Adherence to nutritional guidelines in pregnancy: evidence from the Growing Up in New Zealand birth cohort study

Prenatal determinants of anxiety symptoms in middle childhood. Evidence from Growing Up in New Zealand

BACKGROUND

Early life environments can have long-lasting impacts on future health and wellbeing. Maternal health during pregnancy, including experiencing stress or mood disorders, has been associated with psychopathology in later life. Anxiety disorders are one of the most prevalent mental health conditions, affecting approximately 7 % of children and adolescents globally, with a lifetime prevalence of 15-20 %. Identifying prenatal risk factors can support future and current public health interventions and maternity care.

METHODS

Data were obtained from the Growing Up in New Zealand longitudinal study of child development. Prenatally, mothers provided sociodemographic information as well as data on their mental health, potential teratogens, and lifestyle factors such as supplement intake and exercise levels. At 8-years old, 4922 children self-completed the PROMIS-SF anxiety measure. Bivariate analyses and backward stepwise regression were used to determine the best multivariable model.

RESULTS

Significant prenatal predictors of anxiety symptoms at 8-years old included elevated maternal depression symptoms, body mass index in the overweight/obese range, exercise patterns, and paracetamol, anti-inflammatory and alcohol intake.

LIMITATIONS

Sample attrition from baseline to 8-year may have affected statistical power. To further untangle the effect of timing and duration of the exposures reported in this study, larger sample sizes would be required.

CONCLUSIONS

Prenatal mental health and wellbeing was significantly associated with child anxiety symptoms at 8-years of age. This study highlights the importance of supporting expectant mothers' health and wellbeing during pregnancy to ensure children have the best opportunity to have good mental health.

Knowledge, attitude and practices of health professionals with regard to plant-based diets in pregnancy: a scoping review

OBJECTIVE

This scoping review aimed to systematically map and describe the existing evidence regarding the knowledge, attitudes and practices of health professionals with regard to plant-based diets during pregnancy and to highlight areas for further research.

DESIGN

Following a pre-registered protocol, online databases were searched using a comprehensive search string, in addition to selected grey literature sources, and reference lists of included studies. The studies were independently screened for eligibility by two authors, SM and JM. Data from all eligible studies were charted by the first author, and a narrative summary was performed.

SETTING

Maternal health care services.

RESULTS

Ten studies were included for review, from New Zealand (n 2), Australia (n 2), Germany, Netherlands, United Kingdom, France, Italy and Peru. Most of these studies were observational, employed various validated and non-validated survey instruments, interviews and one education intervention. Knowledge was the most frequently assessed outcome in the reviewed studies. Health professionals' knowledge of plant-based nutrition in pregnancy was reported to be limited and frequently attributed to a lack of nutrition training. Participants' personal dietary patterns and work specialisation appear to be closely associated with their knowledge, attitudes and practices regarding plant-based diets.

CONCLUSION

This review identified a significant research gap regarding health professionals' practices in relation to plant-based diets during pregnancy. Additionally, this review has demonstrated the need for further research, awareness and practice protocols to promote high-quality care and education or professional development to address the prevalent lack of knowledge among this group.

Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors with nutrition and food practices during pregnancy in Thailand: a qualitative study

BACKGROUND

Although nutrition is an essential contributor to the quality of pregnancy outcomes, little is known about the experiences and influences affecting dietary behaviors during pregnancy among migrant women, particularly those from Myanmar, the largest immigrant population in Thailand. To fill this gap, we conducted a descriptive qualitative study to explore Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors concerning nutrition and food practices during pregnancy.

METHODS

We conducted focus group discussions (FGDs) with fifty Myanmar immigrant pregnant women aged 18-45 years across all trimesters, who were recruited using purposive sampling from a public tertiary hospital. The FGDs were conducted in Thai or Myanmar using semi-structured guides that probed women's pregnancy perceptions and experiences about nutrition and food patterns during pregnancy. The FGDs were audio-recorded, translated, and transcribed. Direct content analysis was used to guide the analysis through an ecological perspective framework.

RESULTS

The seven FGDs with fifty women revealed four major themes involving perceptions, beliefs, and information-seeking behaviors. The qualitative results consisted of (1) a positive attitude toward better changes under difficult conditions (setting goals for infant health; uncertainty about changes); (2) beliefs about eating patterns and dietary practices during pregnancy (taboos aimed at protecting women's health and ensuring safe childbirth; taboos aimed at guaranteeing infant safety); (3) limited access to appropriate information about nutrition (unclear dietary information from healthcare providers; ease of learning from experiences in informal social networks); and (4) difficult living conditions in a non-native setting (work-related influences on dietary behaviors; lack of comprehensible language to gain food literacy). In addition, the results were highlighted across four levels of ecological perspectives.

CONCLUSIONS

Immigrant pregnant women are a vulnerable population that should be treated with equity to ensure quality of life through optimal nutrition throughout pregnancy. Respectful care requires that healthcare providers develop culturally sensitive nutrition interventions to increase nutrition literacy, accessibility, and pregnancy outcomes.

Are first-trimester pregnant women consuming adequate and diverse diet? A hospital-based cross-sectional study in Karachi, Pakistan

BACKGROUND

Maintaining a healthy and diverse diet during pregnancy is crucial for maternal well-being and fetal development. The first trimester marks the beginning of vital developmental processes influenced by maternal nutritional status. Therefore, we aimed to determine dietary adequacy and diversity among first-trimester pregnant women.

METHODS

In this cross-sectional study, we recruited 306 first-trimester pregnant women from the antenatal clinics of Aga Khan University Hospital, Karachi (January 2020 to September 2021). Eligible women possessed smartphones (for the mHealth intervention trial) and reported no major comorbidities or medication use. Data about socio-demographic, obstetric, and dietary history were collected through interviews using a structured questionnaire. Booking weight, height, blood pressure, and haemoglobin levels were extracted from medical records. An aggregate dietary risk score (DRS) was calculated separately for quantity and quality by summing the DRS for each of the six major food groups. A score of 0 was assigned to adequate, 1.5 to intermediate, and 3 to inadequate quantity or quality categories. Data were analysed using STATA 14.0.

