A qualitative study of motivators and barriers to healthy eating in pregnancy for low-income, overweight, African-American mothers

Barriers and facilitators to healthy eating during post-partum among non-Hispanic Black mothers

Maternal diet is a key predictor of child diet, yet an in-depth inquiry into the barriers and facilitators for the adoption of healthy eating behaviours during the post-partum period is lacking, specifically for non-Hispanic Black mothers. This study used qualitative research methods to investigate healthy eating practices among a sample of non-Hispanic Black mothers participating in a family-based obesity prevention intervention. In-depth interviews were conducted with 22 mothers who participated in the Mothers and Others: Family-based Obesity Prevention for Infants and Toddlers intervention trial. Interviews were audio-recorded and transcribed verbatim. A deductive and inductive process was used to develop a consensus codebook; once the data were coded, matrices were developed to explore the data and identify similarities and differences between respondents. Relevant themes were identified, and salient quotes were used to illustrate each theme. Mothers believed that time and taste were significant barriers to eating healthy. Social influence and social support had both positive and negative influences on mothers' ability to adopt healthy eating behaviours. Despite their children often being a facilitator to healthy eating, many mothers struggled with finding the time, energy and desire to focus on themselves when it came to healthy eating. Many mothers were intent on preparing healthy meals and snacks for their children but did not prepare them for themselves. Future interventions should focus on the importance of role-modelling healthy eating behaviours for their children and include behaviour change strategies that incorporate skill-building activities emphasizing time-saving methods for planning and preparing healthy meals and snacks for the whole family to eat.

Efficacy of an mHealth-delivered behavioral intervention on weight loss and cardiometabolic risk in African American postpartum people with overweight or obesity: the SnapBack randomized controlled trial

OBJECTIVE

The objective of this study was to evaluate the efficacy of a mobile health (mHealth)-delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months.

METHODS

A randomized controlled trial of 300 African American postpartum people with overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care (n = 151) or a 12-month mHealth-delivered intervention (n = 149) comprising behavior change goals, interactive self-monitoring text messages, and counseling support.

RESULTS

Intervention and usual-care participants did not significantly differ in 12-month mean postpartum weight change (1.1 vs. 1.6 kg, p = 0.5; difference -0.6 kg, 95% CI: -2.3 to 1.2). However, high intervention engagement led to weight loss compared with weight gain among those who were less engaged (-0.6 vs. 2.4 kg, p = 0.01; difference -3.0 kg, 95% CI: -5.4 to -0.6). The intervention reduced systolic BP relative to usual care (-1.6 vs. 2.4 mm Hg, p = 0.02; difference -4.0 mm Hg, 95% CI: -7.5 to -0.5), but this effect did not extend to other cardiometabolic risk factors.

CONCLUSIONS

Among African American postpartum people enrolled in WIC, an mHealth-delivered intervention reduced systolic BP but not additional cardiometabolic risk factors or weight. Intervention participants with high engagement had significantly better postpartum weight outcomes, and thus, next steps include addressing barriers to engagement.

Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis

BACKGROUND

Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population.

AIM

Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups.

METHODS

Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists.

FINDINGS

Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors.

DISCUSSION

Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers.

CONCLUSION

We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women.

Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review

INTRODUCTION

Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling.

METHODS

An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition.

RESULTS

Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines.

DISCUSSION

Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.

Association between density of food retailers and fitness centers and gestational diabetes mellitus in Eastern Massachusetts, USA: population-based study

Background

Few studies have investigated the relationship between the food and physical activity environment and odds of gestational diabetes mellitus (GDM). This study quantifies the association between densities of several types of food establishments and fitness centers with the odds of having GDM.

Methods

The density of supermarkets, fast-food restaurants, full-service restaurants, convenience stores and fitness centers at 500, 1000 and 1500 m (m) buffers was counted at residential addresses of 68,779 pregnant individuals from Eastern Massachusetts during 2000-2016. The 'healthy food index' assessed the relative availability of healthy (supermarkets) vs unhealthy (fast-food restaurants, convenience stores) food retailers. Multivariable logistic regression quantified the cross-sectional association between exposure variables and the odds of having GDM, adjusting for individual and area-level characteristics. Effect modification by area-level socioeconomic status (SES) was assessed.

Findings

In fully adjusted models, pregnant individuals living in the highest density tertile of fast-food restaurants had higher GDM odds compared to those living in the lowest density tertile (500 m: odds ratio (OR):1.17 95% CI: [1.04, 1.31]; 1000 m: 1.33 95% CI: [1.15, 1.53]); 1500 m: 1.18 95% CI: [1.01, 1.38]). Greater residential density of supermarkets was associated with lower odds of GDM (1000 m: 0.86 95% CI: [0.74, 0.99]; 1500 m: 0.86 95% CI: [0.72, 1.01]). Similarly, living in the highest fitness center density tertile was associated with decreased GDM odds (500 m:0.87 95% CI: [0.76, 0.99]; 1500 m: 0.89 95% CI: [0.79, 1.01]). There was no evidence of effect modification by SES and no association found between the healthy food index and GDM odds.

Interpretation

In Eastern Massachusetts, living near a greater density of fast-food establishments was associated with higher GDM odds. Greater residential access to supermarkets and fitness centers was associated with lower the odds of having GDM.

Funding

NIH.

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.

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.

Food Choice and Dietary Perspectives of Young, Urban, Black Pregnant Women: A Focus Group Study

Black pregnant women in Chicago are disproportionately affected by maternal morbidity and mortality and are more likely to reside in neighborhoods that experience greater economic hardships and food apartheid than any other race/ethnicity. Addressing social determinants of health such as structural inequities, economic environment, and food apartheid issues may provide insights into eliminating Black maternal morbidity and mortality disparities. This study explores food choice determinants and dietary perspectives of young, urban, Black pregnant women. Two audio-recorded focus groups were conducted in Chicago, IL between March 2019 and June 2019 to discuss pregnancy experiences and factors affecting maternal nutrition. Thematic analysis was used to identify the codes, themes, and subthemes of the data. Data analysis was guided by the Social Ecological Model (SEM) as a theoretical framework. Eleven, young, Black women were recruited. Three major themes were discussed across the SEM levels that influenced food choice including food access, stress and family influences on eating, and the need for nutritional education during pregnancy. These choices were primarily rooted in the detrimental effects of food apartheid experienced within the participants' neighborhoods. Therefore, acknowledging, understanding, and addressing food apartheid and its impact on Black maternal health disparities is needed in clinical practice, research, and policy change.

Perceived challenges and strategies to achieve Canada's Food Guide recommendation to "Cook more often": Findings from parents of young children

Unhealthy diets are detrimental to health, but home meal preparation is associated with better diet quality. Among a sample of parents of children aged 2-12, this study aimed to 1) explore perceived challenges and strategies to meeting the 2019 Canada's Food Guide recommendation of "Cook more often". From October 2019 to January 2020, 8 focus groups were conducted with 40 parents (73% mothers; 78% white) from Southwestern Ontario, Canada. Sessions were audio-recorded and transcribed verbatim. A hybrid thematic approach with inductive and deductive data analysis was used. Reported challenges included time constraints, picky eating, lacking cooking skills, high price of some fresh ingredients, school restrictions on meals at school, and the influence of children's peers on food choices, mainly unhealthy snacks. Reported strategies to mitigate some challenges included planning and preparing meals ahead of time, using technology or services to make meal planning and grocery shopping more convenient, using devices and kitchen instruments, such as Crockpot®, to make cooking faster, receiving help from spouse or child(ren), and acknowledging that foods perceived as less healthful in moderation can be included in meal preparation. These findings can help inform interventions and educational campaigns to support cooking among families with young children.

