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Beasant L, Ingram J, Emmett PM, Cade JE, Taylor CM. Adherence to the national guidance on foods and drinks to limit or avoid during pregnancy in England: the PEAR Study. Public Health Nutr 2024; 27:e106. [PMID: 38433598 PMCID: PMC11010152 DOI: 10.1017/s1368980024000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The National Health Service (NHS) England website provides guidance on foods/drinks to avoid or limit during pregnancy because of microbiological, toxicological or teratogenic hazards. The aims were to determine adherence and whether demographic characteristics were associated with adherence. DESIGN Cross-sectional study. SETTING Online survey of postpartum women resident in England during pregnancy. PARTICIPANTS Recently, postpartum women resident in England during their pregnancy (n 598; median age 33 (IQR 30-36) years) completed an online questionnaire (April-November 2022). Questions included those on consumption of twenty-one food/drink items that the NHS advises pregnant women to avoid/limit. The study is part of the Pregnancy, the Environment And nutRition (PEAR) Study. Summary statistics were used to determine proportions adhering to the guidance. Adjusted logistic regression was used to model the associations of adherence with demographic characteristics. RESULTS Adherence was generally high (>90 % for eight of ten food/drink items to be avoided). However, among pre-pregnancy consumers, several items were not completely avoided, for example, 81 % (128/158) for game meat/gamebirds, 37 % (176/478) for cured meats and 17 % (81/467) for soft cheeses. Greater educational attainment (e.g. caffeinated soft drinks OR 2·25 (95 % CI 1·28, 3·94)), greater maternal age (e.g. oily fish 1·64 (1·05, 2·56)) and lower parity (e.g. caffeinated coffee 0.28 (0.11, 0.69)) were the most usual characteristics associated with adherence. CONCLUSION Evidence of concerning levels of non-adherence for some food/drink items suggests a case for more education on some of the guidance, particularly for women with lower educational attainment, greater parity and greater maternal age. Further research on barriers to the implementation of the guidance is needed.
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Affiliation(s)
- Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School,
University of Bristol, BristolBS8 2PS, UK
| | - Jenny Ingram
- Centre for Academic Child Health, Bristol Medical School,
University of Bristol, BristolBS8 2PS, UK
| | - Pauline M Emmett
- Centre for Academic Child Health, Bristol Medical School,
University of Bristol, BristolBS8 2PS, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition,
University of Leeds, Leeds, UK
| | - Caroline M Taylor
- Centre for Academic Child Health, Bristol Medical School,
University of Bristol, BristolBS8 2PS, UK
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Maugliani A, Baldi F. Surveys as a valid tool for assessing food safety knowledge amongst pregnant women in high-income countries: a rapid review. Reprod Toxicol 2023; 119:108411. [PMID: 37245697 DOI: 10.1016/j.reprotox.2023.108411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
Pregnancy, being a vulnerable period, is the time when woman are most motivated to change their diet and lifestyle. Ensuring food safety during this susceptible time of life is essential for avoiding the related risks. Although a wealth of recommendations and guidelines have been issued for for pregnant women, further evidence is required regarding their effectiveness in implementing the knowledge and changing behaviour on food safety topics are needed. Surveys are often used as a research tool to investigate knowledge and awareness amongst pregnant women. Our main aim is to analyse and describe the results of an ad hoc research approach developed to characterise the main features of surveys identified in the PubMed database. The three major food safety issues - microbiological, chemical and nutritional- were analysed. We identified eight main key features to provide a summary of the evidence with a transparent and reproducible methodology. Our results help summarise the knowledge on the features of for pregnant women, by focusing on high-income countries over the last five years. We observed a high level of heterogeneity and methodological variability in food safety surveys. This is a novel approach that could be used to analyse surveys utilising a robust methodology. The outcomes are useful for guiding new survey design methodology and/or the modification existing surveys. Our findings could help to fill knowledge gaps by improving the use of innovative strategies for recommendations and guidelines on food safety for pregnant women. Non-high-income countries deserve separate and more comprehensive consideration.
