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Cutajar L, Dahlen HG, Leechburch Auwers A, Vir S, Berberovic B, Jedrzejewski T, Burns ES. Model of care matters: An integrative review. Women Birth 2023:S1871-5192(22)00367-5. [PMID: 36642558 DOI: 10.1016/j.wombi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pregnant women are entitled to quality care during pregnancy. Some health districts offer a variety of maternity care models but, not all women are aware of what is available and there is limited research on the experiences of women within their chosen or allocated model of care. AIM The aim of this integrative review is to explore the available literature on women's experiences of the model of care accessed during pregnancy. METHOD A database search of CINAHL, MEDLINE, SCOPUS, OVID, JBI and Cochrane Database was conducted to identify original research articles published in English between 2011 and 2021. In total, 20 articles met the inclusion criteria. FINDINGS The included papers came from nine different countries and reported on eight different models of care. Following analysis of the articles one overarching theme 'Model of care matters', and six sub themes were identified: 1.'Choosing a model', 2.'Learning about pregnancy and birth', 3.'Being known', 4.'Making social and emotional connections', 5.'Receiving enabling or disabling care' and 6.'Integrated care is best'. Some women disclosed that they had no choice in the model they were allocated, while others stated they were not provided with information about all available models of care. CONCLUSION A lack of integrated care between medical and midwifery models led to feelings of dissatisfaction and distress during pregnancy. Positive experiences were reported when women developed a connection with the care provider. The development of a well-informed decision aid could alleviate deficits of information, and clarify the subtle differences that occur within various models.
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Affiliation(s)
- Lisa Cutajar
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
| | | | - Swati Vir
- South Western Sydney Primary Health Network, Australia.
| | | | | | - Elaine S Burns
- School of Nursing and Midwifery, Western Sydney University, New South Wales, Australia.
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Crane T, Buultjens M, Fenner P. Art-based interventions during pregnancy to support women's wellbeing: An integrative review. Women Birth 2020; 34:325-334. [PMID: 32912739 DOI: 10.1016/j.wombi.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The transition to motherhood is a dynamic experience. Antenatal care and education are designed to support women during pregnancy, however childbearing women often report a further need for emotional and social support beyond preparation for birth. Broadening routine antenatal care to included art-based interventions may offer women an opportunity to explore important aspects of the transition to motherhood. AIM The aim of this integrative review is to synthesise research regarding the use of art-based interventions with women during pregnancy. METHOD A systematic integrative review of the current evidence-base was conducted. A multi-database keyword search was implemented, and a total of six articles met inclusion criteria. Results were analysed using an inductive thematic analysis framework. FINDINGS Six studies met the inclusion criteria. Three major themes were generated: art-based engagements supported women to express complex emotion, fostered a sense of connection and strengthened personal resourcefulness. DISCUSSION Creative expression provided an opportunity to explore important aspects of the motherhood experience including, complex emotion, identity and bonding with the unborn child. Being in a group enhanced the health effects of art-making and the social connection felt supportive when role and identity was evolving. CONCLUSIONS Whilst research on the current topic is emergent, preliminary results suggest that facilitated art-based programs are valuable for pregnant women. Art-based experiences offer women a unique opportunity to explore the full dimensionality of the transition to motherhood which can contribute to improved health and wellbeing. These findings suggest that art-based programs may serve to complement existing antenatal care models.