Association of plant-based dietary patterns in first trimester of pregnancy with gestational weight gain: results from a prospective birth cohort

BACKGROUND/OBJECTIVES

Plant-based dietary patterns are becoming more popular worldwide. We aimed to examine the relationship between plant-based dietary patterns and the risk of inadequate or excessive gestational weight gain (GWG) in Iranian pregnant women.

METHODS

We prospectively followed 657 pregnant women in Iran. Adherence to the plant-based diet, represented by plant-based (PDI), healthy (hPDI) and unhealthy plant-based (uPDI) dietary indexes was evaluated by applying a 90-item food frequency questionnaire during the first trimester of pregnancy. Multivariable-adjusted Cox proportional-hazards regression model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) across quartiles of plant-based diet scores.

RESULTS

Over 25,562 person-weeks of follow-up, we documented 106 and 294 participants with inadequate and excessive GWG, respectively. We found a strong inverse association between adherence to the PDI and inadequate GWG after adjustment for demographic and confounding variables. Women in the highest quartile of the PDI had 50% lower risk of inadequate GWG than those in the lowest quartile (adjusted HR: 0.50; 95%CI 0.29, 0.89; P = 0.02). No significant association was found between hPDI and uPDI and inadequate GWG. There was no association between PDI, hPDI, and uPDI and the risk of excessive GWG.

CONCLUSIONS

Greater adherence to a plant-based diet during the first trimester of pregnancy may be associated with a lower risk of inadequate GWG. This finding needs to be confirmed in larger cohort studies, considering other pregnancy outcomes such as birth weight and the potential changes across the trimester in terms of food types and quantity.

Does Internet use connect smallholder farmers to a healthy diet? Evidence from rural China

Introduction

Undernutrition and micronutrient malnutrition remain problems of significant magnitude among small-scale subsistence farmers, posing a serious threat to their health and well-being. Developing a healthy diet can effectively reduce this threat. Fortunately, the Internet can speed up the process.

Methods

Based on survey data from 5,114 farm households in nine provinces in China, this study quantitatively assesses the impact of Internet use on the dietary quality of smallholder farmers using OLS regression models and PSM models.

Results/Discussion

(1) Internet use can significantly contribute to dietary diversity and dietary rationality among smallholder farmers, thus optimizing their dietary structure. (2) Internet use significantly increased the average consumption amounts of milk and its products (2.9 g), fruits (21.5 g), eggs (7.5 g), and vegetables (27.1 g), while also decreasing the intake of salts (1.5 g) and oil (3.8 g). (3) The pull of internet use to improve diet quality is more significant for smallholder households with lower levels of education, older heads of households, and higher household incomes. (4) A possible mechanism is that Internet use increases household income and information access skills of rural residents, thus improving their dietary quality. In summary, governments should further promote Internet penetration in rural areas for health purposes.

Facilitators and barriers influencing weight management behaviours during pregnancy: a meta-synthesis of qualitative research

BACKGROUND

Obesity and overweight are considered risk factors for a range of adverse outcomes, including stillbirth. This study aims to identify factors reported by women influencing weight management behaviours during pregnancy.

METHODS

A systematic search was conducted in five databases from inception to 2019 and updated in 2021. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women's experiences of weight management during pregnancy were included. Meta-ethnography was used to facilitate the meta-synthesis of 17 studies.

RESULTS

Three themes were identified during the analysis: (1) Awareness and beliefs about weight gain and weight management, which included level of awareness and knowledge about dietary and exercise recommendations, risk perception and decision balance, perceived control over health and weight gain and personal insecurities. (2) Antenatal healthcare, women's experiences of their interactions with healthcare professionals during the antenatal period and the quality of the education received had an effect on women's behaviour. Further, our findings highlight the need for clear and direct information, and improved interactions with healthcare professionals, to better support women's weight management behaviours. (3) Social and environmental influence, the social judgement and stigmatization associated with overweight and obesity also acted as a negative influence in womens' engagement in weight management behaviours.

CONCLUSION

Interventions developed to promote and maintain weight management behaviours during pregnancy should consider all levels of influence over women's behaviours, including women's level of awareness and beliefs, experiences in antenatal care, education provision and social influence.

Maternal pre-pregnancy body mass index, gestational weight gain, and pubertal timing in daughters: A systematic review and meta-analysis of cohort studies

The timing of daughter's puberty onset is constantly earlier. It is still unclear about the maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) as important prenatal factors that may affect offspring's onset of puberty. Thus, we evaluated the association among maternal pre-pregnancy BMI, GWG, and daughters' early pubertal development based on the existing literature. Literature review was conducted in different databases, including Web of Science, Pubmed, Wiley, ScienceDirect, Web of Science, and Chinese National Knowledge Infrastructure databases up to June 2021. We selected random effects model or fixed effects model for meta-analysis according to the I² statistics value to obtain the summary measurement. A total of 12 cohort studies were included. Compared to maternal pre-pregnancy normal weight, maternal pre-pregnancy overall overweight/obesity (RR = 1.24; 95% CI 1.17 to 1.32), obesity (RR = 1.35; 95% CI 1.23 to 1.48), and overweight (RR = 1.17; 95% CI 1.09 to 1.26) were significantly associated with the increased risk of earlier timing of pubertal onset in daughters. Daughters born of mothers with pre-pregnancy overall overweight/obesity, obesity, and overweight had earlier pubertal onset compared to those born of mothers with normal weight ([mean difference = -3.03, 95% CI: -3.97 to -2.10], [mean difference = -3.50, 95% CI: -5.38 to -1.62], and [mean difference = -2.89, 95% CI: -4.07 to -1.71], respectively). The effects were also significant in the assessed three milestones (menarche, breast development, and pubic hair development). Maternal excessive GWG increased the risk of early pubertal timing in daughters (RR = 1.19; 95% CI 1.09 to 1.30).

Experiences of Food-Insecure Pregnant Women and Factors Influencing Their Food Choices

Introduction

Food insecurity (FI), an inadequate access to healthy, affordable food, is a public health concern primarily driven by material hardship. Optimal antenatal nutrition promotes best health outcomes for the mother and baby. Pregnant women experiencing FI are less able to access healthy foods, increasing the risk of complications such as gestational diabetes and preterm labour. Little is known about the experiences of food-insecure pregnant women in obtaining sufficient, nutritious food, their perceptions regarding antenatal nutrition and how this contributes to their food choices.

Methods

This qualitative study conducted from August to November 2020, during the COVID-19 pandemic, examined the experiences and coping strategies of food-insecure pregnant women, and the factors influencing their food choices. Seven English-speaking food-insecure pregnant women participated in semi-structured interviews. Interview transcripts were thematically analysed, informed by grounded theory methodology.

Results

Three themes were identified through analysis of the interviews related to strategies that managed household food supply, factors that influenced food choices, and experiences of pregnancy during the COVID-19 pandemic. As a result of a limited food budget, pregnancy symptoms, the cognitive overload that attends the FI experience, and the acute yet significant impact of the pandemic, food-insecure pregnant women in this study defaulted to cheap and convenient food choices despite acknowledging the importance of eating well for pregnancy.

Conclusion

FI during pregnancy is burdensome, relentless and undermines women’s wellbeing. Supportive strategies within antenatal healthcare settings are urgently required to deliver an equitable health response for vulnerable women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-022-03440-3.

