Nutrition advice during pregnancy: do women receive it and can health professionals provide it?

Midwives' perspectives on women's dietary intake during pregnancy: A systems thinking approach

BACKGROUND

Prenatal nutrition status and maternal dietary behaviours are known to impact maternal and child health outcomes.

AIM

We aimed to inform strategies for improving prenatal diet quality and their integration into pregnancy care.

METHOD

Group Model Building (GMB) workshops were conducted with midwives from six health services. A Causal Loop Diagram (CLD) was developed to illustrate how the factors contributing to poor nutrition during pregnancy were interconnected and influenced each other and to identify priority action areas. Workshops were recorded and transcripts thematically analysed to provide a deeper understanding of the challenges of dietary advice provision and intervention opportunities.

RESULTS

The GMB process created a CLD that included 51 factors that were perceived to be driving poor dietary intake in pregnancy. These were grouped into five priority areas for action: knowledge and education, food availability and access, personal and family circumstances, health system, and care. Thematic analysis of the workshop transcripts revealed four major themes related to midwives' perspectives on the challenges associated with delivering dietary advice in pregnancy care: hospital service provision, pregnancy care clinicians, psychosocial factors affecting women, and maternal diet and health. Intervention targets were identified as continuity of care, nutrition education, guidelines and resources, personalised dietary advice, dietary data collection, and dietitian referrals.

CONCLUSION

Midwives' perspectives on the drivers of poor prenatal nutritional intake were multifaceted, spanning the personal, environmental and health system levels. Nutrition interventions should consider the health system and service context, along with pregnant women's dietary knowledge and education, access to healthy food, social, cultural, and personal circumstances, and clinical care experience.

Enhancing perinatal health patient information through ChatGPT - An accuracy study

Objectives

To evaluate ChatGPT's accuracy as information source for women and maternity-care workers on "nutrition" and "red flags" in pregnancy.

Methods

Accuracy of ChatGPT-generated recommendations was assessed by a 5-point Likert scale by eight raters for ten indicators per topic in four languages (French, English, German and Dutch). Accuracy and interrater agreement were calculated per topic and language.

Results

For both topics, median accuracy scores of ChatGPT-generated recommendations were excellent (5.0; IQR 4-5) independently of language. Median accuracy scores varied with a maximum of 1 on a 5-point Likert-scare according to question's framing. Overall accuracy scores were 83-89 % for 'nutrition in pregnancy' versus 96-98 % for 'red flags in pregnancy'. Inter-rater agreement was good to excellent for both topics.

Conclusion

Although ChatGPT generated accurate recommendations regarding the tested indicators for nutrition and red flags during pregnancy, women should be aware of ChatGPT's limitations such as inconsistencies according to formulation, language and the woman's personal context.

Innovation

Despite a growing interest in the potential use of artificial intelligence in healthcare, this is, to the best of our knowledge, the first study assessing potential limitations that may impact accuracy of ChatGPT-generated recommendations such as language and question-framing in key domains of perinatal health.

Providers' Practices and Associated Factors in Educating Pregnant Women on the Prevention of Maternal Anemia During Antenatal Care Visits in Ujiji Municipality, Kigoma Region, Tanzania

BACKGROUND

Anemia in pregnancy is among the preventable severe public health problems, responsible for around 14.5% of maternal mortality in Tanzania. Antenatal visits are among the pillars that aid in reducing the burden of anemia in pregnancy. However, there are discrepancies in adherence and performance across different domains of Antenatal care (ANC) by healthcare workers. Therefore, this study examined providers' practices and associated factors in educating pregnant women on preventing maternal anemia during antenatal care visits in Kigoma and Ujiji Municipal Council in the Kigoma region.

METHODS

This was a cross-sectional design involving a total of 430 client exit interviews across 18 facilities. The association between the provision of maternal anemia education and other factors such as health facility level, age group, sex, economic activities, and ANC visitation was analyzed using multivariate logistic regression. p-values less than 0.05 were considered significant throughout the study.

RESULTS

The study revealed that most participants (70.4%) reported receiving anemia information during ANC visits. The most common topics were insecticide-treated nets (ITNs) (76%) and types of food to prevent anemia (74%), while 20.8% and 24.8% reported receiving information about worm infestation and deworming, respectively. Only 34.4% (95%CI: 26.5-43.3%) of pregnant women were informed of at least five topics.

CONCLUSIONS

The study reveals limited education provision on anemia among pregnant women. There is a discrepancy in topic coverage among facilities and individuals.

Pregnant Women's Experiences With a Collaborative Midwife-Dietitian Empowerment Programme to Improve Diet Quality

BACKGROUND

Pregnancy is a crucial period prompting increased intentions for lifestyle changes. Suboptimal diet quality during pregnancy can cause adverse health outcomes for both mother and child. The Power 4 a Healthy Pregnancy (P4HP) programme aims to improve the diet quality of pregnant women through empowerment, by providing four additional consultations to discuss nutrition with a midwife and dietitian. This research aimed to study the experiences of pregnant women engaged in the P4HP programme.

METHODS

A qualitative study using in-depth interviews was conducted. Participants were recruited through purposive sampling from women who completed the P4HP programme. Semi-structured interviews were conducted using time-lining as an explorative tool. Interview transcripts underwent thematic analysis following Braun and Clarke's six-phase process, combining inductive and deductive coding approaches.

RESULTS

Twenty-two interviews were conducted with women from eight midwifery practices. Four main themes emerged: (1) women report various dietary improvements, influenced by diverse factors, (2) most pregnant women evaluate the P4HP programme positively, (3) the dietitian plays a key role in empowering pregnant women towards healthy dietary intakes and (4) midwives support pregnant women in maintaining dietary improvements. Participants viewed the P4HP consultations favourably, which facilitated empowerment through personalized guidance, reassurance, and increased awareness and confidence levels. Motivated by their desire to ensure optimal nutrition for their babies, women made multiple improvements in their diet quality. While the guidance of the midwife served as a motivational factor to sustain these changes, it was the personalized nutritional guidance provided by the dietitian that women found instrumental in achieving actual dietary changes.

CONCLUSION

Our outcomes emphasize the importance of integrating dietitian consultations in standard antenatal care to promote enhancements in the diet quality of pregnant women.

Provider advice, pregnant persons' expectations, and actual gestational weight gain among United States military health care beneficiaries: a secondary analysis of a randomized controlled trial

INTRODUCTION

Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. Previous literature shows provider advice and expectations regarding GWG significantly associated with GWG outcomes. In this study, we explore the influence of these factors on GWG in a military population in this secondary analysis of data from a randomized controlled trial.

MATERIALS AND METHODS

Participants (N = 377) came from a completed randomized controlled trial focused on behavioral interventions for healthy GWG and/or postpartum weight loss among TRICARE beneficiaries. At baseline, participants filled out a 5-item questionnaire assessing provider advice and self-expectations for GWG. For the actual GWG primary outcome variable, we calculated the difference between the weight obtained in the first trimester and the weight obtained at 36 weeks of gestation. We used regression models to assess the predictive ability of expectations about GWG on actual GWG.

RESULTS

Participants with higher baseline BMIs were more likely to expect excessive GWG as defined by the National Academy of Medicine (NAM; Overweight: 46.3%, Obesity: 65.4%). Participants' expectations showed a significant association with actual GWG (OR 2.1, 95% CI 1.29-3.41, p = 0.003). Most participants (64.7%) reported no provider advice about how much weight to gain during their pregnancy. Of those who did receive advice, 55.4% reported that it was within the NAM guidelines.

CONCLUSIONS

The study documented infrequent provider advice about GWG in a large sample of TRICARE beneficiaries (i.e., both active duty and non-active duty individuals) and supported an association between self-expectations and later actual GWG. Future studies might test strategies to increase/improve provider advice regarding GWG and to aid pregnant individuals in shaping and achieving their GWG expectations.

CLINICAL TRIAL REGISTRATION

The trial was prospectively registered on clinicaltrials.gov (NCT03057808) on February 20, 2017.

