1
|
Ibrahim HA, Alshahrani MS, Elgzar WT. Mediterranean Diet Adherence beyond Boundaries: Sociodemographic and Pregnancy-Related Determinants among Saudi Women. Nutrients 2024; 16:2561. [PMID: 39125440 PMCID: PMC11314460 DOI: 10.3390/nu16152561] [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: 07/12/2024] [Revised: 08/02/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
Although the expected benefits of the Mediterranean diet (MD) are comprehensive, its implementation is hampered by poor adherence. Several factors can affect adherence to MD guidelines. The current study aimed to explore sociodemographic and pregnancy-related determinants of MD adherence among Saudi women. A correlational cross-sectional research design was conducted on a snowball sample of 774 pregnant women from the Najran region, Saudi Arabia, using an online survey between February and May 2024. A self-administered questionnaire consisting of sociodemographic data, pregnancy-related characteristics, and the MD scale was used for data collection. The current study showed that only 32.2% of participants had high adherence to the MD, and 57.6% had moderate adherence. Regarding sociodemographic determinants of MD adherence, highly educated, older women with lower pre-pregnancy body mass index (BMI) and higher monthly income increased the probability of high adherence to the MD (p < 0.05). In addition, being physically active before or during pregnancy significantly increased the woman's probability of having higher adherence to the MD (p < 0.05). Concerning pregnancy-related determinants, having a planned pregnancy and regular antenatal care (ANC) increased the woman's probability of high adherence to the MD by nearly 1.3 times (p < 0.05). In addition, low adherence to the MD increases the risk of gestational diabetes. In conclusion, numerous sociodemographic and pregnancy-related determinacies can significantly affect a woman's adherence to the MD. Healthcare providers should address these determinants during the planning and implementation of pregnant women's nutritional counseling to make the counseling process woman-centered and more effective.
Collapse
Affiliation(s)
- Heba A. Ibrahim
- Department of Maternity and Childhood Nursing, Nursing College, Najran University, Najran 66441, Saudi Arabia;
| | - Majed S. Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran 66441, Saudi Arabia
| | - Wafaa T. Elgzar
- Department of Maternity and Childhood Nursing, Nursing College, Najran University, Najran 66441, Saudi Arabia;
| |
Collapse
|
2
|
Acire PV, Bagonza A, Opiri N. The misbeliefs and food taboos during pregnancy and early infancy: a pitfall to attaining adequate maternal and child nutrition outcomes among the rural Acholi communities in Northern Uganda. BMC Nutr 2023; 9:126. [PMID: 37932846 PMCID: PMC10629057 DOI: 10.1186/s40795-023-00789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In developing countries, the practice of food taboo is pervasive. The types of foods considered as taboos and the reasons attached to taboos vary from society to society. Food taboos have been recognized as one of the factors contributing to maternal undernutrition in pregnancy, especially in rural settings. In the rural Acholi community where malnutrition is prevalent, very little is known about these food taboos and misbeliefs. This study, therefore, aims to explore various misbeliefs and food taboos in the time of pregnancy that can influence maternal and child nutrition outcomes in Acholi. METHODS A community-based qualitative cross-sectional study was conducted between April and May 2022 in five districts in the Acholi subregion. Focus group discussions (FGDs) and key informant interviews (KIIs) were used to collect data. Data transcription was done verbatim, organised into themes, assigned unique color codes, and manually analysed thematically. RESULTS Upon scrutiny of the transcripts, three themes were eminent. The first theme focused on foods that are considered taboos in Acholi community and the reasons linked to them. Participants indicated offals, chicken, wild birds, smoked meat and fish, sugarcane, garden egg ('Tula'), groundnut, bush meat, mushrooms, honey, sour fruits, or meals (oranges, mango, passion fruits, lemon, tamarind, 'Malakwang'), goat's meat, 'Lalaa' (the bitter green leafy vegetable), and 'Lamola' (Hyptis spicigera) as the major taboo foods. The second theme was the reasons underlying the adherence to the food taboos and misconceptions. Cultural dictates, individual characteristics, and societal context were the main reasons for the adherence to food taboos. The third theme looked at the misconceptions and other taboos during pregnancy. It was found that pregnant women are not allowed to touch grave soil, shave their hair, walk over an anthill, slaughter chicken or birds, have sex during pregnancy, sit on animal's hide or skin, and/or touch needles. CONCLUSIONS Nutritional counseling and education should focus more on addressing food taboos. The mode of delivery of the nutrition message should be inclusive, targeting pregnant women and their spouses, school-going children, adolescent girls, and cultural leaders at their respective points of contact.
Collapse
Affiliation(s)
- Peter Vivian Acire
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda.
| | - Arthur Bagonza
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Nicolas Opiri
- College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
3
|
Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
Collapse
Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| |
Collapse
|
4
|
Yu Y, Feng C, Bédard B, Fraser W, Dubois L. Diet quality during pregnancy and its association with social factors: 3D Cohort Study (Design, Develop, Discover). MATERNAL & CHILD NUTRITION 2022; 18:e13403. [PMID: 35821643 PMCID: PMC9480933 DOI: 10.1111/mcn.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
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.