Perceptions of Tailored Dietary Advice to Improve the Nutrient Adequacy of the Diet in French Pregnant Women

Tailored dietary counseling could be specifically efficient during pregnancy, a period accompanied by a rise in nutrition awareness, but little is known about the expectations of pregnant women in this regard. We studied these expectations regarding tailored dietary advice in French women during their pregnancy, as well as their motivations and the perceived barriers and enablers. In French pregnant women, we evaluated the perceptions of tailored dietary advice provided by stepwise dietary counseling based on three types of dietary changes, consisting of: (1) a modification of the amounts consumed, (2) substitutions within the food subgroups, and (3) substitutions between food subgroups. A sequential explanatory mixed-method approach was designed. Using qualitative data from a focus group study (n = 40), we intended to explore in depth the women’s expectations regarding dietary advice and adherence to a tailored approach. These were combined with quantitative and qualitative data from a 6-week online longitudinal study (n = 115), using questionnaires designed to assess the modifications of dietary habits during pregnancy and to evaluate each type of dietary change. Both studies confirmed that most women in our samples did indeed intend to institute changes regarding healthier dietary practices during pregnancy. The principal motivation behind changes to their habits was to ensure the health and well-being of both their babies and themselves. The proposal of dietary advice that is tailored to both the current diet and the specific needs of pregnant women, but that is also positive and credible, was perceived as enabling implementing healthier dietary practices during pregnancy. Regarding the implementation of the dietary changes proposed, the enablers and barriers identified differed between modifications of the amounts consumed and substitutions. The women displayed interest in all types of dietary changes. This gave relevance to combining different types of changes in order to propose dietary counseling during pregnancy. Tailored dietary counseling was identified by French pregnant women in our samples as enabling them to adopt a healthier diet. However, perceived barriers might limit the implementation of dietary changes, especially when they involved marked modifications to their usual diet.

Pregnancy after bariatric surgery: Effects of personalized nutrition counseling on pregnancy outcomes

BACKGROUND & AIMS

Nutritional challenges following bariatric surgery can be intensified during pregnancy and may have crucial effects on the fetus, including lower birth weight. To the best of our knowledge, the effect of nutritional counseling during post-bariatric pregnancy to improve maternal diet quality and eating habits on neonatal outcome has not been evaluated. The aim of this research was to examine the effects of personal nutritional counseling during post-bariatric pregnancy on nutritional intake and neonatal outcomes.

METHODS

We performed a non-randomized, intervention-control clinical trial. Women (n = 61) were divided into three groups; two prospective, and one retrospective: 1. An Intervention Bariatric Prospective group 2. A Control Prospective group without surgery, and 3. A Control Bariatric Retrospective group. Patient enrollment was performed from April 2016 to March 2018. The intervention program included biweekly visits with a pregnancy nutrition certified bariatric dietitian. Data collection was performed four times during pregnancy, and included demographic and eating habits questionnaires, 24 h dietary recall, and information about delivery outcomes. In the retrospective group delivery outcomes and Food Frequency Questionnaire was collected once, after delivery.

RESULTS

There were no differences between groups at baseline except for a higher pre-pregnancy BMI in the post-bariatric groups. In the prospective groups, dietary protein, energy, and iron were found to be consumed in higher amounts in the Control-Prospective group than in the Intervention Bariatric-Prospective group (p < 0.05), without the addition of supplements. On the other hand, iron and calcium calculated from diet with supplements, were found to be significantly higher in the Intervention Bariatric Prospective group than in the Control Prospective group. In addition, consumption of saturated fats, oil, and salty snacks was lower in both prospective groups compared to the retrospective group (p < 0.05), suggesting better food quality habits for the bariatric group with nutritional counseling. Mean birth weight was significantly lower in the Control Bariatric Retrospective group than in the Control-Prospective group (3074 ± 368 g vs. 3396 ± 502 g, respectively. p = 0.023). In the Intervention Bariatric Prospective group, mean birth weight was 3168 ± 412 g, and no significant difference was observed from the Control Prospective group. Birth percentiles were also significantly lower in the Control Bariatric Retrospective group compared to the Control Prospective group (27th vs. 42nd, respectively. p < 0.05). In the Intervention Bariatric Prospective group, mean birth percentile was 35th, and no significant difference was observed from the Control Prospective group. As for the weight change of the woman during pregnancy, the highest variability was noted among the Control Bariatric Retrospective group with cases of weight loss up to 37 kg, due to conception close to the bariatric operation. Nevertheless, this variable was controlled, and showed no significant impact on birth weight results.

CONCLUSIONS

Our results suggest that personalized nutritional counseling care during post bariatric pregnancy improved nutrient intake of mothers and may contribute to higher birth weight of offspring. Further research is needed to examine the effects of prenatal nutrition care intervention, in addition to repeating this trial with a larger sample size, to allow for clearer findings.

CLINICAL TRIAL REGISTRATION

IRB number: 0310-15-RMB.

IDENTIFICATION NIH NUMBER

NCT02697981 URL: https://www.nih.gov.

The impact a Mediterranean Diet in the third trimester of pregnancy has on neonatal body fat percentage

Maternal diet during pregnancy has long been recognised as an important determinant of neonatal outcomes and child development. Infant body composition is a potentially modifiable risk factor for predicting future health and metabolic disease. Utilising the Mediterranean Diet Score, this study focused on how different levels of Mediterranean Diet adherence (MDA) in pregnancy influence body fat percentage of the infant. Information on 458 pregnant women in their third trimester of pregnancy and their infants was obtained from The ORIGINS Project. The data included MDA score, body composition measurements using infant air displacement plethysmography (PEA POD), pregnancy, and birth information. Infants born to mothers with high MDA had a body fat percentage of 11.3%, whereas infants born to mothers with low MDA had a higher body fat percentage of 13.3% (p = 0.010). When adjusted for pre-pregnancy body mass index and infant sex, a significant result remained between high vs. low MDA and infant fat mass (FM) (2.5% less FM p = 0.016). This study suggests that high MDA in pregnancy was associated with a reduced body fat percentage in the newborn. Future studies are needed to understand whether small but significant changes in FM persist throughout childhood.

Assessment of Cooking Matters Facebook Platform to Promote Healthy Eating Behaviors among Low-Income Caregivers of Young Children in the United States: A Pilot Study

How best to deliver healthy-eating education through social media among a low-income population remains understudied. To assess the impact of the Cooking Matters (CM) Facebook page on healthy eating behaviors among low-income caregivers, we conducted a pre–post survey of new CM Facebook followers in early 2020. A convenience sample was recruited at baseline from WICShopper app users and the CM Facebook page. The recruited sample included 397 low-income caregivers of a child younger than 6 who never followed CM Facebook. Among the baseline caregivers, 184 completed the follow-up survey. Paired t-test and McNemar–Bowker tests were conducted to compare the outcomes pre- and post-following CM Facebook. A binary indicator was developed to measure whether the outcomes were improved (1 = Improved; 0 = Not improved). Multi-variable logistic regressions were applied to examine the relationship between whether the outcome was improved with reference to the baseline socio-demographics. No significant differences were detected between pre and post outcomes overall (p > 0.05), except improvement in feeding healthy meals within the budget available (p < 0.05). However, improvement in select outcomes was more significant in men and single-parent households. The CM Facebook page could be an important platform to influence low-income caregivers of young children.

Relative Importance of Determinants of Changes in Eating Behavior during the Transition to Parenthood: Priorities for Future Research and Interventions

Background: Healthy eating behavior throughout pregnancy and postpartum is important. This study aimed to investigate the perceived sex-specific importance of determinants of changes in eating behavior during pregnancy and postpartum. Methods: Fifty-four determinants were rated by first-time parents (n = 179) on their impact. Experts (n = 31) rated the determinants in terms of their modifiability, relationship strength, and population-level effect from which a “priority for research”-score was calculated. Results: During pregnancy, the three highest rated determinants by women were “health concerns”, “physiological changes”, and “fatigue”. Men perceived “health concerns”, “health consciousness”, and “influence of the pregnant partner” as important. Postpartum, the three highest rated determinants by women were “adaptation to rhythm of baby”, “baby becomes priority”, and “practical constraints because of the baby”. Men perceived “adaptation to rhythm of baby”, “fatigue”. and “(lack of) anticipation” as important. According to the experts, “professional influence”, “food knowledge”, and “home food availability” received high priority scores for both sexes and during both periods. Conclusions: Priority for research and interventions should go towards tailored family-based approaches focusing on food education in a broad sense taking into account aspects such as health consciousness, self-efficacy skills, and the social and home food environment while being supported by healthcare professionals.