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Affiliation(s)
- Tess Crane
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Melissa Buultjens
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Patricia Fenner
- Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
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Dietary Interventions for Healthy Pregnant Women: A Systematic Review of Tools to Promote a Healthy Antenatal Dietary Intake. Nutrients 2020; 12:nu12071981. [PMID: 32635332 PMCID: PMC7400659 DOI: 10.3390/nu12071981] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Maternal nutrition is essential for the development and lifelong health of the offspring. Antenatal care provides unique opportunities for nutrition communication, and health promotion tools (e.g., guidelines, instruments, packages, or resources) might help to overcome several concurrent barriers. We conducted a systematic literature review to map tools that are available for the promotion of a healthy dietary intake in healthy pregnant women in Western countries, and to identify what makes these tools feasible and effective for these women and their healthcare providers. Seventeen studies were included, evaluating tools with various delivery modes, content, and providers. Nine studies employed multiple, complementary delivery methods and almost all studies (n = 14) tailored the content to varying degrees, based on the individual characteristics and lifestyle behaviors of the participants. We found that the feasibility of a tool was dependent on practical issues, time investment, and providers’ motivation, skills, and knowledge, while the effectiveness was related more to the type of provider and the content. Most effective interventions were provided by dietitians and nutritionists, and were highly tailored. Based on the results of this review, we believe that custom tools that are sensitive to inequalities are needed to support all women in obtaining or maintaining a healthy diet during pregnancy.
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Rouhi M, Stirling CM, Crisp EP. Mothers' views of health problems in the 12 months after childbirth: A concept mapping study. J Adv Nurs 2019; 75:3702-3714. [PMID: 31452233 DOI: 10.1111/jan.14187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/22/2019] [Accepted: 08/10/2019] [Indexed: 01/03/2023]
Abstract
AIMS To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth. BACKGROUND Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems. DESIGN A mixed method concept mapping study. METHOD Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth. RESULTS Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems. CONCLUSION Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support. IMPACT Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.
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Affiliation(s)
- Maryam Rouhi
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Christine M Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Elaine P Crisp
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Lucas CJ, Lyell E, Koch B, Elder V, Cummins L, Lambert S, McMahon AT, Charlton KE. Feasibility of face-to-face and online learning methods to provide nutrition education to midwives, general practice nurses and student nurses. BMJ Nutr Prev Health 2019; 2:80-85. [PMID: 33235961 PMCID: PMC7664485 DOI: 10.1136/bmjnph-2019-000031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/04/2019] [Accepted: 08/12/2019] [Indexed: 12/05/2022] Open
Abstract
Midwives and general practice nurses are ideally positioned to provide nutrition education to pregnant women. However, it appears that they do not receive sufficient nutrition training to enable them to fulfil this role. This study aimed to develop, implement and evaluate a suite of learning resources developed specifically for midwives, general practice nurses and student nurses. A four-module suite of learning resources was developed based on recommendations in the Australian Antenatal Care Clinical Guidelines as well as formative evaluation with stakeholders. The feasibility of these modules was tested using a pre-test and post-test quasi-experimental design with three arms using convenient sampling (face-to-face with midwives; online with student nurses; and online with midwives, nurses and practice nurses). Completion rates across the three study arms were poor (n=40 participants in total). For the combined data, there was a significant increase in knowledge scores across all modules from the pretest score (median (IQR): 3.46 (2.09–4.13)) to the post-test score (5.66 (4.66–6.00)) (p<0.001). Studies of high quality are required to determine if changing the nutrition knowledge and confidence in delivering nutrition care of health professionals results in sustainable changes to their clinical practice.
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Affiliation(s)
- Catherine Jane Lucas
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ellen Lyell
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Britney Koch
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Victoria Elder
- Maternity and Women's Health, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Leanne Cummins
- Maternity and Women's Health, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Sarah Lambert
- Higher Education Participation and Partnerships Program, Deakin University, Burwood, Victoria, Australia
| | - Anne T McMahon
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen E Charlton
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
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Rissel C, Khanal S, Raymond J, Clements V, Leung K, Nicholl M. Piloting a Telephone Based Health Coaching Program for Pregnant Women: A Mixed Methods Study. Matern Child Health J 2019; 23:307-315. [PMID: 30756280 PMCID: PMC6394500 DOI: 10.1007/s10995-019-02735-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals. Methods A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals. Results Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women. Conclusions for Practice Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received. TRIAL REGISTRATION: ACTRN12615000397516 (retrospectively registered).