Collapse
Affiliation(s)
- Yamei Yu
- School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
| | - Cindy Feng
- School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- Department of Community Health and Epidemiology Dalhousie University Halifax Nova Scotia Canada
| | - Brigitte Bédard
- School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences Université de Sherbrooke, and the Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS) Sherbrooke Quebec Canada
| | - Lise Dubois
- School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
| |
Collapse
|
5
|
Papazian T, Salameh P, Abi Tayeh G, Kesrouani A, Aoun C, Abou Diwan M, Rabbaa Khabbaz L. Dietary patterns and birth outcomes of healthy Lebanese pregnant women. Front Nutr 2022; 9:977288. [PMID: 36238451 PMCID: PMC9551999 DOI: 10.3389/fnut.2022.977288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to define the dietary patterns (DPs) of a sample of Lebanese pregnant women and to establish their correlation with maternal and neonatal outcomes. Methods A cross-sectional study was conducted among 358 Lebanese pregnant women. Maternal socio-demographic variables, anthropometric measurements, gestational weight gain and neonatal outcomes such as weight, length, head circumference and Apgar score were collected by qualified dietitians. Dietary intake was assessed by a validated food frequency questionnaire and three 24-h dietary recalls. DPs were determined, a posteriori, by a factor analysis to distinguish the inter-correlations between the food groups and a cluster analysis method to assemble the participants into groupings based on similarities in food consumption. Results The identified DPs were not exclusively composed of specific food groups, since some components were overlapping in the DPs. The first one was characterized by a high consumption of starchy vegetables, unsaturated fats and unhealthy foods, the second was rich in fruits and vegetables, seeds, rice and pasta, and in fried local meals and the third was mainly based on protein-rich foods like poultry, fish, eggs and dairy products. They were named respectively as “Westernized,” “Mixed” and “Neo-Mediterranean” by the research team. Women having the lowest pre-gestational body mass index (BMI) and higher gestational age followed mainly the “Neo-Mediterranean” eating pattern. Conclusion The three identified DPs among Lebanese pregnant women were correlated with the pre-gestational BMI, and some maternal variables. However, neither the maternal nor the neonatal outcomes were correlated with the DP adopted by the mothers.
Collapse
Affiliation(s)
- Tatiana Papazian
- Department of Nutrition, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
- *Correspondence: Tatiana Papazian
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban (INSPECT-LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Georges Abi Tayeh
- Department of Gynecology and Obstetrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Assaad Kesrouani
- Department of Gynecology and Obstetrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Carla Aoun
- Department of Nutrition, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Mia Abou Diwan
- Department of Nutrition, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Lydia Rabbaa Khabbaz
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| |
Collapse
|
6
|
Gonzalez-Nahm S, Østbye T, Hoyo C, Kravitz RM, Benjamin-Neelon SE. Associations Among Food Security, Diet Quality, and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina. J Acad Nutr Diet 2022; 122:565-572. [PMID: 34481120 PMCID: PMC10880738 DOI: 10.1016/j.jand.2021.08.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/16/2021] [Accepted: 08/27/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Low food security during pregnancy can negatively affect women's physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood. OBJECTIVE This study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina. DESIGN This was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy. PARTICIPANTS AND SETTING This study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016. MAIN OUTCOME MEASURE Diet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well. STATISTICAL ANALYSIS PERFORMED Multiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake. RESULTS In this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = -.43; P = 0.03). CONCLUSIONS Very low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.
Collapse
Affiliation(s)
- Sarah Gonzalez-Nahm
- Department of Nutrition, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina
| | - Richard M Kravitz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
7
|
ROCHA GG, ANDRADE-SILVA A, ALVES-SANTOS NH, CASTRO MBTD. Association between maternal dietary intake classified according to its degree of processing and sex-specific birth weight for gestational age. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Objective To assess the association between the maternal diet, according to the degree of processing of food consumption, and birth weight for gestational age and sex. Methods A cross-sectional study with 300 women was conducted from February 2009 to 2011 from a maternity ward in Mesquita, Rio de Janeiro. The outcome was based on sex-specific birth weight for gestational age: small, adequate, or large. A validated food frequency questionnaire was used to estimate the food consumption during the 2nd and 3rd trimesters of pregnancy. The food intake was classified into three groups according to the degree of processing: 1) unprocessed or minimally processed foods and culinary ingredients (oil, fats, salt, and sugar), 2) processed foods, and 3) ultra-processed foods. Descriptive analyses were made to assess the tertiles of the percentage of energy intake of each food group on the outcome and on maternal and infant characteristics. Multinomial logistic regressions were used to test the association of the tertiles of food according to the degree of processing on the outcome (adequate, small, or large birth weight for gestational age and sex). Results The analysis of the food frequency questionnaire from the 300 women indicated that the mean percentage of kcal consumed from unprocessed and minimally processed food and culinary ingredients was 54.0%, while the percentages of energy from processed foods and ultra-processed foods were 2.0% and 44.0%, respectively. The highest tertile of consumption of unprocessed and minimally processed food and culinary ingredients had a protective effect on the prevalence of newborn large for gestational weight in relation to the lowest (OR: 0.13; 95% IC: 0.02 to 0.89; p=0.04). Conclusion High consumption of unprocessed and minimally processed food and culinary ingredients during the last six months of pregnancy might be a protective factor against having a newborn large for gestational weight when compared to mothers with the lowest consumption.
Collapse
|
8
|
Bianchi CM, Mariotti F, Reulet E, Le Goff G, Lluch A, Verger EO, Huneau JF, Gurviez P. Perceptions of Tailored Dietary Advice to Improve the Nutrient Adequacy of the Diet in French Pregnant Women. Nutrients 2021; 14:nu14010085. [PMID: 35010960 PMCID: PMC8747067 DOI: 10.3390/nu14010085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
Tailored dietary counseling could be specifically efficient during pregnancy, a period accompanied by a rise in nutrition awareness, but little is known about the expectations of pregnant women in this regard. We studied these expectations regarding tailored dietary advice in French women during their pregnancy, as well as their motivations and the perceived barriers and enablers. In French pregnant women, we evaluated the perceptions of tailored dietary advice provided by stepwise dietary counseling based on three types of dietary changes, consisting of: (1) a modification of the amounts consumed, (2) substitutions within the food subgroups, and (3) substitutions between food subgroups. A sequential explanatory mixed-method approach was designed. Using qualitative data from a focus group study (n = 40), we intended to explore in depth the women’s expectations regarding dietary advice and adherence to a tailored approach. These were combined with quantitative and qualitative data from a 6-week online longitudinal study (n = 115), using questionnaires designed to assess the modifications of dietary habits during pregnancy and to evaluate each type of dietary change. Both studies confirmed that most women in our samples did indeed intend to institute changes regarding healthier dietary practices during pregnancy. The principal motivation behind changes to their habits was to ensure the health and well-being of both their babies and themselves. The proposal of dietary advice that is tailored to both the current diet and the specific needs of pregnant women, but that is also positive and credible, was perceived as enabling implementing healthier dietary practices during pregnancy. Regarding the implementation of the dietary changes proposed, the enablers and barriers identified differed between modifications of the amounts consumed and substitutions. The women displayed interest in all types of dietary changes. This gave relevance to combining different types of changes in order to propose dietary counseling during pregnancy. Tailored dietary counseling was identified by French pregnant women in our samples as enabling them to adopt a healthier diet. However, perceived barriers might limit the implementation of dietary changes, especially when they involved marked modifications to their usual diet.