Enablers and barriers to women's lifestyle behavior change during the preconception period: A systematic review

Healthy lifestyle behaviors during the preconception period are important to optimize maternal and child outcomes, including weight. However, the majority of women do not have optimal preconception lifestyle behaviors. This systematic review explored enablers and barriers to women's preconception lifestyle behaviors using the Capability, Opportunity, Motivation, Behaviour (COM-B) model and Theoretical Domains Framework (TDF). Preconception was defined as the time before conception, capturing planned and unplanned pregnancies. Medline Complete, EMBASE, PsycINFO, and CINAHL were searched for peer-reviewed, quantitative and qualitative primary studies (English, 2006-2020) that explored enablers and barriers to lifestyle behaviors (diet, physical activity, smoking, alcohol use, supplement intake). Forty-two studies (of 3406) were included, assessing supplement use (n = 37), diet (n = 10), smoking (n = 10), alcohol use (n = 8), and physical activity (n = 5). All three COM-B components were identified only for diet and supplement use. Of the 14 TDF domains, 7 were identified: knowledge, beliefs about capabilities, beliefs about consequences, goals, intentions, social support, and environmental context and resources. The presence/absence of knowledge on healthy behaviors was the most commonly assessed enabler/barrier. Future studies should explore a wider range of factors influencing preconception women's capability, opportunity, and motivation to modify their lifestyle behaviors.

Relationships between excessive gestational weight gain and energy and macronutrient intake in pregnant women

OBJECTIVE

This study aimed to compare energy and macronutrient intake, birth weight, and anthropometric parameters (mid-upper arm circumference or tricipital skin-fold thickness) between women who had adequate and excessive gestational weight gain (GWG) during pregnancy.

METHODS

We studied 115 pregnant women and divided them according to GWG into two groups: adequate GWG (n = 49) and excessive GWG (n = 66). We assessed the medical history, clinical examinations, and dietary habits through a detailed 7-day dietary recall using myfitnesspal software.

RESULTS

Weight, body mass index, mid-upper arm circumference, and tricipital skin-fold thickness were significantly higher at the time of delivery in women with excessive GWG compared with those with adequate GWG. A lipid-based diet was a risk factor for excessive GWG (relative risk: 1.488, 95% confidence interval: 1.112-1.991), whereas a protein-based diet was a protective factor (relative risk: 0.6723, 95% confidence interval: 0.4431-1.020). We found no significant relationship between a carbohydrate-based diet and GWG. The total energy intake was significantly higher in the excessive GWG group than in the adequate GWG group.

CONCLUSIONS

Mainly a lipid-based diet in pregnant women might represent a risk factor for excessive GWG. However, a protein-based diet is a protective factor for excessive GWG.

Does stress attenuate motivation for healthful eating in pregnancy and postpartum?

Despite high motivation for healthful eating during pregnancy, maternal diet quality is inadequate. During pregnancy, women may relax effortful control over eating to reduce stress; thus, stress may override motivation to eat healthfully. This secondary analysis of data from the Pregnancy Eating Attributes Study longitudinal cohort investigated associations of motivation for healthful eating and perceived stress with diet quality during pregnancy (n = 365) and postpartum (n = 266), and investigated whether stress modifies associations of motivation with diet quality. Women (M_age = 31.3; gestational age ≤ 12 weeks) were recruited from the Chapel Hill, North Carolina area and completed multiple 24-h diet recalls (once each trimester of pregnancy, and at 4-6 weeks, 6 months, and 1 year postpartum) and validated measures of perceived stress and motivation for healthful eating (autonomous and controlled). Hierarchical multiple regressions tested associations of diet quality (Healthy Eating Index-2015) with stress, motivation, and their interactions. Additionally, themes extracted from previously-analyzed focus groups conducted with a subsample of participants were re-examined for content relevant to stress, motivation, and diet. Pregnancy and postpartum diet quality was positively associated with autonomous motivation, but was unassociated with controlled motivation and stress. Interaction terms did not appreciably improve model fit. Focus group participants described both internal and external forces contributing to their motivation for healthy eating during pregnancy and described the impact of stress on eating behaviors through amplification of food cravings. Future research is needed to identify influences on maternal motivation for healthful eating.

Recruitment planning for clinical trials with a vulnerable perinatal adolescent population using the Clinical Trials Transformative Initiative framework and principles of partner and community engagement

Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.

Factors Influencing Pregnancy and Postpartum Weight Management in Women of African and Caribbean Ancestry Living in High Income Countries: Systematic Review and Evidence Synthesis Using a Behavioral Change Theoretical Model

Background: Women of black African heritage living in high income countries (HIC) are at risk of obesity and weight-related complications in pregnancy. This review aimed to synthesize evidence concerning attitudes to weight management-related health behaviors in pregnancy and postpartum, in women of black African ancestry, living in high-income countries. Methods: A systematic review of the literature and thematic evidence synthesis using the Capability-Opportunity-Motivation Behavioral change theoretical model (COM-B). Databases searched included MEDLINE, EMBASE, Web of Science, and Scopus. The CASP tool was used to assess quality. Results: Twenty-four papers met the selection criteria, most of which were from the US. Motivational factors were most commonly described as influencers on behavior. Normative beliefs about "eating for two," weight gain being good for the baby, the baby itself driving food choice, as well as safety concerns about exercising in pregnancy, were evident and were perpetuated by significant others. These and other social norms, including a cultural acceptance of larger body shapes, and daily fast food, created a challenge for healthy behavior change. Women also had low confidence in their ability to lose weight in the postpartum period. Behavior change techniques, such as provision of social support, use of credible sources, and demonstration may be useful to support change. Conclusions: The women face a range of barriers to engagement in weight-related health behaviors at this life-stage. Using a theoretical behavior change framework can help identify contextual factors that may limit or support behavior change.

Exploring the nutritional beliefs of pregnant women in Yazd city

Introduction

During the pregnancy, a woman as a healthy person grows another human being in her body and needs more cares due to changes in psychological and physical needs. This study aimed to explore the nutritional beliefs of pregnant women in Yazd city.

Methods

This was a qualitative study conducted with a conventional content analysis approach. A total of 12 participants were selected from women referred to the community health centers in Yazd, Iran, by the purposeful sampling method. Data were collected through recorded semi-structured interviews that were transcribed verbatim and analyzed by the Lundman and Granheim's content analysis method.

Results

In this study, after analyzing the data, 10 main categories and 26 subcategories were extracted. The codes were 446 cases with no overlap, which was reduced after careful review and integration of similar items. Topics of categories included: The concept of nutrition during pregnancy, Nutrition limitations during pregnancy, Myths about food during pregnancy, Doubts about nutrition during pregnancy, Pregnancy food style, Sources of nutritional information in pregnancy, Positive Consequences of Healthy Nutrition in Pregnancy, Consequences of inappropriate pregnancy nutrition, Religious Beliefs in Pregnancy Nutrition, social support.

Conclusion

The results indicated that the women were committed to their own nutritional beliefs that derive from their culture and this study provided a clear picture of the cultural beliefs of Yazdi women regarding pregnancy nutrition. According to the results, it is necessary to design the education process based on the culture of the community in order for that process to be effective.

