relevant discriminatory capacity was observed for the other perinatal outcomes. Conclusion: These findings indicate that, rather than overall diet quality, specific dietary components—such as higher consumption of ultra-processed foods and lower participation of unprocessed foods—are associated with relevant maternal and perinatal outcomes. The results reinforce the importance of nutritional monitoring during prenatal care, with an emphasis on promoting diets based on unprocessed and minimally processed foods, particularly among high-risk pregnant women.Acesso EmbargadoGestanteGanho de PesoAssistência Pré-NatalEstado NutricionalAlimento ProcessadoPregnant WomenWeight GainPrenatal CareNutritional StatusUltra-Processed FoodCIENCIAS DA SAUDE::NUTRICAODissertação