Collapse
Affiliation(s)
- Clélia M. Bianchi
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - François Mariotti
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
- Correspondence:
| | - Elodie Reulet
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - Gaëlle Le Goff
- AgroParisTech, INRAE, UMR SayFood, Université Paris-Saclay, 91700 Massy, France; (G.L.G.); (P.G.)
| | - Anne Lluch
- Alimentation Science Department, Danone Nutricia Research, Centre Daniel Carasso, RD 128, 91737 Palaiseau, France;
| | - Eric O. Verger
- MoISA, University Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, 34394 Montpellier, France;
| | - Jean-François Huneau
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - Patricia Gurviez
- AgroParisTech, INRAE, UMR SayFood, Université Paris-Saclay, 91700 Massy, France; (G.L.G.); (P.G.)
| |
Collapse
|
9
|
Determinants of the Essential Elements and Vitamins Intake and Status during Pregnancy: A Descriptive Study in Polish Mother and Child Cohort. Nutrients 2021; 13:nu13030949. [PMID: 33809457 PMCID: PMC8001522 DOI: 10.3390/nu13030949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 01/17/2023] Open
Abstract
The study objective was to identify determinants of essential elements and vitamins intake, and microelements and vitamins concentration in blood among pregnant women from Poland. Based on the data from food frequency questionnaires and information about supplements taken (n = 1252), daily supply of six elements (calcium, magnesium, iron, zinc, copper, selenium) and nine vitamins (folate, vitamins A, E, C, B1, B2, B3, B6, B12) was calculated. Zinc, copper, selenium (n = 340), vitamin A and E (n = 358) concentration was determined in blood collected during pregnancy. Most of the women did not meet the demand for essential elements and vitamins with a diet. About 94% of the respondents declared supplements use. The women with higher education, indicating leisure-time, physical activity and multiparity had a higher chance of meeting the average demand for the majority of the analyzed nutrients. On the other hand, factors such as BMI < 18.5kg/m2, a higher level of stress, and late first medical-care visit were associated with a lower chance of meeting the recommendations. Higher socio-economic status was a determinant of a higher selenium concentration in plasma (β = 3.1; 95%CI: 0.2–5.9), whereas BMI ≥ 25 kg/m2, and multiparity of a higher copper concentration in plasma (β = 0.2; 95%CI: 0.03-0.4; β = 0.2; 95%CI: 0.1–0.4). Higher plasma concentration of vitamin E was noted among women older than 30 years of age comparing to those who were 30 or younger (β = 1.5; 95%CI: 0.6–2.4). Although more studies are required, especially such based on laboratory measures, our results indicate target groups for dietary interventions during pregnancy for children’s optimal health and development.
Collapse
|
10
|
Mooney J, Lipsky LM, Liu A, Nansel TR. Does stress attenuate motivation for healthful eating in pregnancy and postpartum? Appetite 2021; 163:105207. [PMID: 33737210 DOI: 10.1016/j.appet.2021.105207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/23/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Despite high motivation for healthful eating during pregnancy, maternal diet quality is inadequate. During pregnancy, women may relax effortful control over eating to reduce stress; thus, stress may override motivation to eat healthfully. This secondary analysis of data from the Pregnancy Eating Attributes Study longitudinal cohort investigated associations of motivation for healthful eating and perceived stress with diet quality during pregnancy (n = 365) and postpartum (n = 266), and investigated whether stress modifies associations of motivation with diet quality. Women (Mage = 31.3; gestational age ≤ 12 weeks) were recruited from the Chapel Hill, North Carolina area and completed multiple 24-h diet recalls (once each trimester of pregnancy, and at 4-6 weeks, 6 months, and 1 year postpartum) and validated measures of perceived stress and motivation for healthful eating (autonomous and controlled). Hierarchical multiple regressions tested associations of diet quality (Healthy Eating Index-2015) with stress, motivation, and their interactions. Additionally, themes extracted from previously-analyzed focus groups conducted with a subsample of participants were re-examined for content relevant to stress, motivation, and diet. Pregnancy and postpartum diet quality was positively associated with autonomous motivation, but was unassociated with controlled motivation and stress. Interaction terms did not appreciably improve model fit. Focus group participants described both internal and external forces contributing to their motivation for healthy eating during pregnancy and described the impact of stress on eating behaviors through amplification of food cravings. Future research is needed to identify influences on maternal motivation for healthful eating.
Collapse
Affiliation(s)
- Jan Mooney
- Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Colvard Hall, 9201 University City Boulevard, Charlotte, NC, 28223, USA; Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, USA.
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, USA
| | - Aiyi Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, USA
| | - Tonja R Nansel
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20817, USA
| |
Collapse
|
11
|
Janssen A, Parslow E. Pregnancy persistently reduces alcohol purchases: Causal evidence from scanner data. HEALTH ECONOMICS 2021; 30:231-247. [PMID: 33155361 DOI: 10.1002/hec.4188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/12/2020] [Accepted: 10/17/2020] [Indexed: 06/11/2023]
Abstract
We analyze household-level changes in alcohol consumption in response to pregnancy. Using scanner data, we identify households with a pregnant household member. Within an event study and a dynamic difference-in-differences estimation, we find that during a first pregnancy, households reduce their alcohol purchases by 36%. After pregnancy, purchases of alcohol are 34% lower than before pregnancy. We do not find any effect during the second pregnancy. One possible explanation for our result is that lower consumption during pregnancy changes habits and reduces consumption in the long term. We discuss other explanations and comment on policy implications.