Socio-economic Variables Associated with Motivational Barriers of Food Choice among Lactating Women from Central Ethiopia: A Cross-sectional Study

Understanding the drivers of food choice is essential to guide the nutrition interventions and tailor nutrition counseling messages. There is strong evidence from a published study, which demonstrate attention for the need to consider the wide range of drivers during food choice. Due to the large variety of food products on the market, consumers make a multitude of food choice daily. The study aimed to assess major motivational drivers of food choice among randomly selected lactating women aged 15-49 years (423) from Debrebirhan Town using face to face interview. Logistic regression analysis was used to find association b/socio-economic variables and motivational drivers of food choice using SPSS version 20. Candidate variables were selected and transferred using the P- a value of less than 0.25, and AOR was reported. Variables with a P-value less than 0.05 on multiple variable logistic regressions were taken as significant variables. Influences of religion, price, preparation convenience, health value and taste during food choice were responded by above half of women. From logistic regression, 15-25 years' age and self-employed were linked to religious influence in food choice with AOR (95%CI) of 0.09(0.01-0.48) and 4.13(1.4-12.24). Age (15-25 and 26-35 years), education (no, primary and secondary) and being housewife were associated to choosing of foods for their health value with AOR (95%CI) of 0.26(0.12-0.6), 0.37(0.18-0.76), 0.14(0.04-0.42), 0.25(0.13-0.54), 0.33(0.17-0.66) and 2.5(1.23-5). Only family size (2-4 vs.>4 persons) was associated with price concern in food choice with AOR (95%CI) of 0.39(0.21-0.71). Being divorced, husband headed, 7-12 and13-18 month lactation period, 15-25 and 26-35 years' age were related to preparation convenience of foods with AOR (95%CI) of 5.94(1.13-31.33), 0.42(0.18-0.96), 3.26(1.34-7.93), 4.4(1.81-10.72), 0.16(0.05-0.47) and 0.25(0.11-0.59). Self-management approaches by nutrition education and promotion to change eating behaviors of women, increasing supply and price regulation toward healthy foods are recommended.

Impact of preconception, pregnancy, and postpartum culinary nutrition education interventions: a systematic review

CONTEXT

Frequent consumption of home-prepared meals is associated with higher diet quality in children and adults. Therefore, increasing the culinary skills of women and couples during their childbearing years may be an effective strategy for the prevention of overweight and obesity.

OBJECTIVE

To determine the impact of culinary nutrition-education interventions for women with or without their partners during preconception, pregnancy, or postpartum (PPP) on parental cooking skills, nutrition knowledge, parent/child diet quality, or health outcomes.

DATA SOURCES

Eligibility criteria were defined using a PICOS framework. A systematic search strategy was developed to identify eligible studies and was implemented in 11 electronic databases. Reference lists of selected systematic reviews were manually searched for additional studies.

DATA EXTRACTION

Study characteristics and outcomes were extracted from eligible studies by 1 reviewer and checked by a second reviewer.

DATA ANALYSIS

A narrative synthesis of the findings of eligible studies was prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Synthesis Without Meta-Analysis in systematic reviews reporting guideline.

RESULTS

A total of 6951 articles were identified from the search strategy and 31 studies during pregnancy or postpartum were included. By category, the number of studies with a favorable outcome per total number of studies measuring outcome were as follows: parental food/cooking skills (n = 5 of 5), nutrition knowledge (n = 6 of 11), parent/child diet quality (n = 10 of 19), infant feeding (n = 6 of 11), eating behavior (n = 2 of 5), maternal (n = 2 of 5) and child anthropometry (n = 6 of 10), mental health and development n = (2 of 3), and clinical indictors (n = 1 of 1).

CONCLUSIONS

Culinary nutrition-education interventions during pregnancy and the postpartum period show promise in improving cooking skills, diet quality, and a variety of health-related outcomes. The precise effect of these interventions during PPP is limited by the quality and heterogeneity of study designs to date.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020154966.

Competing priorities: a qualitative study of how women make and enact decisions about weight gain in pregnancy

Background

Despite ample clinical evidence that gaining excess weight in pregnancy results in negative health outcomes for women and infants, more than half of women in Western industrialized nations gain in excess of national guidelines. The influence of socio-demographic factors and weight gain is well-established but not causal; the influence of psychological factors may explain some of this variation.

Methods

This is the qualitative portion of an explanatory sequential mixed-methods study designed to identify predictive psychological factors of excess gestational weight gain (QUAN) and then explain the relevance of those factors (qual). For this portion of the study, we used a qualitative descriptive approach to elicit 39 pregnant women’s perspectives of gestational weight gain, specifically inquiring about factors determined as relevant to excess gestational weight gain by our previous predictive study. Women were interviewed in the latter half of their third trimester. Data were analyzed using a combination of unconstrained deductive content analysis to describe the findings relevant to the predictive factors and a staged inductive content analytic approach to examine the data without a focus on the predictive factors.

Results

Very few participants consistently made deliberate choices relevant to weight gain; most behaviour relevant to weight gain happened with in-the-moment decisions. These in-the-moment decisions were influenced by priorities, hunger, a consideration of the consequence of the decision, and accommodation of pregnancy-related discomfort. They were informed by the foundational information a woman had available to her, including previous experience and interactions with health care providers. The foundational information women used to make these decisions was often incomplete. While women were aware of the guidelines related to gestational weight gain, they consistently mis-applied them due to incorrect understanding of their own BMI. Only one woman was aware that weight gain was linked to maternal and infant health outcomes.

Conclusions

There is an important role for prenatal providers to provide the foundational information to positively influence in-the-moment decisions. Understanding how weight gain guidelines apply to one’s own pre-pregnancy BMI and comprehending the well-established link between gestational weight gain and health outcomes may help women prioritize healthy weight gain amongst many competing factors.

Putting Knowledge into Practice: Low-Income Women Talk about Food Choice Decisions

Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.

Improving pregnant women's diet and physical activity behaviours: the emergent role of health identity

Background

Women who gain too much weight in pregnancy are at increased risk of disease and of having children with increased risk. Interventions to improve health behaviours are usually designed for a general population of pregnant women, and trial outcomes show an average impact that does not represent the differences between individuals. To inform the development of future interventions, this study explored the factors that influenced women’s diet and physical activity during pregnancy and aimed to identify the needs of these women with regards to lifestyle support.

Methods

Women who completed a trial of vitamin D supplementation and nurse support in pregnancy were invited to take part in an interview. Seventeen women were interviewed about their lifestyles during pregnancy, the support they had, and the support they wanted. Interview transcripts were coded thematically and analysed to understand the factors that influenced the diets and physical activity levels of these women and their engagement with resources that could provide support.

Results

Women identified barriers to eating well or being physically active, and pregnancy-specific issues like nausea and pain were common. Women’s interest in maintaining a healthy lifestyle and their engagement with lifestyle support was related to the extent to which they self-identified as healthy people. Health-disengaged women were disinterested in talking about their lifestyles while health-focused women did not feel that they needed extra support. Women between these ends of the ‘health identity’ spectrum were interested in improving their health, and were able to identify barriers as well as sources of support.

Conclusions

Lifestyle interventions in pregnancy should be adapted to meet the needs of individuals with different health identities, and encouraging a change in health identity may be one way of supporting sustained change in health behaviours.

Barreras y facilitadores para una alimentación saludable y actividad física en mujeres embarazadas con sobrepeso y obesidad

Objetivo:

identificar barreras y facilitadores sobre dieta saludable y actividad física en mujeres embarazadas con sobrepeso y obesidad que viven en entornos de vulnerabilidad social y económica, destacando determinantes socioeconómicos y culturales.

