What stops us from eating: a qualitative investigation of dietary barriers during pregnancy in Punjab, Pakistan

"I have not been doing it because of my fear of something happening." Exploring perspectives on healthy dietary behaviors and physical activity in Mexican pregnant women and health care professionals: A qualitative study

OBJECTIVES

Mexico exhibits one of the highest prevalence rates of overweight and obesity globally, accompanied by a surge in non-communicable diseases, which in turn leads to elevated mortality rates. Existing efforts to address rising obesity rates have shown limited effectiveness. Maternal weight, diet, and physical activity (PA) during pregnancy affect the mother's and offspring's health. Despite the importance of establishing and engaging in healthy behaviors during pregnancy, little is known about which factors impact these behaviors among pregnant women in Mexico. This study explored perspectives on factors impacting healthy dietary behaviors and PA in pregnancy from pregnant women and health care professionals in Mexico.

METHODS

We conducted semistructured interviews with 11 pregnant women and 12 health care professionals working in prenatal care. Data were analyzed using qualitative content analysis in a stepwise inductive approach.

RESULTS

Classifying factors at the 1) individual level, 2) relational level, and 3) health care system level, three overall themes emerged. At the individual level, challenges with lack of time and competing priorities as well as knowledge of healthy dietary behaviors and PA were identified. At the relational level, influencing factors encompassed financial, social, and emotional support along with descriptive norms. At the health care system level, guidelines for PA during pregnancy and the quality of care were noted.

CONCLUSIONS

This study identified factors impacting healthy dietary behaviors and PA in pregnancy in Mexico. Important considerations for future interventions include addressing sociocultural norms around healthy dietary behaviors and PA in pregnancy and involving pregnant women's families, closest social networks, and health care professionals working at the prenatal care unit.

Between Life and Death: How do Muslim Terminal Patients in Pakistan cope with Hepatitis C utilizing their Beliefs and Social Support?

Life-threatening events including terminal illness intensify the search for meaning and incite individuals to get closer to religion. Terminal patients can often find religious practices as helpful as medical therapy for bettering both physical and mental health. The present research aims to explain the interaction between religion, spirituality, and social support in coping with terminal illness among Muslim hepatitis C patients in Pakistan. A semi-structured open-ended interview guide was utilized to collect the data. Participants expressed that the deployment of religious and spiritual beliefs along with socio-emotional support during illness fostered medical therapy. Participants also revealed that belief in God provided them the strength to be steadfast during the terminal stage of the disease. Religious beliefs enabled terminal participants to accept death as an eventual reality and a normal part of their lives. Furthermore, participants put forward their longing for those kinds of religious practices that terminal diseases usually restrained them from receiving. The emotional support stemming from social relationships also improved resilience to cope with the terminal stage of illness. The study concludes that the interplay of religion, spirituality, and social support normalizes the fear of death, lessens pain, and improves resilience among Muslim hepatitis C patients in Pakistan.

Factors associated with dietary patterns (DPS) and nutritional status among pregnant women in AM-HDSS, South Ethiopia

Background

Malnutrition during pregnancy increases the risk of chronic illness later in life and adverse birth outcomes in subsequent generations. In this regard, consumption of diets rich in adequate energy, protein, vitamins, and minerals from a variety of foods is essential. Evidence on the status of maternal dietary pattern is very crucial. Hence, the aim of this study was to assess factors associated with dietary patterns and nutritional status of pregnant women in South Ethiopia.

Methods

A community-based cross-sectional study was conducted among 638 randomly selected pregnant women using a validated, a pre-tested, contextualized food frequency questionnaire using interviewer-administered structured questionnaire by digital open-source toolkit. Principal component factor analysis was employed to determine dietary patterns. Bivariable and multivariable ordinal logistic regression analyses were used to identify factors associated with dietary patterns and nutritional status, using STATA version 16.