Dietary Habits and Nutritional Knowledge of Pregnant Women: The Importance of Nutrition Education

A good diet during pregnancy is associated with improvements to maternal and fetal health. Nevertheless, excessive weight gain during pregnancy has been reported in several studies. The aim of this review is to determine the dietary habits of pregnant women (measured according to their degree of adherence to the Mediterranean diet, a reference in dietary quality), their knowledge of food and nutrition, and their perceptions of the nutritional education received during their pregnancy, in order to detect intervention needs within that group. The bibliographic search was conducted on three databases (Medline, PubMed central, and Web of Science), using the keywords "pregnancy", "Mediterranean diet", "nutrition knowledge", "nutritional education", and some synonyms. The final selection included 68 original articles. The available evidence indicated that, although pregnant women were aware of the importance of nutrition during pregnancy, their habits showed some room for improvement in terms of diet and physical exercise. Lack of adequate advice was the main barrier to the practice of healthy habits that pregnant women encountered; they considered that the information they received during pregnancy follow-up visits was inadequate. However, the success of interventions within different countries is a source of hope for well-structured nutrition education throughout pregnancy. The lack of nutrition-related knowledge among pregnant women could be originally related to poorly planned nutrition education from healthcare providers. Research focused on the consultations with these healthcare providers could be of help when proposing strategies to improve the content, the depth, and the duration of nutrition education sessions. It should, in any case, be noted that the available evidence in this field is limited to certain geographical origins. Therefore, research that uncovers evidence in different countries will be useful for learning about the factors that condition the habits of pregnant women and, in that way, guide strategies for the improvement of the health of expectant mothers during that stage in their lives.

Access to nutrition advice and knowledge, attitudes and practices of pregnant women in Ireland: A cross-sectional study

BACKGROUND

Healthy nutritional status, appropriate gestational weight gain and a balanced diet are important predictors of perinatal health outcomes. However, gaps exist in the translation of nutrition recommendations into dietary practices of women before and during pregnancy. The present study explored the relationship between access to nutrition advice, nutrition knowledge, attitudes and practices among pregnant women.

METHODS

Pregnant women aged > 18 years in Ireland were eligible to complete a self-administered survey consisting of four subsections (demographics, nutrition knowledge, attitudes and practices) delivered online through Qualtrics.

RESULTS

In this convenience sample (n = 334, median [interquartile range] gestation, 25.0 [16.0, 34.0] weeks), 85% had at least an honours bachelor degree and 88.9% planned their pregnancy. Two out of five women received nutrition advice during their pregnancy, mostly from a midwife. Based on the percentage of correct answers (of 15 questions), women with previous nutrition education (e.g., school home economics) had better median [interquartile range] nutrition knowledge than those with none (80.0% [66.7, 86.7%] vs. 73.3% [60.0, 80.0%], p < 0.001). Those who received nutrition advice during pregnancy did not score higher than those who did not (73.3% [66.7, 80.0%] vs. 73.3% [66.7, 80.0%], p = 0.6). Over three-quarters of participants considered nutritional supplement use to be very or extremely important. Although 73.6% and 92.4% took supplements prior to and during pregnancy, only 25.7% reported compliance with periconceptional folic acid supplementation guidelines. Half of respondents considered healthy eating during pregnancy as very or extremely important.

CONCLUSIONS

Access to nutrition advice during pregnancy was inadequate with poor nutrition knowledge, attitudes and practices observed. Accessible, evidence-based nutrition education for women prior to and during pregnancy is required.

Family Planning and Preconception Care Service Management: The Key Role of Bulgarian GPs

Assisting women in attaining their reproductive goals is crucial for improving the well-being of families and children. As the first point of contact for healthcare, general practitioners (GPs) are ideal for family planning (FP) and preconception care (PCC). However, primary care interventions' efficacy is unclear. The aim of this study was to examine GPs' knowledge, attitudes, and perspectives on FP and PCC service management. Most GPs were aware of FP and PCC services and held a firm conviction that they should be primarily accountable together with obstetrician-gynaecologists. However, it is worth noting that less than 50% of respondents reported receiving thorough and comprehensive knowledge of their respective specialities. Those with general medicine qualifications demonstrated a high level of commitment to providing such services. The women's GPs and those with training in general medicine prescribed birth control pills and emergency contraception three times more frequently than the other doctors who suggested condoms or traditional methods or referred patients to another specialist (p < 0.05). In conclusion, PCC is of the utmost importance, and its effective implementation demands the collaboration of policymakers, healthcare providers, and individuals. GPs are essential in managing FP and PCC. They must incorporate more in-depth PCC into their clinical practice.

Health System and Individual Barriers to Supporting Healthy Gestational Weight Gain and Nutrition: A Qualitative Study of the Experiences of Midwives and Obstetricians in Publicly Funded Antenatal Care in Tasmania, Australia

Individual and health system barriers can impede clinicians from supporting weight-related behaviour change for pregnant women, particularly in publicly funded antenatal care accessed by women from diverse socioeconomic backgrounds. The aim was to understand clinicians' experiences of supporting healthy gestational weight gain for pregnant women in a publicly funded antenatal setting. The work was undertaken to guide the implementation of systems changes, resource development, and workforce capacity building related to nutrition, physical activity, and gestational weight gain in the service. The qualitative descriptive study used purposive sampling and semi-structured interviews conducted between October 2019 and February 2020. Nine midwives and five obstetricians from a publicly funded hospital antenatal service in Tasmania, Australia participated. Interview transcripts were analysed using inductive thematic analysis. The three dominant themes were prioritising immediate needs, continuity of care support weight-related conversations, and limited service capacity for weight- and nutrition-related support. The subthemes were different practices for women according to weight and the need for appropriately tailored resources. Improving access to continuity of care and clinician training, and providing resources that appropriately consider women's socioeconomic circumstances and health literacy would enhance the ability and opportunities for clinicians to better support all women.

Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study

AIM

To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy.

METHOD

Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand.

RESULTS

Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand.

CONCLUSIONS AND IMPLICATIONS

Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.

Nutritional awareness of pregnant women and the underlying influencing factors

Nutritional awareness is described as having knowledge or understanding of nutrition. It is often related to the ability of an individual to make an accurate estimate of their food intake, which involves comparing their actual nutritional behavior with the recommended food consumption. Nutritional awareness of women during the various phases of pregnancy may vary significantly across countries due to cultural and lifestyle differences. There has been extensive research on nutritional awareness of pregnant women in selected countries or regions; however, relatively few studies have explored it during different stages of pregnancy. To fill this gap, this article reviews the existing literature and draws together insights into the following areas: changes in nutritional awareness during various phases of pregnancy, nutritional awareness of pregnant women and its underlying factors in various nations, and the research methods used to study nutritional awareness of pregnant women.

Adherence to the national guidance on foods and drinks to limit or avoid during pregnancy in England: the PEAR Study

OBJECTIVE

The National Health Service (NHS) England website provides guidance on foods/drinks to avoid or limit during pregnancy because of microbiological, toxicological or teratogenic hazards. The aims were to determine adherence and whether demographic characteristics were associated with adherence.

DESIGN

Cross-sectional study.

SETTING

Online survey of postpartum women resident in England during pregnancy.

PARTICIPANTS

Recently, postpartum women resident in England during their pregnancy (n 598; median age 33 (IQR 30-36) years) completed an online questionnaire (April-November 2022). Questions included those on consumption of twenty-one food/drink items that the NHS advises pregnant women to avoid/limit. The study is part of the Pregnancy, the Environment And nutRition (PEAR) Study. Summary statistics were used to determine proportions adhering to the guidance. Adjusted logistic regression was used to model the associations of adherence with demographic characteristics.

RESULTS

Adherence was generally high (>90 % for eight of ten food/drink items to be avoided). However, among pre-pregnancy consumers, several items were not completely avoided, for example, 81 % (128/158) for game meat/gamebirds, 37 % (176/478) for cured meats and 17 % (81/467) for soft cheeses. Greater educational attainment (e.g. caffeinated soft drinks OR 2·25 (95 % CI 1·28, 3·94)), greater maternal age (e.g. oily fish 1·64 (1·05, 2·56)) and lower parity (e.g. caffeinated coffee 0.28 (0.11, 0.69)) were the most usual characteristics associated with adherence.