Metodología:

estudio cualitativo longitudinal, donde las entrevistadas corresponden a mujeres embarazadas seleccionadas de una cohorte prospectiva en México. Se aplicó una guía semiestructurada de entrevista que exploró barreras y facilitadores para llevar una dieta saludable y poder realizar actividad física. Las entrevistas se transcribieron y codificaron en Atlas Ti, generando 23 códigos temáticos.

Resultados:

existen barreras y facilitadores contextuales y sociales que predisponen un mayor riesgo de padecer sobrepeso y obesidad durante el embarazo. Destacan conocimientos limitados sobre una dieta saludable, condiciones de vulnerabilidad social, así como un sentido de fragilidad en las mujeres que incrementa su sedentarismo.

Conclusiones:

en el diseño e implementación de intervenciones en promoción de la salud es fundamental considerar las barreras y facilitadores culturales y socioeconómicas sobre alimentación saludable y actividad física durante el embarazo, para desarrollar intervenciones de salud pública que favorezcan una mayor prevención de sobrepeso y obesidad en mujeres embarazadas.

Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial

BACKGROUND

Obesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group.

METHODS

African American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain.

RESULTS

Among participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms.

CONCLUSIONS

Participants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.

Obese women's perceptions of weight gain during pregnancy: a theory-based analysis

OBJECTIVE

Excess gestational weight gain (GWG) in obese women is linked to adverse maternal outcomes and is particularly pervasive among African Americans, who have the highest obesity rates in the USA. A better understanding of culturally relevant attitudes and perceptions of GWG is needed to develop targeted interventions to prevent excess GWG among this group.

DESIGN

Using the constructs of Social Cognitive Theory, we explored attitudes and perceptions surrounding diet and exercise among low-income obese African-American pregnant women in Baltimore. We conducted twenty-one semi-structured in-depth interviews with pregnant adult women.

SETTING

Participants were recruited from a referral clinic for obese pregnant women at a large urban hospital in Baltimore, MD, USA.

PARTICIPANTS

Twenty-one low-income African-American adult females in the first two trimesters of pregnancy with BMI > 30·0 kg/m2.

RESULTS

Lack of knowledge was not the main obstacle to healthy behaviours during pregnancy. Rather, food cravings and fatigue, an unhealthy physical food environment, limited self-efficacy for controlling excessive GWG, and a lack of adequate emotional and informational support impacted women's agency. While digital technology was discussed as a vehicle to promote maintenance of a healthy weight in pregnancy, further research is needed to test how it can be used to empower women to engage in healthy behaviours during pregnancy.

CONCLUSION

Interventions to prevent excess GWG among African-American pregnant women should harness support from partners and family and must go beyond sharing of clinical knowledge to also include strategies that improve the food environment, diet quality and self-efficacy.

Behavioral Determinants of Objectively Assessed Diet Quality in Obese Pregnancy

Interventions to promote healthy pregnancy in women with obesity by improving diet quality have been widely unsuccessful. We hypothesized that diet quality is determined by eating behaviors, but evidence in women with obesity is lacking. We evaluated diet quality and eating behavior in 56 women with obesity (mean ± SEM, 36.7 ± 0.7 kg/m2, 46% White, 50% nulliparous) early in pregnancy (14.9 ± 0.1 weeks). Diet quality was objectively assessed with food photography over six days and defined by Healthy Eating Index. Eating behaviors were assessed by validated questionnaires. Women reported consuming diets high in fat (38 ± 1% of energy) and the HEI was considered "poor" on average (46.7 ± 1.3), and for 71% of women. Diet quality was independently associated with education level (p = 0.01), food cravings (p < 0.01), and awareness towards eating (p = 0.01). Cravings for sweets and fast foods were positively correlated with respective intakes of these foods (p < 0.01 and p = 0.04, respectively), whereas cravings for fruits and vegetables did not relate to diet intake. We provide evidence of the determinants of poor diet quality in pregnant women with obesity. Based on this observational study, strategies to improve diet quality and pregnancy outcomes are to satisfy cravings for healthy snacks and foods, and to promote awareness towards eating behaviors.

Mediation by self-efficacy in the relation between social support and dietary intake in low-income postpartum women who were overweight or obese

PURPOSE

Using baseline data from a prevention of weight gain intervention study, we investigated whether self-efficacy mediated the relations between social support and dietary intake of saturated fat, fast food, fruit and vegetable in low-income postpartum women who were overweight or obese.

METHODS

Participants (N = 740) completed validated measures of self-reported social support, self-efficacy, and dietary intake of saturated fat, fast food, fruit and vegetable. We performed composite indicator structural equation modeling to test the mediation effect. Effect size was calculated using proportion of maximum possible (POMP) scores in the endogenous variables (e.g., fast food) per unit change in the exogenous variable.

RESULTS

When including the influence of self-efficacy as a mediator, social support indirectly influenced dietary intake of saturated fat (p ≤ 0.001, POMP = -0.77%), fast food (p ≤ 0.001, POMP = -0.28%), and fruit and vegetable (p ≤ 0.001, POMP = 0.53%). Thus, these data are consistent with self-efficacy mediating the relations between social support and dietary intake of saturated fat, fast food, fruit and vegetable in low-income postpartum women who were overweight or obese.

CONCLUSION

Dietary interventions aiming to decrease saturated fat and fast food intake and increase fruit and vegetable intake for the target population may consider including practical skills for increasing social support and self-efficacy that can be implemented in daily life.

Reasons for Late-Night Eating and Willingness to Change:A Qualitative Study in Pregnant Black Women

OBJECTIVE

Late-night eating during pregnancy is associated with greater risk for gestational diabetes. The purposes of this study were to describe reasons why women engage in late-night eating and to understand perceptions about changing this behavior.

DESIGN

Focus groups using a semi-structured interview script.

SETTING

Urban university-affiliated obstetric clinic.

PARTICIPANTS

Low-income black women (n = 18) with overweight/obesity at entry to prenatal care.

PHENOMENON OF INTEREST

Late-night eating.

ANALYSIS

Exhaustive approach coding responses to specific questions.

RESULTS

Individual and interpersonal contributors to late-night eating included hunger, altered sleep patterns, fetal movement, and the influence of others. Food choices were largely driven by taste and convenience. Some women reported that they could alter nightly eating patterns, whereas others would consider changing only if late-night eating were associated with a severe illness or disability for the child.

CONCLUSIONS AND IMPLICATIONS

There was considerable heterogeneity among the participants of this study regarding reasons for late-night eating during pregnancy and attitudes toward changing this behavior. Although the themes identified from this study cannot be generalized, they may be useful to inform future studies. Future research might develop strategies to overcome individual and social factors that contribute to late-night eating during pregnancy.

Food Choices of Young Adults in the United States of America: A Scoping Review

Understanding food choice is critical to developing effective health promotion efforts to counter the leading causes of morbidity and mortality in the United States. Although physiologic, environmental, and social factors influence the development of health conditions, routine decisions, such as food choice, also contribute substantially over time. Behavioral scientists believe that these routine decisions represent a key opportunity to improve population health. We conducted a scoping review of both health and business literature to identify themes in the food choices of young adults aged 19-24 y in the United States. Informed by the Joanna Briggs Institute processes for scoping reviews, we conducted a structured search of 8 health and business databases on 18 April 2017. The databases were PubMed, Business Source Complete, PsycInfo, Cochrane Library, CINAHL, Web of Science, SCOPUS, and ABI/Inform Collection. Eligible literature captured real-world dietary choices of the general population of young adults between 1 January, 2007 and 31 December, 2017. Records were screened in Covidence. Data was extracted into Excel and key findings thematically analyzed. The search returned 9085 records. Ninety-nine records met the eligibility criteria. Themes identified in the foods chosen by young adults include inadequate fruit and vegetable consumption, choosing international flavors and food formats, convenience foods, frequent snacking, the selection of healthy foods based on perceptions of what is healthy rather than the nutrient or calorie content of foods, an interest in sustainable production methods, the desire to customize/tailor foods, foods young people find interesting, and regional foods. This research identified common food choices that can help inform the tailoring of health promotion efforts; however, more research is needed to understand the underlying mechanisms and principles shaping these choices.