Collapse
Affiliation(s)
| | - Elle Parslow
- Stockholm School of Economics, Stockholm, Sweden
| |
Collapse
|
12
|
Fernández-Gómez E, Luque-Vara T, Moya-Fernández PJ, López-Olivares M, Gallardo-Vigil MÁ, Enrique-Mirón C. Factors Influencing Dietary Patterns during Pregnancy in a Culturally Diverse Society. Nutrients 2020; 12:E3242. [PMID: 33113986 PMCID: PMC7690697 DOI: 10.3390/nu12113242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to identify dietary patterns in pregnant women and to assess the relationships between sociodemographic, lifestyle-related, and pregnancy-related factors. This is a descriptive, correlational study involving 306 pregnant women in Melilla (Spain) in any trimester of pregnancy. A validated food frequency questionnaire was used. Dietary patterns were determined via exploratory factor analysis and ordinal logistic regression using the proportional odds model. Three dietary patterns were identified: Western, mixed, and prudent. Sociodemographic, lifestyle-related, and pregnancy-related factors influencing dietary quality were established. The Western dietary pattern was considered the least recommended despite being the most common among women who live in Melilla (p = 0.03), are Christian (p = 0.01), are primiparous women (p < 0.001), and are in their first or second trimester (p = 0.02). Unemployed pregnant women were also more likely to have a less healthy dietary pattern (β = -0.716; p = 0.040). The prudent dietary pattern, the healthiest of the three, was most commonly observed among Muslim women (p = 0.01), women with more than two children (p < 0.001), and women in the third trimester of pregnancy (p = 0.02). Pregnant women who engaged in no physical activity or a low level of physical activity displayed a mixed pattern (p < 0.001). This study provides evidence on the factors influencing dietary patterns during pregnancy and suggests that more specific nutrition programmes should be developed to improve the nutritional status of pregnant women.
Collapse
Affiliation(s)
- Elisabet Fernández-Gómez
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, C/Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (T.L.-V.)
| | - Trinidad Luque-Vara
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, C/Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (T.L.-V.)
| | - Pablo José Moya-Fernández
- Department of Applied Economics, Faculty of Social and Legal Sciences, Melilla Campus, University of Granada, C/Santander s/n, 52001 Melilla, Spain;
| | - María López-Olivares
- Doctoral Degree School, Melilla Campus, University of Granada, C/Santander s/n, 52001 Melilla, Spain
| | - Miguel Ángel Gallardo-Vigil
- HUM-358 Research Group, Department of Research and Diagnostic Methods in Education, Faculty of Education and Humanities, Melilla Campus, University of Granada, C/Santander s/n, 52001 Melilla, Spain;
| | - Carmen Enrique-Mirón
- HUM-613 Research Group, Department of Inorganic Chemistry, Faculty of Health Sciences, Melilla Campus, University of Granada, C/Santander s/n, 52001 Melilla, Spain;
| |
Collapse
|
13
|
Rhodes A, Smith AD, Chadwick P, Croker H, Llewellyn CH. Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e18255. [PMID: 32673251 PMCID: PMC7382015 DOI: 10.2196/18255] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. OBJECTIVE This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. METHODS A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. RESULTS In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (-0.28 kg; 95% CI -1.43 to 0.87) or per-protocol data (-0.65 kg; 95% CI -1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. CONCLUSIONS In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.
Collapse
Affiliation(s)
| | | | | | - Helen Croker
- University College London, London, United Kingdom
| | | |
Collapse
|
14
|
Forbes LE, Graham JE, Berglund C, Bell RC. Dietary Change during Pregnancy and Women's Reasons for Change. Nutrients 2018; 10:nu10081032. [PMID: 30096771 PMCID: PMC6115730 DOI: 10.3390/nu10081032] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022] Open
Abstract
Women often make dietary changes during pregnancy; however, dietary modifications and reasons for changes are not well studied. We aimed to describe the dietary changes made during pregnancy, describe reasons for dietary changes, and determine what changes aligned with recommendations. Pregnant women (n = 379) recruited to the Alberta Pregnancy Outcomes and Nutrition (APrON) study in 2009/2010 completed a questionnaire in which they described dietary changes made during pregnancy and reasons for those changes. Changes and reasons were coded into categories. Women commonly reported increasing their intake of milk products, fruit, and sweet items and commonly decreased or eliminated intake of caffeine, alcohol, and meats. Women frequently reduced intake of foods for the baby’s health and increased foods to satisfy cravings. Changes made commonly aligned with recommendations for caffeine, alcohol intake, food safety, milk and alternatives, and fruit. Changes contrary to recommendations were common for fish and meats. The dietary changes women make during pregnancy appear to reflect women’s efforts to balance physiological changes accompanying pregnancy with the desire for healthy pregnancy outcomes. Understanding the reasons behind dietary change during pregnancy will help researchers and health professionals design effective strategies and public health messages to promote healthier pregnancies.
Collapse
Affiliation(s)
- Laura E Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Rd., Guelph, ON N1G 2W1, Canada.
| | - Jocelyn E Graham
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 116 St. and 85 Ave., Edmonton, AB T6G 2R3, Canada.
| | - Casey Berglund
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 116 St. and 85 Ave., Edmonton, AB T6G 2R3, Canada.
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 116 St. and 85 Ave., Edmonton, AB T6G 2R3, Canada.
| |
Collapse
|
15
|
Bevelander KE, Herte K, Kakoulakis C, Sanguino I, Tebbe AL, Tünte MR. Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women's Eating Behavior. Front Psychol 2018; 9:658. [PMID: 29867640 PMCID: PMC5952269 DOI: 10.3389/fpsyg.2018.00658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/16/2018] [Indexed: 01/01/2023] Open
Abstract
The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people's eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women's susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project's findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.