CONCLUSION

Evidence of concerning levels of non-adherence for some food/drink items suggests a case for more education on some of the guidance, particularly for women with lower educational attainment, greater parity and greater maternal age. Further research on barriers to the implementation of the guidance is needed.

The knowledge, attitudes, and behaviours of pregnant women regarding seafood consumption during the antenatal period: a qualitative study

BACKGROUND

Maternal nutrition impacts fetal growth and development. The Food Standards Australia New Zealand (FSANZ) guidelines recommend pregnant women consume 2-3 servings (224-336 g) of fish/seafood per week to support intake of long chain omega 3 fatty acids, given adequate consumption supports numerous health benefits including reduced risk of preterm and early preterm birth. Evidence indicates that pregnant women purposely lower their fish/seafood intake, largely due to fears of methylmercury exposure. The aim of this study was to explore pregnant women's knowledge, attitudes, and behaviours regarding their fish/seafood consumption during the antenatal period.

METHODS

Semi-structured interviews were conducted between October 2018 and December 2020 among a purposive sample of 12 pregnant women from the Australian Capital Territory (ACT). The interviews were recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach. Themes were developed on the women's lived experience related to fish/seafood knowledge, attitudes, and consumption behaviour.

RESULTS

The most prominent finding was widespread non-adherence to fish/seafood consumption guidelines. This was largely owing to a lack of proactive health promotion related to the health benefits of fish/seafood throughout pregnancy, including the health promoting roles of long chain omega 3 fatty acids for fetal growth and development. Three themes were identified: nutrition knowledge; sources of health promotion; and barriers and enablers to fish/seafood consumption.

CONCLUSIONS

To support adequate maternal consumption of fish/seafood throughout pregnancy, emphasis should be placed on the benefits of consuming this food group regularly. Additionally, pregnant women should receive education about the health promoting role of long chain omega 3 fatty acids. Dietitians are well placed to provide this information.

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial

Background

Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM.

Aims

This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care.

Methods

Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval.

Discussion

This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM.

Clinical trial registration

https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

Women Who Give Birth Preterm Do Not Meet Dietary Guidelines During Pregnancy

PURPOSE

To evaluate maternal dietary intake during pregnancy compared with the 2015-2020 and 2020-2025 Dietary Guidelines for Americans (DGA).

STUDY DESIGN AND METHODS

A retrospective observational study design was used. The cohort included women who gave birth to preterm infants between 25 1/7 weeks and 33 6/7 weeks of gestation. Within 2 weeks of birth, participants were asked to recall their diet in the last month of pregnancy using the Dietary Screener Questionnaire. Participants' dietary intakes were compared to current 2020-2025 DGA that include specific recommendations for pregnant women and prior 2015-2020 DGA that were in place during the study period but were not pregnancy-specific.

RESULTS

Forty-five women participated in the study. None met the 2015-2020 or 2020-2025 DGA recommended intake of all seven dietary components. When compared to both DGAs, 2.2% of participants met the recommended dairy intake, 26.7% met the calcium intake, 15.6% were below the threshold for added sugar, and none met the vegetable or whole grain intake. When compared to the 2015-2020 DGA, 28.9% met the fruit intake and 2.2% met the fiber intake. However, when compared to the 2020-2025 DGA, only 2.2% met the fruit intake and none met the fiber intake.

CLINICAL IMPLICATION

Women who gave birth preterm did not adhere to the 2015-2020 or 2020-2025 DGA recommendations in the last month of pregnancy. Nurses are uniquely positioned to provide pregnant women with nutritional screening and counseling as part of routine prenatal care.

Maternal diet quality and associations with plasma lipid profiles and pregnancy-related cardiometabolic health

PURPOSE

To assess the relationship of early pregnancy maternal diet quality (DQ) with maternal plasma lipids and indicators of cardiometabolic health, including blood pressure (BP), gestational diabetes mellitus (GDM) and gestational weight gain (GWG).

METHODS

Women (n = 215) aged 18-40 years with singleton pregnancies were recruited at 10-20 weeks gestation. Diet quality was assessed by the Dietary Guideline Index, calculated at early ([mean ± SD]) (15 ± 3 weeks) and late (35 ± 2 weeks) pregnancy. Lipidomic analysis was performed, and 698 species across 37 lipid classes were measured from plasma blood samples collected at early (15 ± 3 weeks) and mid (27 ± 3 weeks)-pregnancy. Clinical measures (BP, GDM diagnosis, weight) and blood samples were collected across pregnancy. Multiple linear and logistic regression models assessed associations of early pregnancy DQ with plasma lipids at early and mid-pregnancy, BP at three antenatal visits, GDM diagnosis and total GWG.

RESULTS

Maternal DQ scores ([mean ± SD]) decreased significantly from early (70.7 ± 11.4) to late pregnancy (66.5 ± 12.6) (p < 0.0005). At a false discovery rate of 0.2, early pregnancy DQ was significantly associated with 13 plasma lipids at mid-pregnancy, including negative associations with six triglycerides (TGs); TG(54:0)[NL-18:0] (neutral loss), TG(50:1)[NL-14:0], TG(48:0)[NL-18:0], TG(52:1)[NL-18:0], TG(54:1)[NL-18:1], TG(50:0)[NL-18:0]. No statistically significant associations were found between early pregnancy DQ and BP, GDM or GWG.

CONCLUSION

Maternal diet did not adhere to Australian Dietary Guidelines. Diet quality was inversely associated with multiple plasma TGs. This study provides novel insights into the relationship between DQ, lipid biomarkers and cardiometabolic health during pregnancy.

Different experiences of weight management and physical activity during pregnancy - a qualitative study of women and healthcare professionals in Australia

OBJECTIVE

Pregnancy is often described as a pivotal life stage for women, where regular contact with health professionals may play an important role in lifestyle awareness. This study explored the knowledge, practices, and beliefs of health professionals and pregnant women regarding physical activity and weight management during the antenatal period.

METHODS

A qualitative study was undertaken in southeastern Australia using individual interviews. Recruitment sought women of gestation >12 weeks, experiencing an uncomplicated pregnancy (n = 6), and antenatal health professionals including midwives (n = 4) and an obstetrician (n = 1). Data were analysed using Interpretive Phenomenological Analysis.

RESULTS

Three major themes emerged: (1) women rely on multiple sources of pregnancy-related healthy lifestyle information; (2) discussions around healthy lifestyle behaviours are low priority and often inconsistent; and (3) lifestyle-related topics perceived as sensitive make some conversations and actions difficult.

CONCLUSIONS

Pregnant women expressed gaps in lifestyle-related knowledge and education being provided by health professionals. In turn, health professionals expressed difficulty discussing sensitive topics such as weight with pregnant women and had limited knowledge of pregnancy-specific physical activity guidelines. The themes generated by this study may form the foundation for further research to inform clinical policy and practice regarding advice in antenatal care.

Experiences of Physical Activity, Healthy Eating and Quality of Life During and Following Pregnancy in Overweight and Obese Postpartum Women

OBJECTIVES

This retrospective study explored the experiences of women with overweight or obesity regarding physical activity, diet and quality of life leading up to, during, and following pregnancy.

METHODS

A qualitative descriptive design was adopted, whereby data collected through semi-structured interviews were analysed using thematic analysis. Throughout the interviews, individuals were asked to describe their barriers to a healthy lifestyle during and following pregnancy.