RESULTS

The mean ± SD for DRS quantity and quality were 10.6 ± 2.4 and 7.5 ± 2.5, respectively. Adequate dietary quantity and quality per week for starch-based food were reported by 14.4% and 21.2%, for vegetables by 0.3% and 49%, for fruits by 41.2% and 88.6%, for animal and plant protein by 19% and 0%, for milk and milk products by 1% and 37.6% and for oils and fats by 90.5% and 8.8%, respectively. Sweet and savoury snacks were eaten by 74.8% and 53.9%, respectively. Ready-made meals, carbonated beverages, packaged juices, and additional salt were consumed by 55.2%, 46.4%, 34.3%, and 7.5%, respectively. The median (IQR) water intake was 6 (4-8) glasses/day.

CONCLUSIONS

During the early stages of pregnancy, women enrolled for antenatal care at an urban private tertiary care hospital report inadequate dietary intake for various food groups, except for the quantity of oils/fats and the quality of fruit consumption. Poor dietary practices underscore the need for focused and impactful dietary counselling during the initial stages of pregnancy.

The Intake of Omega-3 Fatty Acids, the Omega-3 Index in Pregnant Women, and Their Correlations with Gestational Length and Newborn Birth Weight

BACKGROUND

During pregnancy, the demand for omega-3 fatty acids, notably docosahexaenoic acid (DHA), escalates for both maternal and foetal health. Insufficient levels can lead to complications and can affect foetal development. This study investigated omega-3 status and its relation to dietary intake in pregnant Latvian women, along with its impact on gestational duration and newborn birth weight.

METHODS

The study comprised 250 pregnant and postpartum women with a mean age of 31.6 ± 4.8 years. Nutrition and omega-3 supplementation data were collected through a questionnaire covering 199 food items and 12 supplements. Fatty acids in erythrocyte membrane phospholipids were analysed via gas chromatography with flame ionization detection.

RESULTS

The median omega-3 fatty acid intake, including eicosapentaenoic acid (EPA) and DHA from diet and supplements, was 0.370 g/day, which is deemed sufficient. However, the median weekly fish intake (126.0 g) and daily nut/seed intake (7.4 g) were insufficient. The median omega-3 supplement intake was 1.0 g/day. No correlation between omega-3 supplement intake and the omega-3 index was observed. There was a weak correlation between the DHA intake from fish and the omega-3 index (r = 0.126, p = 0.047), while a significant correlation between the total EPA and DHA intake from various sources and the omega-3 index was noted (r = 0.163, p = 0.01). Most women (61.6%) had an omega-3 index < 4%, while 34.8% had an index between 4 and 8%, and only 3.6% had an index > 8%. Notably, significant differences in EPA levels and the omega-3 index were found among respondents with differing infant birth weights (p < 0.05).

CONCLUSIONS

The omega-3 intake during pregnancy adheres to the established guidelines, although fish consumption remains insufficient. A preconception evaluation of the omega-3 index is advocated to optimize prenatal intake. The indications suggest potential correlations between EPA levels, the omega-3 index, and infant birth weight.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The relationship between perceived stress and pregnancy distress with self-care of pregnant women: The mediating role of social support-A cross-sectional study

Background and Aims

Pregnancy is a stressful experience, which can affect different aspects of a woman's life. Yet, women with a supportive network of friends and family may experience lower stress and improved self-care behavior. The study aimed to investigate the relationship between perceived stress and pregnancy distress with the self-care of pregnant women, as well as the mediating role of social support.

Methods

This cross-sectional study was conducted from February to May 2022 in Babol, Iran. A total of 157 pregnant women participated in the study. The participants completed five questionnaires, including a demographic and obstetric questionnaire, a Self-care questionnaire, Perceived Social support (PSS), Perceived Stress Inventory (PSI), and Pregnancy Specific Distress. Structural equation modeling was used to test the hypothesis relationships among the variables.

Results

We found that Perceived stress (β = -0.221, p = 0.012β) and pregnancy distress (β = -0.203, p = 0.002β) had a negative and significant effect on the self-care of pregnant women. Also, perceived stress (β = -0.429, p < 0.001β) and pregnancy distress (β = -0.381, p < 0.001β) had a negative and significant effect on the social support of pregnant women. The results exhibited a significant specific indirect effect between pregnancy distress, perceived stress, and pregnancy self-care, with social support as the mediator: standardized indirect effect = -0.068, -0.076, respectively.

Conclusion

According to the findings, social support plays a direct and mediating role in improving self-care behaviors among pregnant women. Therefore, providing strategies and measures to improve perceived social support by maternal health professionals may be expected to reduce the impact of stress on pregnant women's self-care. The implementation of policies and social interventions to improve the social support of pregnant women can be one of the applications of the findings.

Comparative Assessment of Diet Quality and Adherence to a Structured Nutrition and Exercise Intervention Compared with Usual Care in Pregnancy in a Randomized Trial

Background

In trials testing the efficacy of diet and exercise modifications during pregnancy on health outcomes, assessment of participant adherence to interventions of diet and exercise is rarely reported, with few standard methods existing to measure adherence.

Objective

We aimed to assess the maternal diet quality and create an algorithm to evaluate adherence to an intervention of high protein/dairy nutrition and walking exercise from early pregnancy to birth.

Methods

In Be Healthy in Pregnancy randomized trial (NCT01693510), diet quality was measured using scores from an adapted PrimeScreen food frequency questionnaire, nutrient intake assessed by 3-day diet records, and physical activity using accelerometry at 14-17 (early), 26-28 (middle), and 36-38 (late) weeks' gestation. A novel adherence score was derived by combining data for compliance with prescribed protein and energy intakes and daily step counts in the intervention group. Between-group diet quality scores and changes in adherence scores in the intervention group across pregnancy were analyzed using generalized estimating equations adjusted for prepregnancy body mass index and study site.

Results

Diet scores were similar for intervention (n = 55) and control (n = 56) groups at baseline but only the intervention group significantly improved and maintained their scores from early to middle (18.7 ± 7.6 vs. 22.9 ± 6.1; P < 0.001) and late (22.5 ± 6.9; P < 0.008) pregnancy. Protein intake was significantly (P < 0.001) higher but energy intakes were similar in the intervention group compared with those in the control group. Adherence scores for the intervention increased significantly (P < 0.01) from early (1.52 ± 0.70) to midpregnancy (1.89 ± 0.82) but declined from midpregnancy to late (1.55 ± 0.78; P < 0.0005) pregnancy primarily owing to lower step counts.