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Affiliation(s)
- Chris Rissel
- NSW Office of Preventive Health, Liverpool, NSW, Australia.
| | - Santosh Khanal
- NSW Office of Preventive Health, Liverpool, NSW, Australia
| | - Jane Raymond
- NSW Ministry of Health, North Sydney, NSW, Australia
| | | | - Kit Leung
- NSW Ministry of Health, North Sydney, NSW, Australia
| | - Michael Nicholl
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Rule T, Beckmann M. Introducing a new collaborative prenatal clinic model. Int J Gynaecol Obstet 2018; 144:248-251. [PMID: 30582765 DOI: 10.1002/ijgo.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 12/21/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To measure quality of care-planning for women in a new collaborative prenatal model of care. METHODS A collaborative patient-centered (CPC) model was introduced into a tertiary prenatal clinic, replacing the traditional model. A retrospective analysis was conducted of women with a first documented hospital doctor contact between February 1, 2015, and October 1, 2016. Quality of care-planning before and after introduction of the model was compared by measuring the number and size of documented care plans and amount of doctor contact. Categorical data were compared using χ2 or Fisher exact tests; continuous data were analyzed using the student t test. RESULTS Quality of care was measured for 3606 women before, and 3511 after, introduction of the CPC model. Under the model, more women had clinical risks identified and care plans documented (2224 [63.3%] vs 1883 [52.2%]; P<0.001), and more clinical risks were identified (1.07 vs 0.74; P<0.001). Doctors documented more in each care plan (P<0.001) and had more subsequent clinical contact with women (0.69 ± 1.23 vs 0.88 ± 1.34; P<0.001) in the model. CONCLUSION Introduction of a collaborative model in a tertiary prenatal clinic improved identification of clinical risks and documentation of care plans, and increased doctor contacts.
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Affiliation(s)
- Travis Rule
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospitals, Brisbane, Qld, Australia
| | - Michael Beckmann
- Department of Obstetrics and Gynaecology, Mater Mothers' Hospitals, Brisbane, Qld, Australia
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How have the lives of pregnant women changed in the last 30 years? Women Birth 2017; 30:342-349. [DOI: 10.1016/j.wombi.2017.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 01/15/2023]
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Kearney L, Kynn M, Craswell A, Reed R. The relationship between midwife-led group-based versus conventional antenatal care and mode of birth: a matched cohort study. BMC Pregnancy Childbirth 2017; 17:39. [PMID: 28103820 PMCID: PMC5244557 DOI: 10.1186/s12884-016-1216-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Midwife facilitated, group models of antenatal care have emerged as an alternative to conventional care both within Australia and internationally. Group antenatal care can be offered in a number of different ways, however usually constitutes a series of sessions co-ordinated by a midwife combining physical assessment, antenatal education and peer support in a group setting. Midwife-led group antenatal care is viewed positively by expectant mothers, with no associated adverse outcomes identified in the published literature for women or their babies when compared with conventional care. Evidence of an improvement in outcomes is limited. The aim of this study was to compare mode of birth (any vaginal birth with caesarean birth) between pregnant women accessing midwife-led group antenatal care and conventional individual antenatal care, in Queensland, Australia. METHODS This was a retrospective matched cohort study, set within a collaborative antenatal clinic between the local university and regional public health service in Queensland, Australia. Midwife-led group antenatal care (n = 110) participants were compared with controls enrolled in conventional antenatal care (n = 330). Groups were matched by parity, maternal age and gestation to form comparable groups, selecting a homogeneous sample with respect to confounding variables likely to affect outcomes. RESULTS There was no evidence that group care resulted in a greater number of caesarean births. The largest increase in the odds of caesarean birth was associated with a previous caesarean birth (p < 0.001), no previous birth (compared with previous vaginal birth) (p < 0.003), and conventional antenatal care (p < 0.073). The secondary outcomes (breastfeeding and infant birth weight) which were examined between the matched cohorts were comparable between groups. CONCLUSIONS There is no evidence arising from this study that there was a significant difference in mode of birth (caesarean or vaginal) between group and conventional care. Group care was associated with a lower risk of caesarean birth after controlling for previous births, with the highest chance for a vaginal birth being a woman who has had a previous vaginal birth and was in group care. Conversely, the highest risk of caesarean birth was for women who have had a previous caesarean birth and conventional care.