Collapse
Affiliation(s)
- Kirsten E. Bevelander
- Communication Science, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Katharina Herte
- Department of Social, Health and Organisational Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Inés Sanguino
- Department of Psychology, King’s College London, London, United Kingdom
| | - Anna-Lena Tebbe
- Department of Psychology, University of Mannheim, Mannheim, Germany
| | - Markus R. Tünte
- Faculty of Psychology, University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
Torkan N, Kazemi A, Paknahad Z, Bahadoran P. Relationship of Social Cognitive Theory Concepts to Dietary Habits of Pregnant Women. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:125-130. [PMID: 29628960 PMCID: PMC5881229 DOI: 10.4103/ijnmr.ijnmr_157_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Nutrition during pregnancy is undoubtedly one of the most important factors affecting maternal health. In this regard, considering the cognitive-behavioral factors associated with feeding, behaviors will play an important role in the effectiveness of interventions. Therefore, this study aimed to investigate the correlation between food habits and structures of social cognitive theory in pregnant women. Materials and Methods In this cross-sectional study, 192 pregnant women were randomly selected. Data were collected using a questionnaire based on the social cognitive theory structures and food habits questionnaire in the questioning manner and was also analyzed using Pearson correlation and multiple linear regression with the software Statistical Package for the Social Sciences, version 19. Results There was a significant correlation between nutritional behavior with self-regulation (p = 0.001), self-efficacy (p = 0.001), outcome expectations (p = 0.001), social support (p = 0.002), and access (p = 0.001). A significant correlation was observed between lack of consumption of unnecessary and unhelpful food with self-regulation (p = 0.02). In the multivariable regression analysis, only self-regulation revealed significant and direct contribution in relation to nutritional behavior (p < 0.001). Conclusions Results of this study showed that self-regulation is one of the important factors associated with feeding behavior in pregnant women so that it is suggested to be considered in nutritional interventions in order to improve nutritional behavior.
Collapse
Affiliation(s)
- Nasrin Torkan
- Student Research Center, Faculty of Nursing And Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Kazemi
- Department of Reproductive Health, School of Nursing And Midwifery, Isfahan University of Medical Siences, Isfahan, Iran
| | - Zamzam Paknahad
- Professor of Nutrition, Isfahan University of Medical Sciences, Faculty of Nutrition And Food Sciences, Isfahan, Iran
| | - Parvin Bahadoran
- Nursing And Midwifery Research Center, School of Nursing And Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| |
Collapse
|
17
|
Understanding maternal dietary choices during pregnancy: The role of social norms and mindful eating. Appetite 2017; 112:227-234. [DOI: 10.1016/j.appet.2017.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/11/2017] [Accepted: 02/03/2017] [Indexed: 11/23/2022]
|
18
|
Food Aversions and Cravings during Pregnancy on Yasawa Island, Fiji. HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2017; 27:296-315. [PMID: 27180176 DOI: 10.1007/s12110-016-9262-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women often experience novel food aversions and cravings during pregnancy. These appetite changes have been hypothesized to work alongside cultural strategies as adaptive responses to the challenges posed by pregnancy (e.g., maternal immune suppression). Here, we report a study that assessed whether data from an indigenous population in Fiji are consistent with the predictions of this hypothesis. We found that aversions focus predominantly on foods expected to exacerbate the challenges of pregnancy. Cravings focus on foods that provide calories and micronutrients while posing few threats to mothers and fetuses. We also found that women who experience aversions to specific foods are more likely to crave foods that meet nutritional needs similar to those provided by the aversive foods. These findings are in line with the predictions of the hypothesis. This adds further weight to the argument that appetite changes may function in parallel with cultural mechanisms to solve pregnancy challenges.
Collapse
|
19
|
Poston L, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Sandall J, Sanders TAB, Sattar N, Seed PT, Robson SC, Trépel D, Wardle J. Improving pregnancy outcome in obese women: the UK Pregnancies Better Eating and Activity randomised controlled Trial. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BackgroundObesity in pregnancy is associated with insulin resistance, which underpins many common complications including gestational diabetes mellitus (GDM) and fetal macrosomia.ObjectivesTo assess the effect of a complex behavioural intervention based on diet and physical activity (PA) on the risk of GDM and delivery of a large-for-gestational age (LGA) infant.DesignThree phases: (1) the development phase, (2) the pilot study and (3) a multicentre randomised controlled trial (RCT) comparing a behavioural intervention to improve glycaemic control with standard antenatal care in obese pregnant women. A cost–utility analysis was undertaken to estimate the cost-effectiveness of the health training (intervention) over and above standard care (control).SettingPilot study: antenatal clinics in four inner-city UK hospitals. RCT: eight antenatal clinics in eight UK inner-city hospitals.ParticipantsWomen were eligible for inclusion if they had a body mass index of ≥ 30 kg/m2, were pregnant with a single fetus and at 15+0to 18+6weeks’ gestation, were able to give written informed consent and were without predefined disorders.InterventionThe intervention comprised an initial session with a health trainer, followed by eight weekly sessions. Dietary advice recommended foods with a low dietary glycaemic index, avoidance of sugar-sweetened beverages and reduced saturated fats. Women were encouraged to increase daily PA.Main outcome measuresDevelopment phase: intervention development, acceptability and optimal approach for delivery. Pilot study: change in dietary and PA behaviours at 28 weeks’ gestation. RCT: the primary outcome of the RCT was, for the mother, GDM [as measured by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)’s diagnostic criteria] and, for the infant, LGA delivery (i.e. customised birthweight ≥ 90th centile for gestational age).ResultsDevelopment phase: following a literature meta-analysis, a study of dietary intention questionnaires and semistructured interviews, an intervention based on behavioural science was developed that incorporated optimal and acceptable methods for delivery. Pilot study: the pilot study demonstrated improvement in dietary behaviours in the intervention compared with the standard care arm but no increase in objectively measured PA. Process evaluation demonstrated feasibility and general acceptability. RCT: the RCT showed no effect of the intervention on GDM in obese pregnant women or the number of deliveries of LGA infants. There