Conclusions

Adherence to an intervention may decline toward the end of pregnancy, particularly in maintaining physical activity. Creation of adherence scores is a feasible approach to measure combined intervention compliance for diet and physical activity and may increase transparency in interpreting results of randomized trials in pregnancy.This trial was registered at clinicaltrials.gov as NCT01689961 (https://clinicaltrials.gov/ct2/show/NCT01689961?cond=NCT01689961&rank=1; registered on 21 September 2012).

Prevalence and maternal determinants of early and late introduction of complementary foods: results from the Growing Up in New Zealand cohort study

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19-2·90), whose mothers were < 30 years old (1·69; 1·46-1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1-1·70), of Māori v. European ethnicity (1·40; 1·12-1·75) or smoked during pregnancy (1·88; 1·44-2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27-0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16-3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24-4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

Diet quality during pregnancy and its association with social factors: 3D Cohort Study (Design, Develop, Discover)

Good diet quality during pregnancy provides adequate nutrition to support both the mothers and the fetus. The objective of this study is to describe the distribution of diet quality during pregnancy and to study the association between social factors and diet quality during pregnancy in a Canadian population. This study was based on 1535 pregnant women who provided dietary information in the 3D Cohort Study in Quebec, Canada. A 3‐day food record was used to collect dietary intake in the second trimester of pregnancy. A Canadian adaption of the Healthy Eating Index (HEI‐C) 2010 was used to quantify diet quality. Univariate and multiple linear regression models were used to calculate unadjusted and adjusted effect estimates and confidence intervals for the association between social factors and HEI‐C. The mean HEI‐C 2010 score in this study was 62.9 (SD: 11.2). Only 4.5% and 8.3% of the pregnant women consumed the recommended amounts of whole grains and ‘greens and beans’, respectively. Diet quality was lower in some subgroups of pregnant women. After multivariable adjustment, lower diet quality was observed in participants who were less educated, younger, overweight or obese before pregnancy, or parous. There was an interaction between ethnicity and immigration status on diet quality in pregnancy. These findings could be useful for health practitioners and policymakers in developing strategies to improve the diet quality of pregnant women.

The diet of the women in Canada still needs improvement, especially regarding whole grains and ‘greens and beans’, where the majority of the women did not meet the recommendations.

Pregnant women who were less educated, younger, overweight or obese before pregnancy, or parous should be targeted for improving diet quality in Canada.

There was an interaction between ethnicity and immigration status on diet quality during pregnancy.

Women's holistic self-care behaviors during pregnancy and associations with psychological well-being: implications for maternal care facilities

Background

Self-care behaviors during pregnancy significantly impacts mother and children's health. This study aimed to explore the self-care behaviors and the associations of these behaviors with the psychological well-being of women during pregnancy, as well as the mediating effects of different social support with these associations.

Methods

A cross-sectional data of 562 pregnant women at Hanoi Obstetrics & Gynecology Hospital and Ca Mau Obstetrics & Pediatrics in Vietnam were analyzed. Questions about self-care behaviors, pregnancy characteristics, social support, and psychological well-being were asked. Multivariate regression models were performed. Structural Equation Modeling (SEM) was employed to test the mediating effects of different social support with the association between self-care behaviors and psychological well-being.

Findings

Only 13% of pregnant women often or always did physical exercise at least three times a week, and 40% consumed enough fiber and five servings of vegetables a day. Only 78.7% always avoided alcohol drinking, and 53.9% of pregnant women avoided being exposed to second-hand smoking and 71,7% avoided using traditional medicine without physicians’ prescriptions. Around 66% of pregnant women always or often had prenatal care checkups as scheduled. Information sources, social support and childbirth expectation were major drivers for self-care practices. SEM model showed that social support mediated the relationship between maternal health behaviors and mental well-being.

Conclusion

This study highlighted the remarkable gaps in self-care practices among our pregnant women, which were significantly associated with their mental well-being. Social support-oriented consultancy and interventions should be warranted for improving behaviors and the mental well-being of pregnant women in Vietnam.

Adherence to Dietary Guidelines among Women with and without Gestational Diabetes: Evidence from the Growing up in New Zealand Study

Diet is thought to play a role in the development and management of gestational diabetes mellitus (GDM). Dietary guidelines provide practical recommendations for achieving nutrient requirements and mitigating the risk of chronic disease. The aim of this study was to describe the adherence to dietary guidelines by women with and without GDM and determine whether adherence is associated with the development of GDM. Adherence to Ministry of Health food group recommendations was assessed in 5391 pregnant women participating in the Growing Up in New Zealand study. A food frequency questionnaire (FFQ) administered during pregnancy provided dietary data. The presence of GDM was determined using diagnostic coding in clinical data and blood glucose results. A quarter of women did not meet any food group recommendations. There were no significant differences in the number of food group targets met by women with or those without GDM. Meeting food group recommendations was not associated with odds of having GDM in adjusted analyses. This study found adherence to dietary recommendations is poor in both women with and without GDM and no association between adherence to food group recommendations and the development of GDM. Greater support is required to assist women to achieve food and nutrition recommendations.

How Do Health Schemas Inform Healthy Behaviours During Pregnancy? Qualitative Findings from the Be Healthy in Pregnancy (BHIP) Study

OBJECTIVE

Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women are frequently not engaging in healthy behaviours linked to appropriate weight gain. The purpose of the current study was to explore women's values and beliefs related to weight, nutrition and physical activity during pregnancy and to describe how these beliefs influence their behaviours.

METHODS

As part of a larger randomized controlled trial, we conducted 20 focus groups with 66 pregnant women between 16 and 24-weeks gestation using a semi-structured interview guide. Focus groups were recorded and transcribed verbatim and analyzed using a grounded theory approach.

RESULTS

Three personal health schemas emerged from the findings which illustrated women's diverging beliefs about their health behaviours in pregnancy. 'Interconnected health' described beliefs regarding the impact their health had on that of their growing baby and awareness of risks associated with inappropriate weight gain. 'Gestational weight gain as an indicator of health' illustrated perceptions regarding how GWG impacted health and the utility of guidelines. Finally, 'Control in pregnancy' described the sense of agency over one's body and health.