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Affiliation(s)
- Lauren Kearney
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
- Women and Families Service Group, Sunshine Coast Hospital and Health Service, Maroochydore DC, Queensland Australia
| | - Mary Kynn
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
| | - Alison Craswell
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
| | - Rachel Reed
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, 4558 Queensland Australia
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Craswell A, Kearney L, Reed R. ‘Expecting and Connecting’ Group Pregnancy Care: Evaluation of a collaborative clinic. Women Birth 2016; 29:416-422. [DOI: 10.1016/j.wombi.2016.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
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Frawley J, Hall H, Adams J, Sibbritt D. Health care utilisation of women who experience pregnancy-related reflux, nausea and/or vomiting. J Matern Fetal Neonatal Med 2016; 30:1938-1943. [PMID: 27594351 DOI: 10.1080/14767058.2016.1232711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Nausea, vomiting and reflux are common conditions experienced by women during pregnancy. The objective of this project was to examine women's use of health services for these conditions. METHODS The study sample was obtained via the Australian Longitudinal Study on Women's Health. A total of 2445 women who were pregnant or who had recently given birth in 2009 were invited to complete a sub-survey in 2010 about pregnancy and health service utilisation. A response rate of 79.2% was obtained. RESULTS During their pregnancy, 604 (32.9%) respondents experienced nausea, with 255 (42.2%) of these women seeking help from a health care practitioner. A total of 201 women (11%) reported repeated vomiting, and 637 women (34.7%) reported reflux, of which 78.6% and 59.2% sought help, respectively. There were no significant differences in the mental and physical health measures between women with nausea, vomiting and/or reflux who sought help and women who did not. Having private health insurance with obstetric cover was associated with seeking help for reflux; this was the only demographic measure significantly associated with seeking help for any condition. CONCLUSION Research is required to understand why many women do not seek professional help for common gastrointestinal conditions during pregnancy.
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Affiliation(s)
- Jane Frawley
- a Faculty of Health , University of Technology Sydney , Ultimo , NSW , Australia and
| | - Helen Hall
- b School of Nursing and Midwifery, Monash University , Frankston , VIC , Australia
| | - Jon Adams
- a Faculty of Health , University of Technology Sydney , Ultimo , NSW , Australia and
| | - David Sibbritt
- b School of Nursing and Midwifery, Monash University , Frankston , VIC , Australia
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Lucas CJ, Charlton KE, Brown L, Brock E, Cummins L. Antenatal shared care: are pregnant women being adequately informed about iodine and nutritional supplementation? Aust N Z J Obstet Gynaecol 2014; 54:515-21. [PMID: 25196454 DOI: 10.1111/ajo.12239] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/17/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess nutrition-related knowledge and practices, including supplement use, of both pregnant women and healthcare providers that participate in antenatal shared care (ANSC). METHODS Pregnant women enrolled in ANSC (n = 142) completed a knowledge and practices survey and a validated iodine-specific Food Frequency Questionnaire. General practitioners (GP) and nurses (N = 61) participating in the ANSC program completed a short survey which assessed their knowledge about nutrition for pregnancy, focussing on iodine. RESULTS Both groups had poor knowledge about the importance and roles of iodine during pregnancy. Most women (82%) reported taking a supplement during their current pregnancy, and 70% were taking a supplement containing iodine. Only 26% of GPs discussed iodine supplementation with pregnant patients. The median (IQR) iodine intake of pregnant women was 189 (129-260) μg/day which meets the estimated average requirement (160 μg/day). Half (52%) of women's dietary iodine was provided by dairy foods, and only 7% came from fish and seafood. Most healthcare providers (74%) expressed interest in receiving ongoing professional education about iodine in pregnancy. CONCLUSION AND IMPLICATIONS Ongoing nutrition education for ANSC health practitioners is required to ensure that women receive sufficient dietary advice for optimal pregnancy outcomes. Further research is required to address reasons behind dietary choices of Australian pregnant women.
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Affiliation(s)
- Catherine J Lucas
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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