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Affiliation(s)
- Antonella Maugliani
- Food Safety, Nutrition and Veterinary Public Health Department, Microbiological Food Safety and Food-borne Diseases Unit, Istituto Superiore di Sanità, Viale Regina Elena, 299 00161 Roma, Italy.
| | - Francesca Baldi
- Food Safety, Nutrition and Veterinary Public Health Department, Nutrition and Health Unit, Istituto Superiore di Sanità, Viale Regina Elena, 299 00161 Roma, Italy
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Beasant L, Ingram J, Taylor CM. Fish Consumption during Pregnancy in Relation to National Guidance in England in a Mixed-Methods Study: The PEAR Study. Nutrients 2023; 15:3217. [PMID: 37513635 PMCID: PMC10384333 DOI: 10.3390/nu15143217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Guidance on foods to limit or avoid in pregnancy is provided on the NHS website for England. Advice on fish consumption is related to exposure to mercury, dioxins and polychlorinated biphenyls, which may have adverse effects on fetal neurodevelopment. Our aim was to provide evidence on the effectiveness of the guidance in minimising exposure to toxins while maximising nutrient intake in a mixed-methods study. An online questionnaire on fish consumption before/during pregnancy was completed by postpartum women (≤12 months) in England (n = 598). A subsample of participants was invited to take part in an interview (n = 14). Women who ate fish before pregnancy reduced their intakes of both oily and white fish during pregnancy, with some avoiding it altogether. Women did not exceed the limit on tinned tuna, but there was evidence of mis-recall on the suggested limit. Overall intakes of fish were below that recommended during pregnancy (36% compliance for pre-pregnancy consumers). Barriers to fish consumption included risk aversion, confusion over specific details of the guidance, cost, availability, family preferences and smell/taste. Clarity and simplicity of the NHS guidance, with an overall message on the number of portions of fish a week advised prominently shown, would help pregnant women to benefit from the nutrients in fish while minimising exposure to toxins. The guidance on the number of cans of tuna advised per week is poorly recalled and needs to be disseminated accurately. The guidance on shark/marlin/swordfish could receive less prominence as it is rarely eaten by pregnant women in England.
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Affiliation(s)
- Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Jenny Ingram
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Caroline M Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
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Beasant L, Ingram J, Tonks R, Taylor CM. Provision of information by midwives for pregnant women in England on guidance on foods/drinks to avoid or limit. BMC Pregnancy Childbirth 2023; 23:152. [PMID: 36890490 PMCID: PMC9993745 DOI: 10.1186/s12884-023-05441-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/10/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The National Health Service (NHS) website gives guidance for pregnant women in England on foods/drinks to avoid or limit because of microbiological, toxicological or teratogenic hazards. These include, for example, some types of soft cheeses, fish/seafood and meat products. This website and midwives are trusted sources of information for pregnant women, but the ways in which midwives can be supported to provide clear and accurate information are unknown. AIMS The aims were to: (1) determine midwives' accuracy of recall of information and confidence in delivering the guidance to women; (2) identify barriers to provision; (3) identify the ways in which midwives provide this information to women. METHODS Registered Midwives practicing in England completed an online questionnaire. Questions included those on what information they provided and their confidence in delivering it, the ways they provided information on foods to avoid/limit, their recall of some of the guidance, and what resources they used. Ethics approval was given by the University of Bristol. RESULTS More than 10% of midwives (n = 122) were 'Not at all confident/Don't know' in providing advice about ten items, including game meat/gamebirds (42% and 43%, respectively), herbal teas (14%) and cured meats (12%). Only 32% correctly recalled overall advice on eating fish, and only 38% the advice on tinned tuna. The main barriers to provision were lack of time in appointments and lack of training. The most usual methods of disseminating information were verbal (79%) and signposting to websites (55%). CONCLUSION Midwives were often unconfident about their ability to provide accurate guidance, and recall on items tested was frequently mistaken. Delivery of guidance by midwives on foods to avoid or limit needs to be supported by appropriate training and access to resources, and sufficient time in appointments. Further research on barriers to the delivery and implementation of the NHS guidance is needed.