Result

The dietary habits of pregnant women were best explained by three distinct dietary patterns. Urban dwellers (AOR = 2.18; 95% CI: 1.33, 3.59), from high socio-economic status (AOR = 2.43; 95% CI: 1.68, 3.51), from middle socio-economic status (AOR = 1.72; 95% CI: 1.19, 2.48), primigravida mothers (AOR = 1.72; 95% CI: 1.07, 2.78), and multigravida mothers (AOR = 2.08; 95% CI: 1.39, 3.10) were high likelihood to consume the highest tercile of "Cereals-Pulses and Dairy" compared to rural dwellers, from low socio-economic status and grand multigravida, respectively. Attending formal education (AOR = 1.60; 95% CI: 1.02, 2.51), from higher socioeconomic status (AOR = 1.56; 95% CI: 1.02, 2.38), not having food aversion (AOR = 1.98; 95% CI: 1.16, 3.39), and had good dietary knowledge (AOR = 2.16; 95% CI: 1.08, 4.32) were associated with a higher tercile consumption of "Nutrient-Dense" food compared to those without formal education, having food aversion and had poor dietary knowledge, respectively. Not attending formal education (AOR = 2.22; 95% CI: 1.48, 3.36), had decision-making autonomy (AOR = 1.91; 95% CI: 1.26, 2.90), and had good dietary knowledge (AOR = 1.86; 95% CI: 1.13, 3.08) were found to consume the highest tercile of "Leafy local food" compared to their counterpart. Consumption of lower terciles "Nutrient-Dense" food (AOR = 1.63; 95% CI: 1.07, 2.47) and "Leafy local food" (AOR = 2.32; 95% CI: 1.54, 3.51) were found to be factors associated with under nutrition during pregnancy.

Conclusion

Three distinct dietary patterns were identified. Factors associated with these major dietary patterns included place of residence, socio-economic status, educational level, dietary knowledge, food aversion, number of pregnancies, and maternal decision-making autonomy. Under nutrition among pregnant women was found to be high and associated with the consumption of 'Nutrient-Dense' and 'Leafy local' foods. Therefore, concerned health authorities should strengthen dietary counseling during pregnancy, provide family planning services, and promote women's education.

Dietary knowledge, attitude, practice, and associated factors among pregnant mothers in Ethiopia: a systematic review and meta-analysis

Background

Despite global efforts, progress in reducing maternal malnutrition falls short of international goals, which is the same for Ethiopia, provided that studying dietary knowledge, attitude, and practice and their determinants is crucial to developing and implementing effective interventions, which this review tried to investigate in an Ethiopian context.

Methods

We searched on Scopus, HINARI, PubMed, and Google Scholar on January 3, 2024. We used the Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. Certainty was assessed using sensitivity and subgroup analyses and the Luis Furuya-Kanamori (LFK) index. The random effects model was used to determine the effect estimates with a p value less than 0.05 and a 95% CI.

Results

The pooled good dietary knowledge, favorable attitude, and good practice were 48.0% (95% CI: 39.0-57.0%), 47.0% (95% CI: 38.0-55.0%), and 34.0% (95% CI: 28.0-40.0%), respectively. Knowledge and attitude had bidirectional relationships and were affected by sociodemographic variables and gynecological issues. The dietary practice was influenced by urban residency (OR = 6.68, 95% CI: 2.49-10.87), food security (OR = 3.51, 95% CI: 1.02-5.99), knowledge (OR = 4.53, 95% CI: 3.22-5.74), nutrition information (OR = 3.07, 95% CI: 1.13-5.02), attitude (OR = 2.32, 95% CI: 1.34-3.30), family support (OR = 2.14, 95% CI: 1.43-2.85), perceived severity of malnutrition (OR = 2.07, 95% CI: 1.82-2.31), and positive perception of dietary benefit (OR = 2.19, 95% CI: 1.56-2.82).

Conclusion

The good dietary practice was lower than the knowledge and the favorable attitude toward it. It was influenced by sociodemographic variables, income and wealth, knowledge and information, attitudes and intentions, gynecological and illness experiences, family support and decision-making, and expectations of nutrition outcomes and habits. Sociodemographic and gynecological issues were also found to influence both dietary knowledge and attitude, which were also found to have bidirectional relationships.Systematic review registration: PROSPERO identifier: CRD42023440688.

Grandmothers - a cultural resource for women and children's health and well-being across the life cycle

Grandmothers exist in all societies. Especially in the non-western Majority World, where Elders are both highly respected and responsible for transmitting their knowledge to younger generations, there is extensive anecdotal evidence of Grandmothers' role in health promotion and healing. However, due to Eurocentric and reductionist views of families and communities, in the extensive past research on maternal, child and adolescent health issues across Africa, Asia, Latin America and the Middle East, and in Indigenous societies in North America, Australia and New Zealand, scant attention has been given to the role of Grandmothers. This paper addresses this oversight and supports the imperative to decolonize health promotion in the non-western world by building on non-western worldviews, roles and values. Based on an eclectic body of both published and gray literature, this review presents extensive evidence of Grandmothers' involvement across the life cycle of women and children and of the similar core roles that they play across cultures. While in some cases Grandmothers have a negative influence, in most cases their involvement and support to younger women and children is beneficial in terms of both their advisory and their caregiving roles. For future research and interventions addressing maternal, child and adolescent health, the conclusions of this review provide strong support for: adoption of a family systems framework to identify both gender-specific and generation-specific roles and influence; and the inclusion of Grandmothers in community health promotion programs dealing with different phases of the life cycle of women and children.