RESULTS

Ten women (34.5 ± 5.2 years old, BMI 30.4 ± 3.5 kg·m- 2) who were between 12 and 52 weeks postpartum participated. A range of themes were identified when discussing barriers to physical activity and healthy eating during and following pregnancy. For example, tiredness, especially in the third trimester of pregnancy, and a lack of support at home, was often cited as preventing engagement in exercise and healthy eating practices. A lack of convenience when attending exercise classes, medical complications following the birth and the cost of attending pregnancy-specific classes were identified as barriers to exercise engagement. Cravings and nausea were identified as barriers to healthy eating during pregnancy. Quality of life was positively associated with exercise and healthy eating, whilst a lack of sleep, loneliness and a loss of freedom since the baby had arrived negatively influenced quality of life.

DISCUSSION

Postpartum women with overweight and obesity experience many barriers when attempting to engage in a healthy lifestyle during and following pregnancy. These findings can be used to inform the design and delivery of future lifestyle interventions in this population.

Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study

Guidance on foods to limit or avoid in pregnancy is provided on the NHS website for England. Advice on fish consumption is related to exposure to mercury, dioxins and polychlorinated biphenyls, which may have adverse effects on fetal neurodevelopment. Our aim was to provide evidence on the effectiveness of the guidance in minimising exposure to toxins while maximising nutrient intake in a mixed-methods study. An online questionnaire on fish consumption before/during pregnancy was completed by postpartum women (≤12 months) in England (n = 598). A subsample of participants was invited to take part in an interview (n = 14). Women who ate fish before pregnancy reduced their intakes of both oily and white fish during pregnancy, with some avoiding it altogether. Women did not exceed the limit on tinned tuna, but there was evidence of mis-recall on the suggested limit. Overall intakes of fish were below that recommended during pregnancy (36% compliance for pre-pregnancy consumers). Barriers to fish consumption included risk aversion, confusion over specific details of the guidance, cost, availability, family preferences and smell/taste. Clarity and simplicity of the NHS guidance, with an overall message on the number of portions of fish a week advised prominently shown, would help pregnant women to benefit from the nutrients in fish while minimising exposure to toxins. The guidance on the number of cans of tuna advised per week is poorly recalled and needs to be disseminated accurately. The guidance on shark/marlin/swordfish could receive less prominence as it is rarely eaten by pregnant women in England.

Effects of intensive nutrition education and counseling on nutritional status of pregnant women in East Shoa Zone, Ethiopia

Background

Nutritional status is defined as an individual's health condition as it is influenced by the intake and utilization of nutrients. Maternal malnutrition is widespread throughout the world, with Sub-Saharan Africa and Asia bearing the brunt of the burden. The objective of this study was to evaluate the effect of intensive nutrition education and counseling on nutritional status during pregnancy.

Methods and materials

The study was a one-year, two-arm parallel design cluster randomized controlled trial conducted in the East Shoa zone, Ethiopia, from January 1, 2021, to February 30, 2022. A total of 374 participants were enrolled in the intervention (n = 185) and control (n = 189) groups. End-line data were collected from 163 women, from each group. The intervention package provided three counseling sessions by trained midwives, three-page take-home brochures prepared in local languages, and the delivery of 18 weekly serial short text messages. The women in the control group received routine nutrition education from the health facilities. After adjusting for potential confounders, a linear mixed-effects model was employed to assess the intervention effect.

Results

After the intervention, the mean mid-upper arm circumference in the intervention group increased by 1.8% (23.08 vs. 23.44, p < 0.01). Similarly, the proportion of undernutrition in the intervention group was 11% (25 vs. 36%, p = 0.02) lower compared to the control arm. At the end of the trial, women in the intervention arm had significantly better nutritional status than women in the control group (β = 0.47, p < 0.01).

Conclusion

The findings showed that intensive nutrition education and counseling using the health belief model was effective in improving nutritional status and reducing undernutrition among pregnant women. As a result, nutrition education and counseling using HBM constructs, as well as regular reminder messages, should be provided to pregnant women as part of the routine antenatal care service.

Nutritional Education in the Midwife's Consultation Room

Evidence of the importance of maternal nutrition during pregnancy is growing, and midwives are the healthcare professionals in charge of monitoring pregnancy. In the present review, the aim is therefore to look at the relevant contributions on midwifery and the role of midwifery in the provision of nutritional education. Searches were conducted on three databases-Medline, PubMed Central, and Web of Science-using two key search terms ("nutrition" and "midwives") and their synonyms, for an extensive set of results. The final selection consisted of 27 original papers, most of which concerned the nutritional knowledge of midwives, their training, and their views, attitudes, and practices within the field of nutrition. According to the findings, although the midwives considered nutritional education to be part of their role and they agreed on the importance of nutrition during pregnancy, their knowledge of this topic was poor, perhaps due to inadequate nutritional education during their midwifery training. Academic programs on midwifery must therefore be reviewed, so as to increase the workload of nutrition-related subjects, in order to reinforce the corresponding knowledge bases of future midwives. In addition, based on the success of the nutritional interventions discussed in the present review, these sorts of initiatives could be of utmost importance to improve the knowledge of practicing midwives. In any case, it must be highlighted that the available evidence discussed in this review was drawn from only a few countries around the world. Further studies involving midwives of varied origins are therefore needed. Such research would be of immense assistance in the design of the corresponding nutritional interventions in the field, so as to improve the health of pregnant women.

Qualitative Exploration Study of Perceptions of Women and Nurse-Midwives on Antenatal Care Information and Communication in Tanzania

Background

Antenatal health information enables pregnant women to make informed choices for their health during pregnancy and childbirth. Worldwide, evidence shows inadequate coverage of the information provided to women during antenatal care visits. Interaction between women and providers is important to ensure effective information exchange. This study aimed to explore women's and nurse midwives' perceptions of their interactions and the information they shared about care during pregnancy and childbirth in Tanzania.

Methods

Formative explorative research using in-depth interviews was conducted with eleven Kiswahili-speaking women who had normal pregnancies and had more than three antenatal contacts. Also, five nurse-midwives who worked in the ANC clinic for a year or more were included in the study. A thematic analysis based on descriptive phenomenology guided the analysis of data that was informed by the WHO quality of care framework.

Results

Two major themes emerged from the data, enhancing communication and respectful delivery of ANC information and receiving information about pregnancy care and safe childbirth. We found that women felt free to communicate and interact with midwives. Some women feared interacting with midwives and other midwives were difficult to approach. All women acknowledge receiving antenatal care information. However, not all women reported receiving all ANC information as per national and international guidelines. Inadequate staffing and time were the reasons for poor prenatal care information delivery.

Conclusion

Women did not report most of the information provided during ANC contacts as per the national ANC guidelines. The inadequate number of nurse-midwives, increased number of clients, and insufficient time were reported to contribute to inadequate provision of information during antenatal care. Strategies for effective provision of information during antenatal contacts should be considered including using group antenatal care and information communication technology. Further, nurse-midwives should be sufficiently deployed and motivated.

Is Health Education among the Decisive Factors for the Diet Quality of Pregnant Women in Poland?

Health education (HE), an educational process that leads to increased nutritional awareness and improved health, is one of the factors influencing diet quality (DQ) during pregnancy. The aim was to evaluate the DQ of pregnant women and its determinants considering their HE. The study included 122 pregnant women aged 20-40 years. DQ was assessed using the Kom-PAN^® questionnaire and the Pro-Healthy Diet Index (pHDI). Data collected included dietary habits, socio-demographic data, education level, place of residence, and maternal lifestyle-related characteristics, namely, pre-pregnancy weight, trimester of pregnancy, and pre-pregnancy and pregnancy physical activity (PA). Weekly energy expenditure was determined using the Polish version of the PPAQ questionnaire. HE at school more than tripled the odds of a higher DQ. Women in their second trimester were 54% more likely to have a higher DQ than women in their third trimester of pregnancy. Undertaking pre-pregnancy PA increased the odds of a higher DQ 2.5 times. Comparative analyses performed in a group of women with HE (HEG, n = 33) and without HE (nHEG, n = 89) showed better DQ in the former, but this was still unsatisfactory in health-promoting properties. The results obtained showed that the HE and trimester of pregnancy and pre-pregnancy Pa influenced DQ in pregnant women.