CONCLUSIONS FOR PRACTICE

Our results showed that health-related behaviours in pregnancy are driven by personal health schemas which are often discordant with clinical evidence. Interventions and health care provider advice aimed at behaviour modification would benefit from first understanding and addressing these schemas. Tackling the conflict between beliefs and behaviour may improve health outcomes associated with appropriate weight gain in pregnancy.

Associations between antenatal maternal diet and other health aspects with infant temperament in a large multiethnic cohort study: a path analysis approach

OBJECTIVES

The aim of this study was to assess the association of antenatal maternal dietary patterns (DPs) and other health aspects with infant temperament in a large multiethnic cohort, taking maternal personality and prenatal stress into account.

DESIGN AND METHODS

Using data from 3968 children born in 2009/2010 and their mothers from the Growing Up in New Zealand cohort, infant temperament was assessed at 9 months using the Infant Behavior Questionnaire-Revised Very Short Form. Maternal antenatal diet and other health aspects were assessed antenatally. Maternal DPs (n=4) were derived using principal components analysis based on food intake reported on a 44-item food frequency questionnaire. Path analyses investigated factors associated with infant temperament, namely maternal personality, prenatal maternal stress, DPs and other health aspects, including potential inter-relations and mediating effects.

RESULTS

Women who scored higher in the fusion DP (standardised beta (β)=0.05; 95% CI 0.02 to 0.09) and healthy DP (β=0.05; 95% CI 0.02 to 0.09), who exercised more (β=0.04; 95% CI 0.01 to 0.07), and who drank less alcohol (β=-0.05; 95% CI -0.08 to -0.02) were more likely to have infants with an overall less difficult temperament. Sex-specific differences were found in the associations between maternal DP and infant temperament. Maternal personality and prenatal stress were significantly associated with all dimensions of infant temperament. The strongest predictors for a more difficult temperament were prenatal stress (β=0.12; 95% CI 0.08 to 0.15) and the personality dimensions neuroticism (β=0.10; 95% CI 0.07 to 0.14) and extraversion (β=-0.09; 95% CI -0.12 to -0.06).

CONCLUSIONS

Associations of antenatal maternal diet and health aspects with infant temperament were statistically significant but small. While they should not be overinterpreted as being deterministic, the findings of this study support the link between maternal modifiable health-related behaviours and infant temperament outcomes.

The Impact of COVID-19 on diet and lifestyle behaviours for pregnant women with diabetes

Background/aims

A self-reported online survey was performed to investigate the immediate effect of COVID-19 lockdown restrictions in New Zealand on dietary intake, and lifestyle behaviours among pregnant women with diabetes.

Participants/methods

The survey was sent to 82 pregnant women who had Type 1, Type 2 Diabetes, or Gestational Diabetes and attended the Diabetes in Pregnancy Clinic in Wellington, New Zealand in May 2020, while the most restrictive COVID-19 lockdown measures were in place. All women received standard pregnancy nutrition advice provided by a dietitian, were monitoring blood glucose levels with nursing support, and seeing specialist endocrinologists and obstetricians for their pregnancy care.

Results

Fifty women (61%) responded to the survey. There was no evidence of differences in dietary intake during the restrictions, compared to before, for most food items. During the restriction's women consumed more bread (Odds Ratio (95% CI): 0.39 (0.18–0.83) p = 0.02); less battered fish: 3.11 (1.20–8.05) p = 0.02; and less hot chips/fries: 6.32 (2.67–14.93) p < 0.0001. During the restriction's women consumed more meals at home: 0.05 (0.14–0.15) p < 0.0001; less takeaways: 3.63 (1.54–7.34) p = 0.003; and less restaurant and café meals: 15.05 (6.03–37.59) p < 0.0001, when the services reopened.

Conclusions

The nutrition of pregnant women with diabetes was not compromised during a brief COVID-19 lockdown restriction. This finding is reassuring, with countries worldwide adopting brief intermittent lockdown periods to restrict the spread of the COVID-19 virus.

An index measuring adherence to New Zealand Infant Feeding Guidelines has convergent validity with maternal socio-demographic and health behaviours and with children's body size

Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort’s adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) assess the IFI’s convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from the Growing Up in New Zealand cohort (n 6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd 2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children’s overweight/obesity/central adiposity, were in the expected directions and confirm the IFI’s convergent construct validity.

Sociodemographic Factors Associated with Adherence to Dietary Guidelines in Women with Gestational Diabetes: A Cohort Study

Dietary advice is the cornerstone of care for women with gestational diabetes mellitus (GDM). However, adherence to this advice is variable. We aimed to identify the proportion of women with GDM who adhere to the New Zealand nutrition guideline recommendations and assess the sociodemographic factors linked to dietary adherence. We assessed dietary intake at 36 weeks’ gestation in a cohort of 313 women with GDM and compared this with the dietary recommendations for the management of GDM. Associations between maternal characteristics and dietary adherence were assessed using ANOVA, chi square, logistic regression, and linear regression tests. Women with GDM had an average adherence score of 6.17 out of 10 to dietary recommendations, but no one adhered to all the recommendations. Adherence to recommendations was lowest for saturated fat, and wholegrain breads and cereals. While 85% visited a dietitian, only 28% of women achieved their recommended weight gain. Maternal factors associated with lower dietary adherence were primiparity, no previous history of GDM, being underweight, and smoking. Adherence to the dietary recommendations by women with GDM in New Zealand for the management could be improved. Further research is needed to identify ways for women with GDM to improve their dietary adherence.

First 1000 days: New Zealand Mothers' perceptions of early life nutrition resources

Research into associations between early life nutritional exposures and vulnerability to adult non-communicable disease (NCD) highlights the importance of maternal diet. A booklet outlining evidence-based dietary guidelines for the first 1000 days of life was first published in 2016 by early life nutrition experts for distribution to pregnant women in Australia and New Zealand. First-time New Zealand mothers' (n=9) perceptions of the booklet and its relevance for the future health of their child were explored via semi-structured focus groups and interviews. Recruitment took place via social media channels and antenatal classes around Auckland. Three major themes were identified using thematic analysis: 1. A difference in the ways mothers related to the booklet depending on their apparent level of health literacy and communication preferences; 2. A tendency for women to outsource decision-making to nutrition 'rules', rather than interpreting information to suit personal circumstances; 3. Intense pressure to comply, resulting in feelings of shame or guilt when the 'rules' were not followed. In this study, first-time mums expressed feeling under pressure to 'get it right' and identified a desire for more support from healthcare providers and society. Nutrition education is essential; however, a booklet should provide a starting point for conversation rather than a stand-alone list of recommendations. Further exploration is needed to develop a resource that can be used by health professionals working alongside women and their partners to support healthy child development.