Experiences accessing nutritious foods and perceptions of nutritional support needs among pregnant and post-partum mothers with low income in the United States

Access to nutritious foods, a social determinant of health, contributes to disparities in maternal and infant health outcomes such as mental health, breastfeeding intensity and cardiometabolic risk. This study explored perceived nutrition access and intake among pregnant or post-partum women eligible for Medicaid. Qualitative, semistructured interviews were conducted with 18 women who were either currently pregnant (n = 4) or up to 12 months post-partum (n = 14) in 2021-2022. Mothers spoke English (n = 11) or Spanish (n = 7) and lived in the Texas Panhandle. Interviews were audio-recorded, transcribed, translated (Spanish to English) and verified. Two or more researchers coded each interview until consensus was reached using thematic analysis with ATLAS.ti software. The study revealed five drivers for nutrition access. (1) Social factors influenced nutrition; those with less support expressed limited ability to eat healthfully. (2) The Women, Infants and Children program was perceived as a helpful resource for some, while others faced challenges obtaining it. (3) Stress was bidirectionally related to unhealthy food choices, with food sometimes used as a coping mechanism. (4) Mothers prioritized their babies and others and had limited ability and time to prepare healthy meals. (5) Most participants felt they received inadequate nutrition guidance from their healthcare providers. Participants provided positive responses to a proposed nutritious home-delivered meal intervention. Low-income women may experience nutritional challenges specific to this life stage. Interventions that reduce stress and burden of household tasks (e.g. cooking) and improve education and access to nutritious foods may improve mothers' ability to consume nutritious foods.

Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review

Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional "hot" and "cold" food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).

Effects of a Comprehensive Dietary Intervention Program, Promoting Nutrition Literacy, Eating Behavior, Dietary Quality, and Gestational Weight Gain in Chinese Urban Women with Normal Body Mass Index during Pregnancy

In urban Chinese women with normal body weight during pregnancy, we implemented a comprehensive dietary intervention program aimed at enhancing nutrition literacy, dietary quality, and gestational weight gain. The methods included both online and offline health education on prenatal nutrition, weekly weight monitoring, family back education practices, and real-time dietary guidance. The intervention was delivered to randomly assigned control and intervention group participants from gestational week 12 to week 24. The intervention group (n = 44; 100% complete data) showed significant differences (mean (SD)) compared to the control group (n = 42; 95.5% complete data) in nutrition literacy (53.39 ± 6.60 vs. 43.55 ± 9.58, p < 0.001), restrained eating (31.61 ± 7.28 vs. 28.79 ± 7.96, p < 0.001), Diet Quality Distance (29.11 ± 8.52 vs. 40.71 ± 7.39, p < 0.001), and weight gain within the first 12 weeks of intervention (4.97 ± 1.33 vs. 5.98 ± 2.78, p = 0.029). However, there was no significant difference in the incidence of gestational diabetes (2 (4.5%) vs. 4 (9.5%), p = 0.629). Participants in the intervention group reported an overall satisfaction score of 4.70 ± 0.46 for the intervention strategy. These results emphasize the positive role of comprehensive dietary intervention in promoting a healthy diet during pregnancy.

Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain: Secondary Analysis of a Systematic Review

Importance

Randomized clinical trials have found that antenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, key components of successful interventions for implementation have not been systematically identified.

Objective

To evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform implementation of antenatal lifestyle interventions in routine antenatal care.

Data Sources

Included studies were drawn from a recently published systematic review on the efficacy of antenatal lifestyle interventions for optimizing GWG. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE, and Embase were searched from January 1990 to May 2020.

Study Selection

Randomized clinical trials examining efficacy of antenatal lifestyle interventions in optimizing GWG were included.

Data Extraction and Synthesis

Random effects meta-analyses were used to evaluate the association of intervention characteristics with efficacy of antenatal lifestyle interventions in optimizing GWG. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers.

Main Outcomes and Measures

The main outcome was mean GWG. Measures included characteristics of antenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff, or researcher), delivery format (individual or group), mode, location, gestational age at commencement (<20 wk or ≥20 wk), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 wk], moderate [13-20 wk], and high [≥21 wk]), tailoring, attrition, and adherence. For all mean differences (MDs), the reference group was the control group (ie, usual care).