Exploring Barriers to Healthy Eating Among Women in Their Role as New Mothers with a Theory-Driven Questionnaire

OBJECTIVES

This study aims to propose and evaluate a theory-driven questionnaire addressing barriers to healthy eating among mothers of young children.

METHODS

Statements drawing upon the Social Cognitive Theory were developed/gathered based on literature review and previous qualitative research. Part I (43 items) included general barriers, attitudes to nutrition advice and outcome expectations. Part II (9 items) included subjective knowledge and general self-efficacy scales. An online survey was undertaken with 267 Danish women. The validation process included content and face validity, exploratory factor analysis (EFA) and reliability analysis. Confirmatory factor analysis (CFA) tested possible associations between the constructs and potential health outcomes (BMI and healthiness of eating habits).

RESULTS

The EFA supported an adequate factorial validity with a 5-factor, 37-item structure model for Part I, and a high internal reliability of Parts I and II (Cronbach's alpha > 0.7). The CFA revealed an association between certain constructs and perceived healthiness of eating and BMI. Results support the reliability and factorial validity of the social cognitive measures assessing barriers to healthy eating among mothers.

CONCLUSIONS FOR PRACTICE

These promising findings of reliability and initial validity suggest that researchers and practitioners interested in identifying women who face difficulties in the family food environment may find the scales useful. We propose a short version of the questionnaire for health practitioners.

Selecting a dietary supplement with appropriate dosing for 6 key nutrients in pregnancy

BACKGROUND

Most pregnant women in the United States (US) are at risk of inadequate intake of key nutrients during pregnancy from foods alone. Current dietary supplement practices reduce risk of inadequacy for only some nutrients and induce excessive intake of other nutrients.

OBJECTIVES

Our study aimed to estimate the doses of supplementation needed to help most pregnant women achieve the recommended intake without exceeding upper limits for key prenatal nutrients and to identify US dietary supplements providing these doses.

METHODS

We conducted 24-h dietary recalls in 2450 pregnant participants aged 14-50 y from 2007 to 2019. We estimated the usual intake of vitamins A and D, folate, calcium, iron, and ω-3 FAs from foods alone. We calculated the target doses of supplementation needed to shift 90% of participants to consume above the estimated average requirement and keep 90% below the tolerable upper limit. We identified products in the Dietary Supplement Label Database providing these target doses of supplementation.

RESULTS

The target dose for supplementation was ≥198 mcg retinol activity equivalents of total vitamin A (with ≤2063 mcg preformed retinol); 7-91 mcg vitamin D; 169-720 mcg dietary folate equivalents of folic acid; 383-943 mg calcium; 13-22 mg iron; and ≥59 mg ω-3 FAs. Out of 20,547 dietary supplements (including 421 prenatal products), 69 products (33 prenatal) contained all 6 nutrients; 7 products (2 prenatal) contained target doses for 5 nutrients. Only 1 product (not a prenatal) contained target doses for all 6 nutrients, but it currently costs ∼USD200/mo and requires 7 tablets per daily serving.

CONCLUSIONS

Almost no US dietary supplements provide key nutrients in the doses needed for pregnant women. Affordable and convenient products that fill the gap between food-based intake and estimated requirements of pregnancy without inducing excess intake are needed to support pregnant women and their offspring. Am J Clin Nutr 20XX;xx:xx-xx.

Provision of information by midwives for pregnant women in England on guidance on foods/drinks to avoid or limit

BACKGROUND

The National Health Service (NHS) website gives guidance for pregnant women in England on foods/drinks to avoid or limit because of microbiological, toxicological or teratogenic hazards. These include, for example, some types of soft cheeses, fish/seafood and meat products. This website and midwives are trusted sources of information for pregnant women, but the ways in which midwives can be supported to provide clear and accurate information are unknown.

AIMS

The aims were to: (1) determine midwives' accuracy of recall of information and confidence in delivering the guidance to women; (2) identify barriers to provision; (3) identify the ways in which midwives provide this information to women.

METHODS

Registered Midwives practicing in England completed an online questionnaire. Questions included those on what information they provided and their confidence in delivering it, the ways they provided information on foods to avoid/limit, their recall of some of the guidance, and what resources they used. Ethics approval was given by the University of Bristol.

RESULTS

More than 10% of midwives (n = 122) were 'Not at all confident/Don't know' in providing advice about ten items, including game meat/gamebirds (42% and 43%, respectively), herbal teas (14%) and cured meats (12%). Only 32% correctly recalled overall advice on eating fish, and only 38% the advice on tinned tuna. The main barriers to provision were lack of time in appointments and lack of training. The most usual methods of disseminating information were verbal (79%) and signposting to websites (55%).

CONCLUSION

Midwives were often unconfident about their ability to provide accurate guidance, and recall on items tested was frequently mistaken. Delivery of guidance by midwives on foods to avoid or limit needs to be supported by appropriate training and access to resources, and sufficient time in appointments. Further research on barriers to the delivery and implementation of the NHS guidance is needed.

The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review

Pregnancy involves a metabolic reprogramming that includes changes in the gut microbiota composition in women. Evidence shows that maternal dysbiosis is linked to neonatal dysbiosis, and this factor can determine health status in adulthood. Although there is little literature available on this topic, high heterogeneity is a limitation when examining nutritional interventions. Information has been gathered to contrast the benefits of prebiotic usage, specifically in pregnancy, in its possible complications and in newborns’ gut microbiota development. The objective pursued in this brief narrative review is to provide a clear summary of relevant content when searching with regard to the use of prebiotics in pregnancy, the effects in prenatal and postnatal periods, and to help in clinical decision-making in pregnancy management and lactation. A search has found that the nutritional status of the pregnant mother is key for the earliest microbial colonization in newborns, and thus intervention programs from pregnancy could assure better outcomes in both the mother and offspring. In this sense, prebiotics (administered to mothers who breastfeed or provided in formula milk) are feasible and cost-effective elements that can prevent allergies, colic, and other maladies in newborns.

Nutritional Health Knowledge and Literacy among Pregnant Women in the Czech Republic: Analytical Cross-Sectional Study

Adequate nutrition and the nutritional status of pregnant women are critical for the health of both the mother and the developing foetus. Research has shown a significant impact of nutrition on the child's health and the future risk of developing chronic noncommunicable diseases (NCDs), such as obesity, diabetes, hypertension, and cardiovascular disease. There is currently no data on the level of nutritional knowledge of Czech pregnant women. This survey aimed to evaluate their level of nutritional knowledge and literacy. An analytical cross-sectional study was conducted in two healthcare facilities in Prague and Pilsen between April and June 2022. An anonymous self-administered paper-form questionnaire for assessing the level of nutritional knowledge (40 items) and the Likert scale for assessing nutrition literacy (5 items) were used. A total number of 401 women completed the questionnaire. An individual's nutritional knowledge score was calculated and compared with demographic and anamnestic characteristics using statistical methods. The results showed that only 5% of women achieved an overall nutritional score of 80% or more. University education (p < 0.001), living in the capital city (p < 0.001), experiencing first pregnancy (p = 0.041), having normal weight and being overweight (p = 0.024), and having NCDs (p = 0.044) were statistically significantly associated with a higher nutritional knowledge score. The lowest knowledge scores were found in the areas of optimal energy intake, optimal weight gain, and the role of micronutrients in diet during pregnancy. In conclusion, the study shows limited nutrition knowledge of Czech pregnant women in some areas of nutrition. Increasing nutritional knowledge and nutrition literacy in Czech pregnant women is crucial for supporting their optimal course of pregnancy and the future health of their offspring.

An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial

BACKGROUND

The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak.

OBJECTIVE

This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers.

METHODS

The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome.

RESULTS

The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women.

CONCLUSIONS

Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44456.

Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals

BACKGROUND

An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain.

METHODS

Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively.

RESULTS

Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190.

CONCLUSIONS

Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.