Prenatal Stress and Early Childhood Body Mass Index: A Path Analysis Approach

OBJECTIVES

Stress experienced by mothers during the prenatal period can have negative impacts on offspring development. Elevated BMI in childhood in response to early stress experience is a particularly critical outcome of interest since high BMI in childhood is associated with diabetes, heart disease and stroke in later life. The primary objective of this study was to analyze pathways between prenatal stress and early childhood BMI at 54-months of age and to begin to explore ethnic variations in these pathways.

METHODS

This study used the Growing Up in New Zealand (GUiNZ) dataset, which is a longitudinal, representative birth cohort study that began with recruiting pregnant women in 2009 and 2010 in Auckland, New Zealand. Path analysis modeling was used to explore risk and protective pathways between prenatal maternal stress and early childhood body mass index (BMI) at 54-months of age and differences by ethnicity (n = 5510).

RESULTS

Prenatal stress was positively associated with early childhood BMI at 54-months and maternal nutrition behaviors and length of exclusive breastfeeding mediated this direct relationship (χ² (1) = 0.83, p = 0.36; AIC = 50,496). Mediation and moderation paths varied by ethnicity.

CONCLUSIONS FOR PRACTICE

These findings contribute to the understanding of the intergenerational transmission of stress with respect to early childhood obesity. Reducing early stress exposure and/or addressing mediating and moderating factors linking stress experience with obesity development may prove to be more effective than attempting to alter health behaviors and trajectories in adulthood.

Dietary Choices of New Zealand Women during Pregnancy and Lactation

Dietary recommendations during pregnancy and lactation have become increasingly complex, and sources of information more numerous but not always reliable, potentially causing confusion and unsafe choices. Women were recruited during pregnancy or within six months postpartum and completed questionnaires on dietary choices, food safety, and sources of nutrition information. Women (n = 458) from around New Zealand participated in the study. They consumed a wide range of foods and beverages and reported various dietary changes. In pregnancy, women commonly avoided alcohol (92%), raw milk products (86%), and raw, smoked, or pre-cooked seafood and fish (84%), and made changes due to food safety concerns. Influential advice was acquired from a range of sources including midwives (37%) and the New Zealand pregnancy and breastfeeding guidelines (25%) during pregnancy. Food avoidance was less common in lactation. However, fewer women consumed milk products during lactation (64%) than pregnancy (93%). Potentially unreliable sources were used more frequently in lactation including alternative health practitioners (26%) and family or friends (12%), and dietary changes were often made in response to infant symptoms without supporting evidence. This study highlighted a need for good communication of evidence-based recommendations to women, especially during lactation.

Are antenatal interventions effective in improving multiple health behaviours among pregnant women? A systematic review protocol

BACKGROUND

Maternal behaviours in pregnancy associated with adverse pregnancy, birth and health outcomes include tobacco smoking, poor nutrition, alcohol consumption and low physical activity, collectively referred to as the SNAP risk factors. Due to the high prevalence, co-occurrence and possible interactive health effects of such health behaviours in pregnancy, antenatal interventions that support pregnant women to improve multiple SNAP behaviours have a greater potential impact on the health outcomes of women and their children than interventions addressing single behaviours. The objective of this review is to determine the effectiveness of interventions delivered as part of antenatal care that aim to improve multiple SNAP behaviours among pregnant women.

METHODS

Seven electronic databases will be searched for potentially eligible studies. Eligible studies will include those where pregnant women are attending antenatal care. Studies that examine the effect of an intervention that addresses multiple SNAP behaviours (≥ 2 behaviours) during pregnancy and are delivered or instigated through antenatal care in a healthcare service will be included. Systematic reviews of randomised controlled trials (RCTs), RCTs, cluster RCTs, stepped-wedge RCTs and non-randomised control trials will be eligible. Studies that include a no-intervention control, wait-list control group, standard/usual care, or another active single behavioural intervention (e.g. addressing one behaviour only) will be considered. Two independent reviewers will conduct study screening, data extraction and risk of bias assessment. Discrepancies will be resolved by consensus or a third reviewer if required. A random effects model will be used to synthesise the results. Alternative synthesis methods will be investigated in instances where a meta-analysis is not appropriate, such as summarising effect estimates, combining P values, vote counting based on direction of effect, or synthesis in narrative form.

DISCUSSION

The review will synthesise the evidence on the effect of interventions that address multiple SNAP behaviours in antenatal care and will help researchers, policy-makers and health services to develop and deliver best practice integrated models of antenatal care that have the potential to impact on both the short- and long-term health outcomes for women and their children.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018095315.

Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations?

The maternal diet influences the long-term health status of both mother and offspring. The current study aimed to compare dietary intakes of pregnant women compared to food and nutrient recommendations in the Australian Guide to Healthy Eating (AGHE) and Nutrient Reference Values (NRVs). Usual dietary intake was assessed in a sample of women in their 3rd trimester of pregnancy attending antenatal outpatient clinics at John Hunter Hospital, Newcastle, New South Wales (NSW). Dietary intake was measured using the Australian Eating Survey, a validated, semi-quantitative 120-item food frequency questionnaire. Daily food group servings and nutrient intakes were compared to AGHE and NRV targets. Of 534 women participating, none met the AGHE recommendations for all food groups. Highest adherence was for fruit serves (38%), and lowest for breads and cereals (0.6%). Only four women met the pregnancy NRVs for folate, iron, calcium, zinc and fibre from food alone. Current dietary intakes of Australian women during pregnancy do not align with national nutrition guidelines. This highlights the importance of routine vitamin and mineral supplementation during pregnancy, as intakes from diet alone may commonly be inadequate. Future revisions of dietary guidelines and pregnancy nutrition recommendations should consider current dietary patterns. Pregnant women currently need more support to optimise food and nutrient intakes.