was a reduction in dietary glycaemic load (GL) and reduced saturated fat intake, an increase in PA and a modest reduction in gestational weight gain, all secondary outcomes. Lower than expected was the number of LGA infant deliveries in all women, which suggested that universal screening for GDM with IADPSG’s diagnostic criteria, and subsequent treatment, may reduce the number of deliveries of LGA infants. According to the cost–utility analysis, the estimated probability that the UK Pregnancies Better Eating and Activity Trial (UPBEAT) behavioural intervention is cost-effective at the £30,000/quality-adjusted life-year willingness-to-pay threshold was 1%.LimitationsIncluded the high refusal rate for participation and self-reported assessment of diet and PA.ConclusionsThe UPBEAT intervention, an intense theoretically based intervention in obese pregnant women, did not reduce the risk of GDM in women or the number of LGA infant deliveries, despite successfully reducing the dietary GL. Based on total cost to the NHS provider and health gains, the UPBEAT intervention provided no supporting evidence to suggest that the intervention represents value for money based on the National Institute for Health and Care Excellence benchmarks for cost-effectiveness.Future workAlternative strategies for reducing the risk of GDM in obese pregnant women and the number of LGA infant deliveries should be considered, including development of clinically effective interventions to prevent obesity in women of reproductive age, of clinically effective interventions to reduce weight retention following pregnancy and of risk stratification tools in early pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 and UK Clinical Research Network Portfolio 5035.FundingThis project was funded by the NIHR Programme Grant for Applied Research programme and will be published in full inProgramme Grants for Applied Research, Vol. 5, No. 10. See the NIHR journals library website for further project information. Contributions to funding were also provided by the Chief Scientist Office CZB/4/680, Scottish Government Health Directorates, Edinburgh; Guys and St Thomas’ Charity, Tommy’s Charity (Lucilla Poston, Annette L Briley, Paul T Seed) and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK and the Academy of Finland, Finland. Keith M Godfrey was supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Lucilla Poston and Keith M Godfrey were supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement number 289346.
Collapse
Affiliation(s)
- Lucilla Poston
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Keith M Godfrey
- Lifecourse Epidemiology Unit and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Thomas AB Sanders
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| |
Collapse
|
20
|
Determinants of dietary patterns and diet quality during pregnancy: a systematic review with narrative synthesis. Public Health Nutr 2016; 20:1009-1028. [PMID: 27852338 DOI: 10.1017/s1368980016002937] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify determinants of diet in pregnancy, by detecting factors in our multiple-determinants life course framework that are associated with dietary patterns, quality or guideline adherence. DESIGN A systematic review of observational studies, published in English or German, was conducted. Sociodemographic, lifestyle, environmental and pregnancy-related determinants were considered. Four electronic databases were searched in January 2015 and updated in April 2016 and a total of 4368 articles identified. Risk of bias was assessed using adapted Newcastle-Ottawa Scales. SETTING High- and upper-middle-income countries. SUBJECTS Pregnant or postpartum women reporting their dietary intake during pregnancy. RESULTS Seventeen publications of twelve studies were included and compared narratively due to heterogeneity. Diet in pregnancy was patterned along a social gradient and aligned with other health behaviours before and during pregnancy. Few studies investigated the influence of the social and built environment and their findings were inconsistent. Except for parity, pregnancy determinants were rarely assessed even though pregnancy is a physiologically and psychologically unique period. Various less well-researched factors such as the role of ethnicity, pregnancy intendedness, pregnancy ailments and macro-level environment were identified that need to be studied in more detail. CONCLUSIONS The framework was supported by the literature identified, but more research of sound methodology is needed in order to conclusively disentangle the interplay of the different determinants. Practitioners should be aware that pregnant women who are young, have a low education or do not follow general health advice appear to be at higher risk of inadequate dietary intake.
Collapse
|
21
|
de Gavelle E, de Lauzon-Guillain B, Charles MA, Chevrier C, Hulin M, Sirot V, Merlo M, Nougadère A. Chronic dietary exposure to pesticide residues and associated risk in the French ELFE cohort of pregnant women. ENVIRONMENT INTERNATIONAL 2016; 92-93:533-42. [PMID: 27187793 DOI: 10.1016/j.envint.2016.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 05/14/2023]
Abstract
Dietary exposure to pesticide residues may present a risk to public health, especially for sensitive populations such as pregnant women. To characterize this risk, this study assessed chronic dietary exposure to pesticide residues based on the French ELFE cohort. A self-administered food frequency questionnaire (FFQ) about the last three months of pregnancy filled in by pregnant women in 2011 was used in combination with occurrence data from French Total Diet Studies completed by the results of national monitoring programs on pesticide residues in food. The dietary intake of pesticides (μg/kg of body weight/day) was estimated for 14,099 pregnant women with a complete FFQ, for 317 substances under two occurrence scenarios to handle left-censored data: a lower-bound scenario (LB), where undetected results were set to zero, and an upper-bound scenario (UB), where undetected results were set to the detection limit if the substance was expected to be found in food and zero if it was not. The risk was assessed for 284 substances with a toxicological reference value (TRV) and a good coverage level of the diet potentially contributing to pesticide intake. The cumulative risk was also assessed for seven effects on nervous and thyroid systems using the hazard index and the Cumulative Assessment Groups defined by EFSA. Substances with the highest exposure levels under the LB scenario were, in decreasing order, imazalil, piperonyl butoxide, chlorpropham, thiabendazole, iprodione and propargite. Under the LB scenario, only for lindane did women have a statistically significant probability of exceeding the TRV (2.4%). Under the UB scenario, risk could not be excluded for nine other substances. A better management of left-censored data and more sensitive analyses of the main food contributors might help to refine the UB exposure and risk assessments. A statistically significant cumulative risk was found for neurochemical effects related to high intake levels of three organophosphate insecticides (chlorpyrifos, pirimiphos-methyl and dimethoate) mainly detected in fruits and cereals.