Potential mechanisms and modulators of food intake during pregnancy

Dietary choice during pregnancy is crucial not only for fetal development, but also for long-term health outcomes of both mother and child. During pregnancy, dramatic changes in endocrine, cognitive, and reward systems have been shown to take place. Interestingly, in different contexts, many of these mechanisms play a key role in guiding food intake. Here, we review how food intake may be impacted as a function of pregnancy-induced changes across species. We first summarize changes in endocrine and metabolic signaling in the course of pregnancy. Then, we show how these may be related to cognitive function and reward processing in humans. Finally, we link these to potential drivers of change in eating behavior throughout the course of pregnancy.

Nutrition Education in Medical Schools: What do Medical Students Think?

Objective

To examine medical students' perceptions of the nutrition education received and their ability to apply that knowledge in clinical settings.

Methods

This is a qualitative study using a structured survey with free responses to solicit the perspective of US medical students regarding their nutrition education. A national online survey was distributed by the American Academy of Pediatrics, Section on Pediatric Trainees. An expert committee in nutrition education evaluated and conducted a thematic analysis of the survey responses.

Results

Twenty-four surveys were completed (10 medical students and 14 pediatric interns). The survey revealed students were not satisfied with the nutrition education they received in several areas including nutritional recommendations for obesity and prediabetes/diabetes; nutritional needs during pregnancy, childhood, and adolescent age-related dietary recommendations; cultural influences on diet and eating habits; and food insecurity. Students also reported a lack of confidence in providing healthful nutrition counseling to adolescent patients and delivering culturally appropriate nutrition advice.

Conclusions

Survey responses revealed the need for improvements in several areas of nutrition curricula related to health and chronic disease management and suggest broader social determinants of health such as cultural influences on nutrition practices and food insecurity. The results of this survey provide unique insight into the medical student perspective on nutrition education and can inform the development of future medical school nutrition curriculums.

Perspectives of Maternal Mortality Among Women Who Live in Indiana

OBJECTIVE

To explore the perspectives of women in the lay public in Indiana on the topic of maternal mortality.

DESIGN

Qualitative descriptive design.

SETTING

The state of Indiana.

PARTICIPANTS

Women in the lay public (N = 20) who were recruited from Facebook groups aimed at women with children.

METHODS

We used semistructured phone interviews during which participants described their understanding of maternal mortality and their related experiences. We analyzed the transcribed interviews using content analysis to yield overall themes.

RESULTS

We identified three main themes that described participants' perspectives of maternal mortality: Women Are Not Worried About Mortality Until They Experience Pregnancy Complications, Women Have Limited Information on Maternal Mortality, and Women Often Feel Dismissed During Maternity Care.

CONCLUSION

Our findings suggest that nurses and other health care providers should increase their efforts to effectively communicate about maternal mortality and the associated risk factors and to follow evidence-based guidelines for respectful maternity care.

Nutrition Literacy Among Latina/x People During Pregnancy Is Associated With Socioeconomic Position

BACKGROUND

During pregnancy, Latina/x people experience nutrition and nutrition-related health inequities. Nutrition literacy is a potential factor impacted by these inequities. However, the nutrition literacy level of Latina/x people during pregnancy is not well investigated.

OBJECTIVES

The study aimed to assess the nutrition literacy level of Latina/x people during pregnancy and explore the association of nutrition literacy with socioeconomic position.

DESIGN

This was a cross-sectional study of data collected from 2016 to 2018 within the double-blinded, randomized clinical trial Assessment of Docosahexaenoic Acid on Reducing Early Preterm Birth.

PARTICIPANTS/SETTING

A total of 112 Latina/x people during pregnancy from the Kansas City metro area were included in this study.

MAIN OUTCOME MEASURES

Nutrition literacy level assessed between 12 and 20 gestational weeks using the Nutrition Literacy Assessment Instrument, both in English and Spanish.

STATISTICAL ANALYSES PERFORMED

Descriptive measures were used to describe the nutrition literacy level during pregnancy. Multiple logistic regression models were used to examine the association between low nutrition literacy and socioeconomic position, adjusting for age and race.

RESULTS

In this study, most participants demonstrated low nutrition literacy during pregnancy. Those with low nutrition literacy were 2 times more likely to have low annual household income (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 0.99-7.59), 3 times more likely to prefer Spanish as their primary language of communication (OR = 3.03, 95% CI: 0.95-9.67), and 7 times more likely to be uninsured (OR = 7.47; 95% CI: 1.57-35.64).

CONCLUSIONS

Nutrition literacy scores during pregnancy were associated with variables of socioeconomic position. Future research should focus on nutrition literacy associations with health outcomes during pregnancy and interventions to improve the nutrition literacy level of primarily Spanish-speaking people who have low household incomes and are uninsured.

Cesarean section and body mass index in children: is there a causal effect?

Obesity is considered a global public health problem. Cesarean section has been associated with high body mass index (BMI) and increased obesity throughout life. However, this association has been challenged by some studies. This study aims to assess the causal effect of cesarean section on the BMI of children aged 1-3 years. This is a cohort study of 2,181 children aged 1-3 years, born in 2010, obtained from the BRISA Birth Cohort, in São Luís, state of Maranhão, Brazil. Sociodemographic variables, maternal characteristics, type of childbirth, morbidity, anthropometric measurements, and BMI were assessed. Marginal structural models with a counterfactual approach were used to check the causal effect of the type of childbirth on obesity, weighted by the inverse probability of selection and exposure. Out of the 2,181 children assessed (52% female), 50.6% were born by cesarean section, 5.9% of the newborn infants were large for gestational age, and 10.7% of them had excess weight. No causal effect of cesarean section on BMI was observed (coefficient = -0.004; 95%CI: -0.136; 0.127; p = 0.948). Cesarean section did not have a causal effect on the BMI of children aged 1-3 years.

Testing the Impact of Familiarity with Health Benefits Information on Dietary Supplement Choice in Pregnancy: An Online Choice Experiment

To help meet the increased requirements for critical nutrients during and around pregnancy, supplementation with essential nutrients is recommended. This study aims to determine how the previous awareness of nutrient health benefits and/or the provision of this information influences the importance placed on nutrients (folate, iodine, omega-3 fatty acids, and vitamin D) when choosing between dietary supplement products for pregnancy. Discrete choice experiment data were collected as part of a cross-sectional online survey administered to 857 pregnant women living in Australia. Four segments of women were identified that differ in their preference criteria when choosing among dietary supplement products for pregnancy. When choosing between products, the reinforcement of perceived health benefits (i.e., showing information on health benefits to those already aware of the benefits) was most effective at increasing the importance of folate (in all segments) and iodine (in two segments, 63% of the sample). Neither prior awareness of health benefits alone nor information provided at the point-of-purchase without prior awareness were enough to increase the importance of folate. Our findings suggest a need for simultaneous strategies that (1) provide information on health benefits before purchase and (2) ensure that information on health benefits is available at the point-of-purchase.

Individual and community-level factors associated with animal source food consumption among children aged 6-23 months in Ethiopia: Multilevel mixed effects logistic regression model

BACKGROUND

Diversified diet in childhood has irreplaceable role for optimal growth. However, multi-level factors related to low animal source food consumption among children were poorly understood in Ethiopia, where such evidences are needed for decision making.

OBJECTIVES

To investigate the magnitude and individual- and community-level predictors of animal source food (ASF) consumption among children aged 6-23 months in Ethiopia.

METHODS

We utilized a cross-sectional pooled data from 2016/19 Ethiopia Demographic and Health Surveys. A stratified two-stage cluster design was employed to select households with survey weights were applied to account for complex sample design. We fitted mixed-effects logit regression models on 4,423 children nested within 645 clusters. The fixed effect models were fitted and expressed as adjusted odds ratio with their 95% confidence intervals and measures of variation were explained by intra-class correlation coefficients, median odds ratio and proportional change in variance. The deviance information criterion and Akaike information Criterion were used as model fitness criteria.