Be Healthy in Pregnancy: Exploring factors that impact pregnant women's nutrition and exercise behaviours

Excess gestational weight gain is associated with short‐ and long‐term pregnancy complications. Although a healthy diet and physical activity during pregnancy are recommended and shown to reduce the risk of complications and improve outcomes, adherence to these recommendations is low. The aims of this study were to explore women's view of nutrition and physical activity during pregnancy and to describe barriers and facilitators experienced in implementing physical activity and nutrition recommendations. In a substudy of the Be Healthy in Pregnancy randomized trial, 20 semistructured focus groups were conducted with 66 women randomized to the control group when they were between 16 and 24 weeks gestation. Focus groups were recorded, transcribed verbatim, coded and thematically analysed. The results indicate that women felt motivated to be healthy for their baby, but competing priorities may take precedence. Participants described limited knowledge and access to information on safe physical activity in pregnancy and lacked the skills needed to operationalize both physical activity and dietary recommendations. Women's behaviours regarding diet and physical activity in pregnancy were highly influenced by their own and their peers' beliefs and values regarding how weight gain impacted their health during pregnancy. Pregnancy symptoms beyond women's control such as fatigue and nausea made physical activity and healthy eating more challenging. Counselling from care providers about nutrition and physical activity was perceived as minimal and ineffective. Future interventions should address improving counselling strategies and address individual's beliefs around nutrition and activity in pregnancy.

Diet quality, nutrient intakes and biochemical status of New Zealand women of childbearing age according to alcohol consumption patterns

OBJECTIVE

To investigate associations between alcohol consumption patterns and diet quality, nutrient intakes and biochemical profile of women of childbearing age.

DESIGN

Nutrient intake data from 24 h diet recalls, alcohol consumption data and diet quality from the Dietary Habits Questionnaire, and biochemical analyses from the cross-sectional 2008/09 Adult Nutrition Survey in New Zealand.

SETTING

New Zealand households.

PARTICIPANTS

New Zealand women aged 18-45 years (n 1124).

RESULTS

All analyses were completed using Stata and survey weights were used to allow for the complex survey design to produce population estimates. Multinomial logistic regression models were used to examine the associations between drinking patterns and the variables of interest, with 'infrequent moderate/light' drinkers being the reference category. The findings indicate that alcohol-consuming women of childbearing age tend to replace food energy with alcohol energy (P = 0·022). 'More frequent heavy' and 'more frequent moderate/light' drinkers had higher intakes of total, mono- and polyunsaturated fats with the latter group also consuming higher levels of saturated fats (P < 0·05). Women who were 'infrequent moderate/light' drinkers had relatively better diet quality, nutrient intakes and adequate biochemical status in comparison to other drinkers and abstainers. 'Infrequent heavy' drinkers, who were predominantly younger in age, had lower serum vitamin B12 levels (P = 0·01) with a higher proportion of women in this category having below-recommended levels of serum folate (P < 0·05).

CONCLUSIONS

Alcohol consumption, especially heavy drinking patterns, may compromise nutritional status of women of childbearing age.

Dietary Patterns and Dietary Adaptations in Women with and without Gestational Diabetes: Evidence from the Growing Up in New Zealand Study

Diet is a cornerstone of the management of gestational diabetes (GDM). We investigated differences in dietary patterns and dietary adaptations among pregnant women with and without GDM participating in the Growing Up in New Zealand study. Presence of GDM was determined using coded clinical data and plasma glucose results meeting the New Zealand Society for the Study of Diabetes diagnostic criteria. Women answered a food frequency questionnaire and questions regarding dietary changes and information received during pregnancy. Women with GDM had lower adherence scores than those without GDM for 'Junk' (mean (SD) score -0.28 (0.95) versus 0.02 (1.01) p < 0.0005) and 'Traditional/White bread' dietary patterns (-0.18 (0.93) versus 0.01 (1.01) p = 0.002). More women with GDM reported avoiding foods high in fat or sugar (25.3% versus 5.7%, p < 0.05) compared to women without GDM. A greater proportion of women with GDM compared with those without GDM received information from dietitians or nutritionists (27.0% versus 1.7%, p < 0.05) or obstetricians (12.6% versus 7.5%, p < 0.05). More women diagnosed before the antenatal interview received advice from dietitians or nutritionists compared with those diagnosed after (46.9% versus 6.0%, p < 0.05). Women with GDM appear to make positive changes to their diet in response to advice received from health care professionals.

Daily decision-making about food during pregnancy: a New Zealand study

Pregnancy has always been a life-changing event for women and their families, but societal concern about pregnancy and motherhood has become intense in the digital age. The role of health promotion agencies and others supplying health-related resources about lifestyle behaviours is both important and in need of scrutiny. Ever increasing advice for pregnant women, their families and health professionals, abounds. This study of decision making during pregnancy investigated how women made everyday decisions during pregnancy about food and drink, as well as dietary supplements and medications, alcohol and recreational drugs. This qualitative interview study was a side-arm to a double-blind randomized, placebo-controlled trial conducted with pregnant women in Wellington New Zealand, 2013-2016. Data from interviews with 20 women were analysed using inductive thematic analysis. In relation to decision-making about lifestyle behaviours, five themes emerged-Information about food; Wanted and unwanted advice; Worry, anxiety and indecision; Making daily decisions about food; Changes in decision making over time. Participating women talked more about food selection and restriction advice than any other lifestyle topic. Analysis demonstrated concern about information accuracy and overload from multiple, diverse sources. Women described learning how to assess resource credibility, how to develop decision-making skills, and who to trust. The study raises important questions about how the health information environment, despite best intentions, can be confusing or potentially harmful. The study underlines the continued importance of the role health professionals have in not only interpreting information to discuss individualized advice, but also in empowering pregnant women to develop lifestyle-related decision-making skills.

Receipt of information about diet by pregnant women: A cross-sectional study

PROBLEM

Given the influence of diet on infant and maternal health outcomes, adequate knowledge about nutrition during pregnancy is critical.

AIMS

To examine among women receiving antenatal care the proportion who: (1) believe information about diet should be provided as part of routine antenatal care; (2) recall receiving advice about diet as part of care including: (a) when information was provided, (b) the healthcare provider who gave information, and (c) the format in which it was provided; and (3) attitudes towards information received.

METHODS

A cross-sectional survey was conducted with women attending a public antenatal clinic in New South Wales, Australia. Women were eligible to participate if they were: pregnant or had given birth in the previous 10 weeks; ≥18 years; and had at least one prior antenatal appointment for their current pregnancy.