Gustatory Function of Pregnant and Nonpregnant Women in a Tertiary Health Institution

Physiological changes in pregnancy may cause taste dysfunction. The aim of this study was to determine and compare gustatory function of pregnant women with nonpregnant women and also to investigate the effect of pregnancy on gustatory function. It was a case-control study of consecutive 70 healthy pregnant women (cases) and 70 healthy nonpregnant women (control). Participants scored their taste perception on a visual analogue scale (1-10) and their gustatory function was assessed using "taste strips" impregnated with graded concentration of sweet, sour, salty, and bitter taste substances applied on tongue surfaces. Subjective mean gustatory score, correct identification of taste in the strips and total taste strip (TTS) score were compared between both groups and analysis was done using appropriate statistics. The mean age of pregnant women (30.5 [3.9]) and controls (28.5 [6.6]) were comparable. Twenty-one (30%) pregnant women changed their diet in first trimester due to change in taste sensation. Almost all cases developed craving for spicy and salty foods and, aversions to fish, beans, and vegetables. There was a significant difference in the subjective rating of taste perception between the 2 groups ( P = .037). About 2.9% of pregnant women have hypogeusia. There was a significant difference between pregnant and nonpregnant women in sour taste ( P = .006; 2.90 [0.71] vs 3.92 [0.82]) and TTS ( P = .02; 27.50 [3.48] vs 29.21 [2.69]) scores, respectively. In conclusion, gustatory function was reduced in pregnancy compared to nonpregnant women and this led to dietary change in some pregnant women.

Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore

Background: The effect of maternal weight on pregnancy and birth outcomes is of great public health concern. For example, overweight and obesity among pregnant women is associated with adverse reproductive health outcomes including gestational diabetes, birth defects, macrosomia and infant mortality.

Objectives: To understand the knowledge, perceptions and experiences during pregnancy among overweight and obese women in Singapore.

Methods: This is a cross-sectional study which employed qualitative techniques. The inclusion criteria is as follows: (1) Women who were overweight or obese before or during first trimester of pregnancy, (2) are able to report their specific pre-pregnancy or first trimester Body Mass Index (BMI), or weight and height, (3) had singleton pregnancy when overweight, are post-delivery for the pregnancy in which they were overweight, and (4) are 21 to 55 years old. Fifteen interviews were voice-recorded and transcribed verbatim. Then, two researchers independently performed the thematic analysis of the transcripts.

Results: The findings revealed that women had gaps in knowledge on the adverse effects of maternal overweight and obesity during pregnancy, and various misconceptions on diet and weight management during pregnancy were prevalent. Conflicting data was obtained for perceptions on the importance, difficulty and levels of motivation for weight management during pregnancy.

Conclusion: There is a pressing need to address knowledge gaps and misconceptions of pregnant women who are overweight or obese. The importance of weight management during pregnancy should be emphasized, and enabling factors put in place.

Dietary Changes Albertan Women Make During Pregnancy: Thematic Analysis of Self-reported Changes and Reasons

PURPOSE

To explore dietary changes Albertan women make during pregnancy, reasons they make changes, and alignment with prenatal nutrition recommendations.

METHODS

Women up to 6 months postpartum were recruited in public health centres and Primary Care Networks. Qualitative data were collected through a self-administered survey including 2 open-ended questions that asked about changes made to food/beverage intake during pregnancy and why these changes were made.

RESULTS

A majority (n = 577) of the 737 women completing the survey described changes they made to their food/beverage intake during pregnancy and 193 respondents provided reasons for these changes. Increased intake of fruits/vegetables, meat, milk, and their alternatives (n = 600); limiting or avoidance of foods/beverages known to be harmful during pregnancy (n = 445); and increased food/fluid intake or meal/snack frequency (n = 405) were commonly reported dietary changes. Motivations relating to health and to control physiological changes/manage health conditions were the most frequent reasons provided.

CONCLUSIONS

Women make diverse dietary changes and have various motivations for food choices during pregnancy. A majority make dietary changes to support a healthy pregnancy. However, the motivation to control discomforts and respond to hunger and thirst sensations reflect a stronger influencer on women's choices than is currently addressed in prenatal nutrition messages.

The influence of maternal dietary patterns on gestational weight gain: A large prospective cohort study in China

OBJECTIVE

The relationship between dietary patterns and gestational weight gain (GWG) in different pregnancy stages has rarely been reported among the Asian population. The aim of this study was to examine the relationship between dietary patterns and GWG in Chinese pregnant women.

METHODS

Participants were women from the Born in Guangzhou Cohort Study who completed a validated food frequency questionnaire at 24 to 27 wk gestation (N = 5733). Dietary patterns were generated by cluster analysis. Maternal prepregnancy weight was self-reported; weights during pregnancy were extracted from medical records. Regression analyses were performed to test the associations between dietary patterns and total GWG and GWG rates (linear regression), and the adequacy of GWG (logistic regression).

RESULTS

According to food consumption frequency, six dietary patterns were generated: "richer in cereals," "richer in vegetables," "richer in meats," "richer in fruits," "richer in fish, beans, nuts, and yogurt," and "richer in milk and milk powder." Compared with women following the richer in cereals pattern, those who followed the richer in fruits pattern had a significantly higher GWG (β = 0.592; 95% confidence interval [CI], 0.166-1.018) and total rate of GWG; those who followed the richer in fish, beans, nuts, and yogurt" pattern had a greater GWG rate in the second trimester, and also had a decreased risk for inadequate GWG (odds ratio, 0.797; 95% CI, 0.638-0.997).

CONCLUSION

Consuming a variety of foods and frequent consumption of fruits during pregnancy contributes to a more rapid increase in GWG among pregnant women in China. Findings may be useful in pregnancy weight monitoring.

Dietary Change during Pregnancy and Women's Reasons for Change

Women often make dietary changes during pregnancy; however, dietary modifications and reasons for changes are not well studied. We aimed to describe the dietary changes made during pregnancy, describe reasons for dietary changes, and determine what changes aligned with recommendations. Pregnant women (n = 379) recruited to the Alberta Pregnancy Outcomes and Nutrition (APrON) study in 2009/2010 completed a questionnaire in which they described dietary changes made during pregnancy and reasons for those changes. Changes and reasons were coded into categories. Women commonly reported increasing their intake of milk products, fruit, and sweet items and commonly decreased or eliminated intake of caffeine, alcohol, and meats. Women frequently reduced intake of foods for the baby’s health and increased foods to satisfy cravings. Changes made commonly aligned with recommendations for caffeine, alcohol intake, food safety, milk and alternatives, and fruit. Changes contrary to recommendations were common for fish and meats. The dietary changes women make during pregnancy appear to reflect women’s efforts to balance physiological changes accompanying pregnancy with the desire for healthy pregnancy outcomes. Understanding the reasons behind dietary change during pregnancy will help researchers and health professionals design effective strategies and public health messages to promote healthier pregnancies.

Added Sugar Intake among Pregnant Women in the United States: National Health and Nutrition Examination Survey 2003-2012

BACKGROUND

Despite associations of dietary added sugar with excess weight gain and chronic disease risk, intake among most Americans exceeds the recommended limits (<10% total energy). Maternal diet plays an important role in pregnancy-related outcomes, but little is known about the extent of added sugar intake during pregnancy.