Collapse
Affiliation(s)
- Erwan de Gavelle
- ANSES - French Agency for Food, Environmental and Occupational Health & Safety, Risk Assessment Department, 14 rue Pierre et Marie Curie, F-94701, Maisons-Alfort Cedex, France.
| | - Blandine de Lauzon-Guillain
- INSERM, UMR 1153 Epidemiology and Biostatistics, Sorbonne Paris City Center (CRESS), ORCHAD Team, Paris, F-75014 France; Paris Descartes University, France
| | - Marie-Aline Charles
- INSERM, UMR 1153 Epidemiology and Biostatistics, Sorbonne Paris City Center (CRESS), ORCHAD Team, Paris, F-75014 France; Paris Descartes University, France
| | - Cécile Chevrier
- INSERM, UMR 1085 IRSET Research Institute in Health, Environment and Occupation, F-35043, Rennes, France
| | - Marion Hulin
- ANSES - French Agency for Food, Environmental and Occupational Health & Safety, Risk Assessment Department, 14 rue Pierre et Marie Curie, F-94701, Maisons-Alfort Cedex, France
| | - Véronique Sirot
- ANSES - French Agency for Food, Environmental and Occupational Health & Safety, Risk Assessment Department, 14 rue Pierre et Marie Curie, F-94701, Maisons-Alfort Cedex, France
| | - Mathilde Merlo
- ANSES - French Agency for Food, Environmental and Occupational Health & Safety, Risk Assessment Department, 14 rue Pierre et Marie Curie, F-94701, Maisons-Alfort Cedex, France
| | - Alexandre Nougadère
- ANSES - French Agency for Food, Environmental and Occupational Health & Safety, Risk Assessment Department, 14 rue Pierre et Marie Curie, F-94701, Maisons-Alfort Cedex, France
| |
Collapse
|
22
|
Kangasniemi M, Blomberg K, Korhonen A. Mothers' perceptions of their health choices, related duties and responsibilities: A qualitative interview study. Midwifery 2015; 31:1039-44. [PMID: 26194325 DOI: 10.1016/j.midw.2015.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/09/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to describe mothers' perceptions of their health choices, related duties and responsibilities. DESIGN descriptive exploratory study with qualitative research method. SETTING interviews conducted after the clients' regular health visits to one publicly provided maternity clinic in a southern city in Finland. PARTICIPANTS 13 mothers aged between 21 and 40-years-old, who were pregnant or had given birth in the past four weeks. Six of participants were pregnant or had delivered for first time and it was the second to fourth pregnancy for the remainder. DATA COLLECTION AND DATA ANALYSIS one-to-one semi-structured interviews using the inductive content analysis method. FINDINGS women reported increased responsibility for their health choices for themselves and their baby during pregnancy. However, their duties and responsibilities were seldom discussed at maternity clinics. The duty to reconsider their health choices was described as a predictor of commitment to their pregnancy and motherhood, but they recognised that it required sufficient knowledge to realise this. In addition, the mothers said their health choices changed from private to one of public interest during this period. CONCLUSIONS health choices are connected to maternal duties and responsibilities, but they can sometimes lack clarity during this new phase of life. In future, more research should be conducted to study maternal duties and responsibilities in different contexts. IMPLICATIONS FOR PRACTICE findings highlight the skills of nurses and midwives at maternity clinics to discuss and support mothers' moral pondering during pregnancy. Although health choices in general are well recognised as a part of maternal counselling, these findings suggest a moral perspective should be incorporated into the advice that is provided.
Collapse
Affiliation(s)
- Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627 70211, Kuopio, Finland.
| | - Katja Blomberg
- Hospital Services of the City of Vantaa, The City of Vantaa, Finland.
| | - Anne Korhonen
- Department of Pediatrics and Adolescence, Oulu University Hospital, P.O. Box 23 90029 OYS, Finland.
| |
Collapse
|
23
|
Shah MK, Kieffer EC, Choi H, Schumann C, Heisler M. Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women. HEALTH EDUCATION & BEHAVIOR 2015; 42:593-603. [PMID: 25636316 DOI: 10.1177/1090198114568307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers. A community-partnered randomized controlled trial (RCT) with pregnant Latino women resulted in significantly improved vegetable, fiber, added sugar, and total fat consumption compared to a minimal intervention group. However, studying RCT intervention effects alone does not explain the mechanisms by which the intervention was successful or help identify which participants may have benefitted most. PURPOSE To improve the development and targeting of future community health worker interventions for high-risk pregnant women, we examined baseline characteristics (moderators) and potential mechanisms (mediators) associated with these dietary changes. METHOD Secondary analysis of data for 220 Latina RCT participants was conducted. A linear regression with effects for intervention group, moderator, and interaction between intervention group and moderator was used to test each hypothesized moderator of dietary changes. Sobel-Goodman mediation test was used to assess mediating effects on dietary outcomes. RESULTS Results varied by dietary outcome. Improvements in vegetable consumption were greatest for women who reported high spousal support at baseline. Women younger than age 30 were more likely to reduce added sugar consumption than older women. Participants who reported higher baseline perceived control were more likely to reduce fat consumption. No examined mediators were significantly associated with intervention effects. CONCLUSION Future interventions with pregnant Latinas may benefit from tailoring dietary goals to consider age, level of spousal support, and perceived control to eat healthy.