RESULT

in Ethiopia, only 22.7% (20.5%-23.9%) of children aged 6-23 months consumed ASF. Younger children aged 6-8 months (AOR = 3.1; 95%CI: 2.4-4.1), home delivered children (AOR = 1.8; 1.4-2.3), from low socioeconomic class (AOR = 2.43; 1.7-3.5); low educational level of mothers (AOR = 1.9; 95%CI: 1.48-2.45) and children from multiple risk pregnancy were significant predictors of low animal source consumption at individual level. While children from high community poverty level (AOR = 1.53; 1.2-1.95); rural residence (AOR = 2.2; 95%CI: 1.7-2.8) and pastoralist areas (AOR = 5.4; 3.4-8.5) significantly predict animal source food consumption at community level. About 38% of the variation of ASF consumption is explained by the combined predictors at the individual and community-level while 17.8% of the variation is attributed to differences between clusters.

CONCLUSIONS

This study illustrates that the current ASF consumption among children is poor and a multiple interacting individual- and community level factors determine ASF consumption. In designing and implementing nutritional interventions addressing diversified diet consumption shall give a due consideration and account for these potential predictors of ASF consumption.

Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis

Background

The barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.

Methods

This was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.

Results

The results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.

Conclusion

The major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.

Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality

Background

In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality.

Methods/design

This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women.

Discussion

This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase.

Trial registration

The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12543-z.

Behaviors, Beliefs, and Recommendations to Optimize Promotion of Safe Fish Consumption Before and During Pregnancy: A Physician Survey

INTRODUCTION

Eating fish before and during pregnancy is important but care must be taken to choose fish which maximize developmental outcomes. Physicians, a trusted health information source, could provide this nuanced communication. This cross-sectional survey of a representative sample of 400 family medicine and obstetrics and gynecology (OB-GYN) physicians in Minnesota was designed to understand physician behaviors and beliefs about safe fish consumption, describe barriers to physician-patient conversations about safe fish consumption generally and as part of prenatal care and to identify resources to help facilitate conversations on this topic.

METHODS

Data was collected January to April 2020. Two hundred nineteen surveys were completed (55% response rate) with 194 reporting seeing patients at least 1 day a week. Descriptive survey results from all were summarized and analyzed overall and by physician specialty. Responses to 3 open-ended questions were thematically coded to enrich the quantitative results.

RESULTS

While 62% of these reported discussing nutrition topics, only about one-third reported discussing with patients the benefits and about one-quarter the risks of eating fish. Despite the relative infrequency of fish discussions, almost all (>90%) respondents agreed that it is important to discuss fish consumption with people who are or may become pregnant. The largest reported barrier to these conversations was time (82%), and the most endorsed resource to overcome identified barriers was talking points (72%).

CONCLUSIONS

Because physicians report limited time, resources that facilitate fish consumption should be succinct while serving to both nudge the message and direct clinicians and their patients to robust information.

Information seeking behaviors, attitudes, and beliefs about pregnancy-related nutrition and supplementation: A qualitative study among US women

Background: Maternal behavior during pregnancy is crucial to her own and her infant's health, and as such, it is important to understand the nutrition and supplement habits of women during pregnancy and what informs those behaviors. Aim: We aimed to assess the information seeking habits, attitudes, and beliefs about pregnancy-related nutrition and supplementation among pregnant women in the United States. Methods: Qualitative study using key informant interviews with pregnant and recently pregnant (n = 21) US women. Themes related to concerns, attitudes, behaviors, and information seeking habits were extracted. Results: The mean age was 31.9 years and all had at least a university degree. Two major themes that emerged: (1) nutrition information-related attitudes and beliefs and (2) food and supplement-related attitudes and beliefs. Pregnant women in the US were underwhelmed with their health care provider experience when receiving information about pregnancy-related nutrition and supplementation. Nutrition was most often addressed in a reactive manner while women desired a more proactive approach. As a result, they conducted their own research using the internet as their primary tool, and ultimately made nutrition and supplement decisions based largely on their own instincts. Conclusion: Women interviewed for this study encountered barriers to pregnancy related nutrition information from a lack of clear communication from their health care provider and ambiguity and inconsistencies in information within and between sources. Women relied on themselves for information seeking and nutrition related decision making throughout their pregnancy.

Association Between Maternal Body Mass and Physical Activity Counseling During Pregnancy

Aims: The antenatal period provides an important opportunity for giving advice on healthy lifestyle choices. However, the prevalence of maternal obesity is increasing, and women report that they do not receive counseling. We investigated the information given to pregnant women on gestational weight gain, physical activity, and nutrition during pregnancy in relation with their initial weight status, current gestational weight gain and diagnoses of either pre-pregnancy overweight/obesity or excessive gestational weight gain. Methods: Cross-sectional survey using a questionnaire. Pregnant participants (n = 141) were recruited from a midwife center. They completed a structured questionnaire on the information they received during their pregnancy and we assessed its relationship with their weight. Results: We found that many pregnant women did not receive advice about physical activity, gestational weight gain and nutrition (37.5, 53.2, and 66.2%, respectively). Women with weight problems (pre-pregnancy overweight/obesity and excessive gestational weight gain) were less targeted for counseling, although more than 80% of the women viewed receiving information on these topics as positive. Also, being informed of a weight problem was associated with a greater chance of receiving information about physical activity, gestational weight gain and nutrition (all p < 0.05). However, verbalization of the weight problems was low (14.0% of women with pre-pregnancy overweight were informed of their status). Conclusion: Health professionals should dispense more information, especially on PA and particularly for women with weight problems. Verbalization of the weight problem seems associated with more frequent transmission of information.

Breastfeeding and weaning practices among mothers in Ghana: A population-based cross-sectional study

BACKGROUND

Children need good nutrition to develop proper immune mechanisms and psychosocial maturity, but malnutrition can affect their ability to realize this. Apart from the national demographic and health survey, which is carried out every 5 years, there have not been enough documented studies on child breastfeeding and weaning practices of caregivers in the Volta Region. We, therefore, examined child breastfeeding and weaning practices of mothers in the Volta Region of Ghana.

METHODS

A sub-national survey method was adopted and a semi-structured questionnaire was used to collect data from 396 mothers and their children. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and logistic regression were employed in analysing the data. We defined exclusive breastfeeding as given only breast milk to an infant from a mother or a wet nurse for six months of life except drops or syrups consisting of vitamins, minerals, supplements, or medicines on medical advice, and prolonged breastfeeding as breastfeeding up to 24 months of age.

RESULTS

The prevalence of exclusive breastfeeding (EBF) was 43.7%. Mothers constituting 61.1% started breastfeeding within an hour of giving birth. In addition to breast milk, 5.1% gave fluids to their children on the first day of birth. About 66.4% started complementary feeding at 6 months, 22.0% breastfed for 24 months or beyond, while 40.4% fed their children on-demand. Child's age (AOR: 0.23, 95% CI:0.12-0.43, p<0.0001), prolonged breastfeeding (AOR: 0.41, 95%CI: 0.12-0.87, p = 0.001), mother's religion (AOR: 3.92, 95%CI: 1.23-12.61, p = 0.021), feeding practices counselled on (AOR: 1.72, 95%CI: 1.96-3.09, p = 0.023), mother ever heard about EBF (AOR: 0.43, 95%CI: 1.45-2.41, p = 0.039), child being fed from the bottle with a nipple (AOR: 1.53, 95%CI: 1.94-2.48, p = 0.003), and age at which complementary feeding was started (AOR: 17.43, 95%CI: 3.47-87.55, p = 0.008) were statistically associated with EBF.

CONCLUSION

Breastfeeding education has been ongoing for decades, yet there are still gaps in the breastfeeding practices of mothers. To accelerate progress towards attainment of the sustainable development goal 3 of ensuring healthy lives and promoting well-being for all at all ages by the year 2030, we recommend innovative policies that include extensive public education to improve upon the breastfeeding and weaning practices of mothers.

Pre-natal nutrition education: Health care providers' knowledge and quality of services in primary health care centres in Lagos, Nigeria

INTRODUCTION

A healthy and balanced diet is very important during pregnancy. By enhancing maternal nutritional status, healthcare providers can lower the risks of pregnancy complications and adverse birth outcomes.