OBJECTIVE

To assess intake and identify the top sources of added sugars in the diets of pregnant vs nonpregnant women in the United States.

DESIGN

Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES), 2003-2004 to 2011-2012.

PARTICIPANTS

Four thousand one hundred seventy-nine pregnant and nonpregnant women (aged 20 to 39 years) who completed a dietary recall.

STATISTICAL ANALYSES PERFORMED

Survey-weighted analyses were used to estimate means (95% CIs) in total grams and as percentage of total energy for added sugar intake by pregnancy status and by demographic subgroup and to identify leading sources of added sugar.

RESULTS

Added sugar intake trended toward being higher in pregnant compared with nonpregnant women in absolute grams, 85.1 g (95% CI: 77.4 to 92.7) vs 76.7 g (95% CI: 73.6 to 79.9), respectively (P=0.06), but was lower among pregnant women when total energy intake was accounted for, 14.8% (95% CI: 13.8 to 15.7) vs 15.9% (95% CI: 15.2 to 16.6) of total energy, respectively (P=0.03). Among pregnant women, added sugar intake was similar among demographic subgroups. However, in multivariable regression, pregnancy status significantly modified the associations of education and income with added sugar intake, whereby less educated and lower-income women who were pregnant had lower added sugar intakes compared with those who were not pregnant, but more educated or higher-income women did not exhibit this pattern. The top five sources of added sugar for all women were sugar-sweetened beverages; cakes, cookies, and pastries; sugars and sweets; juice drinks and smoothies; and milk-based desserts.

CONCLUSIONS

Although pregnant women had higher energy intakes, this was not attributed to higher intakes of added sugar. Although education and income affected consumption during pregnancy, intake of added sugar among all women, regardless of pregnancy status, exceeded recommendations.

Impact of Nutrition Education in Improving Dietary Pattern During Pregnancy Based on Pender's Health Promotion Model: A Randomized Clinical Trial

Background:

Different types of nutrients in adequate amounts are required to meet the increased demands of the mother and the developing fetus. Therefore, we examined the impact of nutrition education on the number of food servings per day.

Materials and Methods:

Pregnant mothers were recruited to a prospective, randomized clinical trial from May to September, 2016. At 6–10 weeks of gestation, the participants were randomly divided into the intervention (n = 96) or the control group (n = 96), and were followed-up until the end of pregnancy. Each woman in the experimental group met the study nutritionist at the time of enrollment and an individualized nutrition plan was developed. In addition, the nutrition education based on Pender's Health Promotion Model (HPM) was designed, including three 45–60 min training sessions in 6–10, 18, and 26 weeks of pregnancy. The participants' usual food intake using a three-day dietary record was assessed at 6–10 weeks and 34–36 weeks of gestation.

Results:

The mean scores of the perceived benefits, self-efficacy, activity-related affect, interpersonal influences (husband support), and commitment to action increased while the competing demand scores decreased in the interventional group compared with the control group. The mean standard deviation (SD) of food portions from grain [10.40 (1.96) versus 12.70 (1.93) in the control group], vegetable [3.88 (1.33) versus 2.96 (0.91)], fruit [4.02 (0.05) versus 3.95 (0.91)], dairy [2.33 (0.68) versus 2.11 (0.45)], and meat [3.17 (0.68) versus 2.96 (0.67)] were improved in the experimental group.

Conclusions:

Pender's HPM for nutrition education is effective based on the compliance of pregnant women to the dietary guideline and the food guide pyramid.

Barriers and Facilitators to Implementing the Uruguayan Dietary Guidelines in Everyday Life: A Citizen Perspective

An in-depth understanding of the citizen's perception and behavior is needed for the development of targeted public policies and interventions that can successfully encourage people to shift their dietary patterns and contribute to the prevention of non-communicable diseases. The present work aimed to identify barriers and facilitators for the adoption of the new Uruguayan dietary guidelines from a citizen perspective. Twelve semistructured focus groups were conducted with a total of 91 people (81% female, age 18-64 years) from 3 Uruguayan cities. Findings identified several multifaceted barriers, including lack of value given to food, meals and cooking, taste preferences for unhealthy foods, the unsupportive social context in terms of household preferences, customs and social norms, and lack of control of the situation through insufficient food capabilities, time scarcity, and an adverse food market environment. The potential facilitators discussed in the focus groups were mainly related to policies and regulations to discourage consumption of unhealthful products and the provision of more education and information. In addition, respondents acknowledged the need for own actions in terms of seeking greater cooking skills and enjoyment, incorporating changes in their daily routines and promoting a more supportive social environment. Results suggest that supportive actions are needed to support citizen's adoption of the new Uruguayan dietary guidelines.

Pregnant women's perceptions of gestational weight gain: A systematic review and meta-synthesis of qualitative research

Excess gestational weight gain has numerous negative health outcomes for women and children, including high blood pressure, diabetes, and cesarean section (maternal) and high birth weight, trauma at birth, and asphyxia (infants). Excess weight gain in pregnancy is associated with a higher risk of long-term obesity in both mothers and children. Despite a concerted public health effort, the proportion of pregnant women gaining weight in excess of national guidelines continues to increase. To understand this phenomenon and offer suggestions for improving interventions, we conducted a systematic review of qualitative research on pregnant women's perceptions and experiences of weight gain in pregnancy. We used the methodology of qualitative meta-synthesis to analyze 42 empirical qualitative research studies conducted in high-income countries and published between 2005 and 2015. With this synthesis, we provide an account of the underlying factors and circumstances (barriers, facilitators, and motivators) that pregnant women identify as important for appropriate weight gain. We also offer a description of the strategies identified by pregnant women as acceptable and appropriate ways to promote healthy weight gain. Through our integrative analysis, we identify women's common perception on the struggle to enact health behaviors and physical, social, and environmental factors outside of their control. Effective and sensitive interventions to encourage healthy weight gain in pregnancy must consider the social environment in which decisions about weight take place.

Association Between Health Beliefs and Gestational Weight Gain

BACKGROUND

The Institute of Medicine (IOM) provides recommendations for optimal weight gain during pregnancy to minimize complications associated with obesity and excessive weight gain. The Health Belief Model and prior research suggest knowledge of health recommendations and associated risks motivate health behaviors. This study determined whether knowledge of maternal and infant obesity risks during pregnancy (ORDP) and knowledge of IOM gestational weight gain (GWG) recommendations were associated with total GWG and likelihood of adhering to IOM recommendations.

MATERIALS AND METHODS

In this prospective survey study, healthy women with a singleton pregnancy were recruited from prenatal clinic waiting rooms of a university medical center to complete a one-time survey of prepregnancy weight and height, demographic variables, knowledge of infant-related ORDP (e.g., large for gestational age), knowledge of maternal-related ORDP (e.g., Cesarean delivery), and knowledge of IOM GWG recommendations. Total GWG was obtained from clinic medical records. Logistic and multiple regression analyses were performed.

RESULTS

The sample consisted of 159 women with average age of 25 and prepregnancy body mass index of 28. Women in the sample were predominantly African American (57%) and from low socioeconomic conditions. Results showed (1) knowledge of GWG recommendations was inversely related to total GWG among normal and underweight women and (2) knowledge of infant-related ORDP was positively related to total GWG among overweight and obese women and the likelihood of exceeding recommendations among normal and underweight women. Knowledge of maternal-related ORDP was not related to GWG.

CONCLUSION

As the Health Belief Model suggests, knowledge appears to be a modifiable factor in preventing excess GWG. However, there may be misinformation regarding how to adhere to clinical recommendations.