FINDINGS

A total of 223 women (64% consent rate) participated. While the majority (86%) believed healthcare providers should be giving dietary information to pregnant women, only 63% recalled receiving information during their current pregnancy. Most often it was given by a midwife (76%). Information was initially provided in the first (52%) or second (38%) trimester, in both written and verbal form (60%). Approximately one third of participants felt overwhelmed or confused by which foods should be avoided during pregnancy.

CONCLUSIONS

A third of women did not recall receiving advice about diet as part of routine antenatal care. There is a need to develop a pathway to provide women with reliable, comprehensive advice about diet early in pregnancy.

Effects of folic acid food fortification scenarios on the folate intake of a multi-ethnic pregnant population

OBJECTIVE

To simulate effects of different scenarios of folic acid fortification of food on dietary folate equivalents (DFE) intake in an ethnically diverse sample of pregnant women.

DESIGN

A forty-four-item FFQ was used to evaluate dietary intake of the population. DFE intakes were estimated for different scenarios of food fortification with folic acid: (i) voluntary fortification; (ii) increased voluntary fortification; (iii) simulated bread mandatory fortification; and (iv) simulated grains-and-rice mandatory fortification.

SETTING

Ethnically and socio-economically diverse cohort of pregnant women in New Zealand.ParticipantsPregnant women (n 5664) whose children were born in 2009-2010.

RESULTS

Participants identified their ethnicity as European (56·0 %), Asian (14·2 %), Māori (13·2 %), Pacific (12·8 %) or Others (3·8 %). Bread, breakfast cereals and yeast spread were main food sources of DFE in the two voluntary fortification scenarios. However, for Asian women, green leafy vegetables, bread and breakfast cereals were main contributors of DFE in these scenarios. In descending order, proportions of different ethnic groups in the lowest tertile of DFE intake for the four fortification scenarios were: Asian (39-60 %), Others (41-44 %), European (31-37 %), Pacific (23-26 %) and Māori (23-27 %). In comparisons within each ethnic group across scenarios of food fortification with folic acid, differences were observed only with DFE intake higher in the simulated grains-and-rice mandatory fortification v. other scenarios.

CONCLUSIONS

If grain and rice fortification with folic acid was mandatory in New Zealand, DFE intakes would be more evenly distributed among pregnant women of different ethnicities, potentially reducing ethnic group differences in risk of lower folate intakes.

Investigating antenatal nutrition education preferences in South-East Queensland, including Maori and Pasifika women

BACKGROUND

Little is reported about the nutrition-related needs and preferences of women seeking maternity services, particularly Maori and Pasifika (M&P) women who have higher chronic disease rates in Queensland.

AIM

Nutrition-related knowledge, needs, behaviours and education preferences were compared between women of M&P ancestry and non-Maori and Pasifika women (NMP).

METHOD

Women (≥18 years) admitted to the postnatal ward were surveyed. Anthropometry, dietary quality, nutrition education preferences, country of birth and ancestry were collected. Analysis included chi-squared and t-tests.

FINDINGS

The survey was completed by 399 eligible women. Country of birth data suggested 4% of respondents were Pasifika and failed to separately identify New Zealand Maori, whereas 18% of respondents (n=73) reported M&P ancestry. Descriptors were similar between groups (28±5 years; 91% any breastfeeding; 18% gestational diabetes mellitus; p>0.05). However M&P women were less often university educated (M&P:6(9%); NMP:71(22%), p<0.01) and more likely had >2 children (M&P: 30(54%); NMP:70(30%), p<0.01). M&P women reported heavier weight at conception (M&P:79.0±20.2kg, 29.2±7.5kg/m²; NMP:71.3±18.9kg, 26.3±6.5kg/m², p<0.01), and were more likely to report excess gestational weight gain (M&P:30(56%), NMP:96(36%), p<0.05). Most (>75%) women did not know their recommended weight gain. Many respondents reported inadequate intake of vegetables (95%), fruit (29%) and dairy (69%) during pregnancy. Two-fifths (38-41%) reported interest in perinatal nutrition education, with topics including healthy eating postpartum.

DISCUSSION

Findings enable targeted service delivery according to women's preferences.

CONCLUSION

Collecting ancestral and maternal data to facilitate the provision of appropriate nutrition education may be critical for achieving optimal maternal outcomes in Maori and Pasifika women.

Predicting healthy eating intention and adherence to dietary recommendations during pregnancy in Australia using the Theory of Planned Behaviour

This study aims to aid in the development of more effective healthy eating intervention strategies for pregnant women by understanding the relationship between healthy eating intention and actual eating behaviour. Specifically, the study explored whether Theory of Planned Behaviour (TPB) constructs [attitude, subjective-norm, perceived-behavioural-control (PBC)] and additional psychosocial variables (perceived stress, health value and self-identity as a healthy eater) are useful in explaining variance in women's 1) intentions to consume a healthy diet during pregnancy and 2) food consumption behaviour (e.g. adherence to food group recommendations) during pregnancy. A cross-sectional sample of 455 Australian pregnant women completed a TPB questionnaire as part of a larger comprehensive web-based nutrition questionnaire. Women's perceived stress, health value and self-identity as a healthy eater were also measured. Dietary intake was assessed using six-items based on the 2013 Australian Dietary Guidelines. Hierarchical multiple linear regression models were estimated (significance level <0.05), which explained 70% of the variance in healthy eating intention scores and 12% of the variance in adherence to food group recommendations. TPB constructs explained 66% of the total variance in healthy eating intention. Significant predictors of stronger healthy eating intention were greater PBC and subjective norm, followed by positive attitude and stronger self-identity as a healthy eater. Conversely, TPB constructs collectively explained only 3.4% of total variance in adherence to food group recommendations. These findings reveal that the TPB framework explains considerable variance in healthy eating intention during pregnancy, but explains little variance in actual food consumption behaviour. Further research is required to understand this weak relationship between healthy eating intention and behaviour during pregnancy. Alternative behavioural frameworks, particularly those that account for the automatic nature of most dietary choices, should also be considered.

Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women

BACKGROUND

A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age.

METHODS

Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9-20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model.

RESULTS

The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04).

CONCLUSIONS

We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov database, NCT01001689 . https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1 .