Results

Overall, 99 studies with 34 546 pregnant individuals were included with differential effective intervention components found according to intervention type. Broadly, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared with those delivered by other facilitators (MD, -1.36 kg; 95% CI, -1.71 to -1.02 kg; P < .001). Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, -3.91 kg; 95% CI -5.82 to -2.01 kg; P = .002) and moderate number of sessions (MD, -4.35 kg; 95% CI -5.80 to -2.89 kg; P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with GWG. These interventions may benefit from an earlier commencement and a longer duration for more effective optimization of GWG.

Conclusions and Relevance

These findings suggest that pragmatic research may be needed to test and evaluate effective intervention components to inform implementation of interventions in routine antenatal care for broad public health benefit.

Dietary Intake patterns in women with GDM and Non-GDM: A comparative study

Objectives

The study aimed to determine dietary Intake patterns in women with GDM and Non-GDM, a comparative study in a tertiary care hospital, Pakistan.

Methods

This comparative cross sectional study was conducted through questionnaire spread over a period of six months of pregnant women visiting to Abbasi Shaheed Hospital for ante-natal visit having 24 to 28 weeks of gestation. With the written consent of the participants dietary intake patterns were assessed in GDM & Non-GDM subjects by a three day 24 hours' recalls and food frequency questionnaire. A 24-hour dietary recall chart is a dietary assessment tool in which participants were asked to recall all food and drink they have consumed in the last 24 hours. The FFQ (food frequency questionnaire) provide a list of foods and participants were asked how often they eat each item on the list. This FFQ has 70 food items. The food frequency was reported as never, per year, per month, once a week, once and a day. The reported intake of food was converted into nutrients intake (carbohydrate, protein, fat) which was calculated by reported intake frequency of each food multiplied by reported portion size and its respective nutrient composition, summing over all foods by a trained Nutritionist.

Results

A total of 75 participants with GDM, and 75 with Non-GDM were enrolled in this study over a period of six months. It was observed that dietary intake patterns have a significant association with GDM. Those who consume carbohydrate mainly containing diet have likely to have GDM. It has been seen that those who have family history of diabetes are more likely to have GDM. Family dietary patterns can affect risk of GDM. Our study has shown that timings of meals did not find have any significant association with GDM.

Conclusion

Dietary patterns strongly influence the risk of GDM. The most contributing factors to risk of GDM are higher intake of carbohydrate rich diet and lesser consumption of fruits and vegetables.

Food taboos during pregnancy: meta-analysis on cross cultural differences suggests specific, diet-related pressures on childbirth among agriculturalists

Pregnancy is the most delicate stage of human life history as well as a common target of food taboos across cultures. Despite puzzling evidence that many pregnant women across the world reduce their intake of nutritious foods to accomplish cultural norms, no study has provided statistical analysis of cross-cultural variation in food taboos during pregnancy. Moreover, antenatal practices among forager and agriculturalists have never been compared, despite subsistence mode being known to affect staple foods and lifestyle directly. This gap hinders to us from understanding the overall threats attributed to pregnancy, and their perceived nutritional causes around the world. The present study constitutes the first cross-cultural meta-analysis on food taboos during pregnancy. We examined thirty-two articles on dietary antenatal restrictions among agricultural and non-agricultural societies, in order to: (i) identify cross-culturally targeted animal, plant and miscellaneous foods; (ii) define major clusters of taboo focus; (iii) test the hypothesis that food types and clusters of focus distribute differently between agricultural and non-agricultural taboos; and (iv) test the hypothesis that food types distribute differently across the clusters of taboo focus. All data were analysed in SPSS and RStudio using chi-squared tests and Fisher's exact tests. We detected a gradient in taboo focus that ranged from no direct physiological interest to the fear of varied physiological complications to a very specific concern over increased birth weight and difficult delivery. Non-agricultural taboos were more likely to target non-domesticated animal foods and to be justified by concerns not directly linked to the physiological sphere, whereas agricultural taboos tended to targed more cultivated and processed products and showed a stronger association with concerns over increased birth weight. Despite some methodological discrepancies in the existing literature on food taboos during pregnancy, our results illustrate that such cultural traits are useful for detecting perception of biological pressures on reproduction across cultures. Indeed, the widespread concern over birth weight and carbohydrate rich foods overlaps with clinical evidence that obstructed labor is a major threat to maternal life in Africa, Asia and Eurasia. Furthermore, asymmetry in the frequency of such concern across subsistence modes aligns with the evolutionary perspective that agriculture may have exacerbated delivery complications. This study highlights the need for the improved understanding of dietary behaviors during pregnancy across the world, addressing the role of obstructed labor as a key point of convergence between clinical, evolutionary and cultural issues in human behavior.