OBJECTIVES

To assess the pre-natal nutrition knowledge and services rendered by healthcare providers in antenatal clinics at Primary Health care Centres in Lagos, Nigeria.

METHODOLOGY

This was a cross-sectional study carried out in June-September 2019. Self-administered questionnaires were used to collect data on nutritional knowledge from 391 nurses and midwives who provided pre-natal nutrition education. Direct observation with checklist was used to assess the nutrition education services at the ANC clinics and covered: adequacy of the venue, availability/use of nutrition education resources, education content and teaching strategies. EPi-Info version 3.5 was used for data analysis. Inferential statistics such as chi square and multiple logistic regression were used to determine associated factors and predictors of nutrition knowledge. The level of significance was set at 5% (p<0.05).

RESULTS

The mean age of respondents was 41.71±10.33years, all were females; 44.8% were Registered Nurses, 12.0% were Registered Midwives, and 23.8% had a B.Sc. in Nursing. Majority (81.3%) had taken a nutrition course in nursing training program, 62.1% as elective classes. Majority (81.1%) had good knowledge of prenatal nutrition. Respondents who were older (51-60years) (p<0.001), single (p<0.001) and Christian (p = 0.001) had significantly better knowledge. Nurses who had University degrees (p<0.001), of higher cadre (p<0.001), more years of practice (p<0.001) and involved in treating severely malnourished children (p = 0.013) were also significantly more knowledgeable. Respondents below 40 years (OR 0.104, CI 0.049-0.218) and those with 10 years or less of practice (OR 0.189, CI 0.092-0.387) had less odds of having good nutrition knowledge. Being single (OR 8.791, CI 3.125-24.731), and Christian (OR = 5.810, CI: 3.321-10.164) predict good nutrition knowledge. In 39% of the 41 PHCs observed, quality of nutrition education services was inadequate. Gaps were mainly in availability of certain nutrition education facilities/resources and teaching strategies.

CONCLUSION

The majority of the respondents had good knowledge of pre-natal nutrition. Overall, however, nutrition education services provided by two-fifths of the facilities were inadequate. Interventions to improve prenatal nutrition knowledge of nurses/midwives should be focused more on those who are younger and have less work experience. All necessary equipment required for health service providers to execute their roles as nutrition counselors and educators should also be provided by the government.

Disparities in Risks of Inadequate and Excessive Intake of Micronutrients during Pregnancy

BACKGROUND

Inadequate or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes.

OBJECTIVE

The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity, education, and prepregnancy BMI.

METHODS

Fifteen observational cohorts in the US Environmental influences on Child Health Outcomes (ECHO) Consortium assessed participant dietary intake with 24-h dietary recalls (n = 1910) or food-frequency questionnaires (n = 7891) from 1999-2019. We compared the distributions of usual intake of 19 micronutrients from food alone (15 cohorts; n = 9801) and food plus dietary supplements (10 cohorts with supplement data; n = 7082) to estimate the proportion with usual daily intakes below their age-specific daily Estimated Average Requirement (EAR), above their Adequate Intake (AI), and above their Tolerable Upper Intake Level (UL), overall and within sociodemographic and anthropometric subgroups.

RESULTS

Risk of inadequate intake from food alone ranged from 0% to 87%, depending on the micronutrient and assessment methodology. When dietary supplements were included, some women were below the EAR for vitamin D (20-38%), vitamin E (17-22%), and magnesium (39-41%); some women were above the AI for vitamin K (63-75%), choline (7%), and potassium (37-53%); and some were above the UL for folic acid (32-51%), iron (39-40%), and zinc (19-20%). Highest risks for inadequate intakes were observed among participants with age 14-18 y (6 nutrients), non-White race or Hispanic ethnicity (10 nutrients), less than a high school education (9 nutrients), or obesity (9 nutrients).

CONCLUSIONS

Improved diet quality is needed for most pregnant females. Even with dietary supplement use, >20% of participants were at risk of inadequate intake of ≥1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities.

Nutrition Practitioner Perceptions of Nutrition Education with Pregnant Clients

OBJECTIVE

Nutrition education during pregnancy is associated with improved maternal and fetal outcomes. This study explored nutrition practitioner perceptions of providing nutrition education to this population and examined gaps in current practices.

METHODS

North Carolina nutrition practitioners (n = 73) working with pregnant women were asked to complete a survey about their provision of nutrition services to pregnant clients. Data were analyzed for descriptive statistics.

RESULTS

Cost (91%) and lack of time to cook (83%) were perceived as the largest barriers for clients to making dietary changes. Topics most requested by clients paralleled those practitioners identified as needs: weight gain (69%), lactation (63%), and general nutrition information (57%). Pamphlets (97%), posters (66%), telehealth (42%), and texting (38%) were accepted education methods.

CONCLUSIONS AND IMPLICATIONS

Evidence-based education on weight, lactation, and general nutrition, using time and cost-efficient approaches, and embracing technology were desired by pregnant clients when receiving nutrition education from nutrition and other health care practitioners and may result in improved maternal and fetal outcomes.

What is needed to facilitate healthy dietary behaviours in pregnant women: A qualitative study of Dutch midwives' perceptions of current versus preferred nutrition communication practices in antenatal care

OBJECTIVE

The aim of this paper was to explore midwives' perceptions of current and preferred nutrition communication practices in antenatal care, and to identify what is needed to achieve their preferred practices.

DESIGN

A qualitative descriptive design was used. Semi-structured interviews were conducted with twenty Dutch midwives working in primary care or secondary care settings across the Netherlands. To create a positive atmosphere, interviews were based on the principles of Appreciative Inquiry.

FINDINGS

Opportunities identified in current practices included midwives' sense of responsibility, their skills and experience, availability of resources, and group consultations. Barriers were the precarity and lack of prioritization of the topic, and the current focus on food safety (risks). Ideally, midwives envisioned nutrition communication as a continuous trajectory, in which not only reliable and consistent information is provided, but also more personalized and positive communication, to empower pregnant women.

KEY CONCLUSIONS

Midwives favour nutrition communication practices characterized by continuity of care and woman-centeredness. Opportunities to realize such practices in antenatal care are the use of innovative tools to support nutrition communication, more sustainable collaborations with dietitians, and better nutrition education for midwives.

IMPLICATIONS FOR PRACTICE

Midwives could act as facilitators and gatekeepers in nutrition communication, requiring limited time and expertise from midwives, and empowering pregnant women.

Determinants of Nutrition Care Practice by Midwives and Nurses in the Antenatal and Postnatal Care Settings: A Multi-Site Cross-Sectional Survey From Ghana

Aim. Midwives and nurses are critical in nutrition care for pregnant women and lactating mothers. Ghanaian nurses and midwives’ perception of the adequacy and their satisfaction with nutrition education received during training in school, level of nutrition care competencies, and nutrition practice behavior is unknown. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self-efficacy and the nutrition care practice of midwives and nurses. We also evaluated determinants of nutrition care practice during routine antenatal and postnatal care. Methods. Cross-sectional study conducted among midwives and nurses working at antenatal and postnatal clinics in Ghana. Data was collected using a self-administered questionnaire. Data analysis was done using descriptive statistics, correlation, and linear regression. Findings. Almost 90% (n = 267) of the participants received nutrition education during training, 77.5% were unsatisfied with the amount of time allocated for nutrition education and 40% felt inadequately prepared from school to provide nutrition care. Self-efficacy ranged from moderate to low. Determinants of nutrition care practice were age of respondents (B = 0.04; P = .002), nutrition-related knowledge (B = 0.05; P = .016), adequacy of nutrition education (B = 0.14; P = .006), nutrition training after school (B = 0.38; P = .010) and nutrition care self-efficacy (B = 0.03; P = .048). Conclusion. Notable knowledge gaps in basic nutrition, inadequate preparedness, and poor confidence to provide nutrition care was common. There is a need to improve the nutrition education experiences of midwives and nurses through curricula revision and refresher training courses.

Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'

Understanding women's perceptions of eating behaviors and dietary patterns can inform the 'teachable moment' model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.