Exploring Australian women's level of nutrition knowledge during pregnancy: a cross-sectional study

BACKGROUND

The Australian Guide to Healthy Eating (AGHE) for pregnancy provides a number of food- and nutrition-related recommendations to assist pregnant women in optimizing their dietary behavior. However, there are limited data demonstrating pregnant women's knowledge of the AGHE recommendations. This study investigated Australian pregnant women's knowledge of the AGHE and related dietary recommendations for maintaining a healthy pregnancy. The variations in nutrition knowledge were compared with demographic characteristics.

METHODS

A cross-sectional study assessed eight different nutrition knowledge domains and the demographic characteristics of pregnant women. Four hundred women across Australia completed a multidimensional online survey based on validated and existing measures.

RESULTS

More than half of the pregnant women surveyed (65%) were not familiar with the AGHE recommendations. The basic recommendations to eat more fruit, vegetables, bread, and cereals but less meat were poorly understood. An in-depth investigation of knowledge of nutrition information revealed misconceptions in a range of areas, including standard serving size, nutrients content of certain foods, energy density of fat, and the importance of key nutrients in pregnancy. Univariate analysis revealed significant demographic variation in nutrition knowledge scores. Multiple regression analysis confirmed the significant independent effects on respondents' nutrition knowledge score (P<0.000) of the education level, income, age, stage of pregnancy, language, and having a health/nutrition qualification. The model indicated that independent variables explained 33% (adjusted R (2)) of the variance found between respondents' knowledge scores.

CONCLUSION

Australian pregnant women's knowledge regarding AGHE for pregnancy and other key dietary recommendations is poor and varies significantly with their demographic profile. The setting of dietary guidelines is not sufficient to ensure improvement in their nutrition knowledge. It is essential that women receive support to achieve optimal and healthy diets during pregnancy.

Dietary Patterns in Pregnancy in New Zealand-Influence of Maternal Socio-Demographic, Health and Lifestyle Factors

Exploration of dietary pattern associations within a multi-ethnic society context has been limited. We aimed to describe dietary patterns of 5664 pregnant women from the Growing Up in New Zealand study, and investigate associations between these patterns and maternal socio-demographic, place of birth, health and lifestyle factors. Participants completed a food frequency questionnaire prior to the birth of their child. Principal components analysis was used to extract dietary patterns and multivariable analyses used to determine associations. Four dietary components were extracted. Higher scores on, ‘Junk’ and ‘Traditional/White bread’, were associated with decreasing age, lower educational levels, being of Pacific or Māori ethnicity and smoking. Higher scores on, ‘Health conscious’ and ‘Fusion/Protein’, were associated with increasing age, better self-rated health, lower pre-pregnancy body mass index (BMI) and not smoking. Higher scores on ‘Junk’ and ‘Health conscious’ were associated with being born in New Zealand (NZ), whereas higher scores on ‘Fusion/Protein’ was associated with being born outside NZ and being of non-European ethnicity, particularly Asian. High scores on the ‘Health conscious’ dietary pattern showed the highest odds of adherence to the pregnancy dietary guidelines. In this cohort of pregnant women different dietary patterns were associated with migration, ethnicity, socio-demographic characteristics, health behaviors and adherence to dietary guidelines.

Prepregnancy Obesity and Primary Cesareans among Otherwise Low-Risk Mothers in 38 U.S. States in 2012

BACKGROUND

The United States has recently experienced increases in both its rate of obesity and its cesarean rate. Our objective was to use a new item measuring prepregnancy body mass index (BMI) on the U.S. Standard Certificate of Live Birth to examine at a population level the relationship between maternal obesity and primary cesarean delivery for women at otherwise low risk for cesarean delivery.

METHODS

By 2012, 38 states with 86 percent of United States births had adopted the U.S. Standard Certificate. The sample was limited to the 2,233,144 women who had a singleton, vertex, term (37-41 weeks) birth in 2012 and no prior cesarean. We modeled the likelihood of a primary cesarean by BMI category, controlling for maternal socio-demographic and medical characteristics.

RESULTS

Overall, 46.4 percent of otherwise low-risk mothers had a prepregnancy BMI in the overweight (25.1%) or obese (21.3%) categories, with the obese category distributed as follows: obese I (BMI 30.0-34.9, 12.4%); obese II (BMI 35.0-39.9, 5.5%); and obese III (BMI 40+, 3.5%). Obesity rates were highest among American Indian and Alaska Native (32.5%) and non-Hispanic black mothers (30.5%). After adjustment for demographic and medical risks, the adjusted risk ratios (95% confidence intervals) of cesarean for low-risk primiparas were: 1.61 (1.60-1.63) for obese I, 1.86 (1.83-1.88) for obese II, and 2.21 (2.18-2.25) for obese III mothers compared with mothers in the normal weight category.

DISCUSSION

A relationship between prepregnancy obesity and primary cesarean delivery among relatively low-risk mothers remained even after controlling for social and medical risk factors.

Adherence to the Australian dietary guidelines during pregnancy: evidence from a national study

OBJECTIVE

To assess dietary intake of pregnant women against the Australian Dietary Guidelines with respect to the Five Food Group recommendations and determine predictors of adherence to the recommendations.

DESIGN

Cross-sectional web-based survey. Data were analysed using descriptive statistics and logistic regression.

SETTING

Pregnant women living in Australia. A national sample was recruited using an online panel provider and a South Australian sample was recruited through the antenatal clinic of a large public maternity hospital.

SUBJECTS

A total of 857 pregnant women.

RESULTS

Fifty-six per cent, 29% and less than 10% of women met the recommendations for the fruit, dairy and other core food groups, respectively. None of the women met the recommendations for all Five Food Groups. Women who were born overseas and who were less physically active pre-pregnancy were less likely to adhere to the fruit and dairy recommendations. Women who smoked during pregnancy, were overweight pre-pregnancy and had lower household incomes were also less likely to meet the fruit recommendations; and women living in metropolitan areas were less likely to meet the vegetable recommendations. Sixty-one per cent believed their diet during this pregnancy was healthy.

CONCLUSIONS

The majority of pregnant women in Australia perceive their diets to be healthy yet they do not consume the recommended daily servings from the Five Food Groups. Intervention strategies are warranted, particularly those that increase women's ability to evaluate their diet and also encourage positive dietary changes. These strategies may increase adoption of dietary guidelines and optimise pregnancy and other long-term health outcomes.