Collapse
Affiliation(s)
| | | | | | - Christina Schumann
- Community Health and Social Services Center (CHASS), Inc., Detroit, MI, USA
| | - Michele Heisler
- University of Michigan, Ann Arbor, MI, USA Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, USA
| |
Collapse
|
24
|
Poston L, Patel N. Dietary recommendations for obese pregnant women: current questions and controversies. Acta Obstet Gynecol Scand 2014; 93:1081-4. [DOI: 10.1111/aogs.12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Lucilla Poston
- Division of Women's Health; Women's Health Academic Centre; King's College London; King's Health Partners; London UK
| | - Nashita Patel
- Division of Women's Health; Women's Health Academic Centre; King's College London; King's Health Partners; London UK
| |
Collapse
|
25
|
McGiveron A, Foster S, Pearce J, Taylor MA, McMullen S, Langley-Evans SC. Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. J Hum Nutr Diet 2014; 28 Suppl 1:29-37. [DOI: 10.1111/jhn.12240] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A. McGiveron
- Lincolnshire Community Health Services NHS Trust; Lincoln UK
| | - S. Foster
- Lincolnshire Community Health Services NHS Trust; Lincoln UK
| | - J. Pearce
- School of Biosciences; University of Nottingham; Loughborough UK
| | - M. A. Taylor
- School of Life Sciences; University of Nottingham; Nottingham UK
| | - S. McMullen
- School of Biosciences; University of Nottingham; Loughborough UK
- National Childbirth Trust; London UK
| | | |
Collapse
|
26
|
Chan-Hon-Tong A, Charles MA, Forhan A, Heude B, Sirot V. Exposure to food contaminants during pregnancy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2013; 458-460:27-35. [PMID: 23639909 DOI: 10.1016/j.scitotenv.2013.03.100] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/29/2013] [Accepted: 03/29/2013] [Indexed: 06/02/2023]
Abstract
During pregnancy, the fetus is exposed to contaminants from its mother's diet. This work provides an assessment of the dietary exposure of pregnant women to inorganic contaminants (aluminum, mercury, lead, inorganic arsenic, cobalt), polychlorodibenzodioxins, polychlorodibenzofurans, dioxin-like and non-dioxin-like polychlorobiphenyls (DL-PCBs, NDL-PCBs), polybromodiphenyl ethers (PBDEs), perfluoroalkyl acids, mycotoxins (zearalenone, patulin, trichothecenes), and heat-generated compounds (acrylamide and polycyclic aromatic hydrocarbons). Consumption data of 2002 pregnant women aged 18 to 45 from the EDEN cohort study were combined with contamination data from the second French total diet study to assess the exposure before pregnancy (n=1861) and during the third trimester of pregnancy (n=1775). Exposure was also assessed considering the season during which the third trimester of pregnancy occurred. Significant changes in consumptions during pregnancy and between seasons were associated with differences in exposures for some substances. Some contaminant exposures appeared to be of health concern. Margins of exposure to acrylamide (635 to 1094 for mean), inorganic arsenic, lead, and BDE-99 (≤100) were too low to exclude all risks. For NDL-PCBs, T-2 and HT-2 toxins, and deoxynivalenol, significant exceedings of toxicological reference values were found before pregnancy, but there was no significant exceeding in the third trimester.
Collapse
Affiliation(s)
- Anne Chan-Hon-Tong
- ANSES (French Agency for Food, Environmental, and Occupational Health and Safety), 27 avenue du Général Leclerc, F-94701 Maisons-Alfort, France
| | | | | | | | | |
Collapse
|
27
|
Poston L, Briley AL, Barr S, Bell R, Croker H, Coxon K, Essex HN, Hunt C, Hayes L, Howard LM, Khazaezadeh N, Kinnunen T, Nelson SM, Oteng-Ntim E, Robson SC, Sattar N, Seed PT, Wardle J, Sanders TAB, Sandall J. Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial. BMC Pregnancy Childbirth 2013; 13:148. [PMID: 23855708 PMCID: PMC3718630 DOI: 10.1186/1471-2393-13-148] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/07/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Complex interventions in obese pregnant women should be theoretically based, feasible and shown to demonstrate anticipated behavioural change prior to inception of large randomised controlled trials (RCTs). The aim was to determine if a) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical activity behaviours, and b) to refine the intervention protocol through process evaluation of intervention fidelity. METHODS We undertook a pilot RCT of a complex intervention in obese pregnant women, comparing routine antenatal care with an intervention to reduce dietary glycaemic load and saturated fat intake, and increase physical activity. Subjects included 183 obese pregnant women (mean BMI 36.3 kg/m2). RESULTS Compared to women in the control arm, women in the intervention arm had a significant reduction in dietary glycaemic load (33 points, 95% CI -47 to -20), (p < 0.001) and saturated fat intake (-1.6% energy, 95% CI -2.8 to -0. 3) at 28 weeks' gestation. Objectively measured physical activity did not change. Physical discomfort and sustained barriers to physical activity were common at 28 weeks' gestation. Process evaluation identified barriers to recruitment, group attendance and compliance, leading to modification of intervention delivery. CONCLUSIONS This pilot trial of a complex intervention in obese pregnant women suggests greater potential for change in dietary intake than for change in physical activity, and through process evaluation illustrates the considerable advantage of performing an exploratory trial of a complex intervention in obese pregnant women before undertaking a large RCT. TRIAL REGISTRATION TRIAL REGISTRATION NUMBER ISRCTN89971375.
Collapse
Affiliation(s)
- Lucilla Poston
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Annette L Briley
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Suzanne Barr
- Division of Diabetes and Nutritional Sciences, King’s College London and King’s Health Partners, London, UK
| | - Ruth Bell
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Helen Croker
- Epidemiology and Public Health, University College London, London, UK
| | - Kirstie Coxon
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Holly N Essex
- Department of Health Sciences, University of York, Newcastle, UK
| | - Claire Hunt
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Louise Hayes
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Louise M Howard
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Nina Khazaezadeh
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Tarja Kinnunen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Eugene Oteng-Ntim
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Naveed Sattar
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| | - Jane Wardle
- Epidemiology and Public Health, University College London, London, UK
| | - Thomas AB Sanders
- Division of Diabetes and Nutritional Sciences, King’s College London and King’s Health Partners, London, UK
| | - Jane Sandall
- Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, 10th floor, North Wing, St.Thomas’ Hospital, London SE1 7EH, UK
| |
Collapse
|