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Affiliation(s)
- Lucy Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jenny Ingram
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Rachel Tonks
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Caroline M Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'. Nutrients 2021; 13:nu13093298. [PMID: 34579175 PMCID: PMC8471126 DOI: 10.3390/nu13093298] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 01/13/2023] Open
Abstract
Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.
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Mierzejewska E, Honorato-Rzeszewicz T, Świątkowska D, Jurczak-Czaplicka M, Maciejewski T, Fijałkowska A, Szulc-Kamińska J, Czach A, Nałecz H, Szostak-Węgierek D, Szamotulska K. Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study. PLoS One 2020; 15:e0227682. [PMID: 31940402 PMCID: PMC6961901 DOI: 10.1371/journal.pone.0227682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/26/2019] [Indexed: 11/18/2022] Open
Abstract
Pregnancy is a period in life in which women are willing to improve their lifestyle. Providing proper information for these women is crucial for their health and the health of their offspring. Clear information about weak points in their nutritional and weight gain knowledge is the first step for proper health care assistance. There are a few previous studies evaluating the nutritional and weight gain knowledge of pregnant women. In the few studies available, different approaches were taken and there was no wider discussion on the content of the questionnaires attempting to measure level of knowledge. The aim of this study, designed in a pilot fashion, was to test the adequacy of the questionnaire as a research instrument in a group of 139 pregnant Polish women. The developed instrument is a 33-item questionnaire comprising four domains: weight gain, importance of nutrients, quality and quantity of food intake. The results of this study indicate that the questionnaire is stable and internal consistency is acceptable (Cronbach’s alpha > 0.7) for dimensions with more than four items. For dimensions with less than four items, internal consistency was poor (Cronbach’s alpha < 0.7). The cumulative explained variance for domains weight gain, importance of nutrients, quantity and quality of food intake was 54.74%, 42.74%, 54.42% and 48.99% respectively. Results from validity, reliability and factor analysis indicate that the questionnaire is adequate for its purpose.
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Affiliation(s)
- Ewa Mierzejewska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | | | - Dorota Świątkowska
- Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | | | - Tomasz Maciejewski
- Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | | | - Anna Czach
- Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Hanna Nałecz
- Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | | | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
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Bryant J, Waller AE, Cameron EC, Sanson-Fisher RW, Hure AJ. Receipt of information about diet by pregnant women: A cross-sectional study. Women Birth 2018; 32:e501-e507. [PMID: 30559008 DOI: 10.1016/j.wombi.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Amy E Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Emilie C Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob W Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alexis J Hure
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
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Waller A, Bryant J, Cameron E, Galal M, Symonds I, Sanson-Fisher R. Screening for recommended antenatal risk factors: How long does it take? Women Birth 2018; 31:489-495. [PMID: 29366711 DOI: 10.1016/j.wombi.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/13/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Detection and management of antenatal risk factors is critical for quality care. AIMS To determine (1) women's views about when they should be asked about antenatal health factors as recommended in the Australian antenatal guidelines; and (2) the time required to provide recommended care using a clinical scenario. METHODS In Phase 1, pregnant women attending an outpatient obstetrics clinic at a public hospital were surveyed about preferred screening for antenatal risk factors during visit(s). In Phase 2, a hypothetical clinical scenario of a woman attending her first antenatal visit with a practising midwife was video-recorded to extrapolate the time taken to ask about and offer assistance to manage clinical, screening and lifestyle risk factors. FINDINGS Most women (96%) perceived they should be asked about each of the risk factors at least once (i.e. at first visit). Total time taken to ask about all risk factors was 52min. More time was spent discussing clinical (11min) than lifestyle factors (4min). Adjusting for the estimated prevalence of each risk factor, the time taken to offer assistance was 8min per woman. Average time required for detecting and offering assistance to manage risk factors is 60min per average risk woman. CONCLUSION Women are willing to be asked about risk factors; however this process is time-consuming. Strategies to streamline visits and prioritise recommendations so time-efficient yet comprehensive care can be delivered are needed, particularly when factors require monitoring over time and for those who may be 'at-risk' for multiple factors.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Emilie Cameron
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Mohamed Galal
- Department of Obstetrics and Gynaecology, Hunter New England Local Health District, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, South Australia, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, University of Newcastle & Hunter Medical Research Institute, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
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