Supporting healthy pregnancies: Examining variations in nutrition, weight management and substance abuse advice provision by prenatal care providers in Alberta, Canada. A study using the All Our Families cohort

Canadian Midwives' Experiences with Nutrition in Their Training and Practice: A Cross-Sectional Study

INTRODUCTION

Midwives are primary prenatal care providers well-positioned to offer nutrition advice to pregnant individuals; however, no Canadian study has assessed midwives' experience with nutrition education. The objective of this study was to investigate Canadian midwives' experiences with nutrition in their practice, their level of nutrition education, and their recommendations on select nutrition topics.

METHODS

This cross-sectional study used an anonymous online survey consisting of 4 sections: demographics, opinions on the importance of nutrition, nutrition recommendations for pregnancy, and nutrition topics that midwives would like more information on. Responses were recorded using Likert-type scales, multiple choice, or open-ended questions. Eligible participants, registered Canadian midwives, were recruited through advertisements in e-newsletters via national and provincial midwifery associations, social media posts, and emails to midwifery clinics. An independent samples t test compared differences in means for continuous outcomes, the χ2 test compared categorical variables, and the Mann-Whitney U test compared ordinal variables. A P < .05 was considered statistically significant.

RESULTS

In total, 161 midwives completed the online survey. Most midwives (92.5%) indicated that nutrition for pregnancy was important, and 83.2% believed their role in providing nutrition information to pregnant women was important. Almost two-thirds (63.8%) of midwives received nutrition education. Comfort levels were highest (median = 4) when providing nutrition advice on healthy eating, weight gain, Listeria, anemia, heartburn, safe food handling, nutrition for breastfeeding, and weight gain for women with obesity. Almost all the midwives (99.4%) had provided nutrition information to pregnant women, and 85.2% of their recommendations aligned with Canadian guidelines and literature.

DISCUSSION

Canadian midwives valued the importance of nutrition during pregnancy and their role in providing nutrition information to pregnant women. The level of comfort in advising on nutrition ranged from uncomfortable to very comfortable depending on the topic, and most (85.2%) of their advice aligned with Canadian guidelines and relevant literature.

Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals

The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health-promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.

Addressing the gaps in nutritional care before and during pregnancy

The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.

MAMMA MIA! Norwegian Midwives' Practices and Views About Gestational Weight Gain, Physical Activity, and Nutrition

Objectives

Most studies regarding prevalence of prenatal lifestyle counseling are based on patient report of provider advice. The aim of the present study was to describe midwives' practice and views in promoting three distinct, but importantly related lifestyle factors: gestational weight gain (GWG), regular physical activity (PA), and nutrition.

Design

A cross-sectional study.

Setting

Healthcare clinics in Oslo and Akershus County, Norway.

Participants

Clinics that expressed interest to participate provided an email list of the midwives. Of 107 midwives invited to participate, 65 completed the 15-min electronic survey (SurveyXact), giving a response rate of 60.7%.

Outcome Measures

We developed a new questionnaire based on questions and results from similar studies, as no validated questionnaires existed when we initiated this project in 2014. The final electronic questionnaire included a mix of close-ended questions, semi-close-ended questions, and 11-point Likert scales and covered demographics, personal health behaviors, counseling practice, views, and self-perceived role in lifestyle counseling.

Results

Mean workload in prenatal care was 78%, and mean years practicing was 8.9 (±7.5). Across all three health topics, most (74-95%) reported to give advice on the first meeting, with a mean frequency of 2.2 (±1.4), 2.7 (±1.8), and 2.7 (±2.0) for GWG, PA, and nutrition counseling, respectively. Approximately 40% did not report advice on GWG or give advice discordant with the Institute of Medicine (IOM) recommendations (2009) for at least one prepregnancy body mass index (BMI) category. GWG was rated as more unpleasant to talk about than PA (3.0 ± 2.8 vs. 1.1 ± 2.5, p < 0.001) and nutrition (3.0 ± 2.8 vs. 1.2 ± 2.5, p = 0.002). Also, regarding the importance of giving lifestyle advice, PA (9.6 ± 0.9 vs. 8.3 ± 2.2, p < 0.001) and nutrition (9.9 ± 0.4 vs. 8.3 ± 2.2, p < 0.001) were rated as more important than advice about GWG. Postpartum, nearly 40% gave advice about PA, whereas only two (3.1%) reported to discuss weight/weight retention (p < 0.001).

Conclusion

While most midwives gave advice on GWG, PA, and nutrition at the first meeting and rated lifestyle counseling as an important topic, the advice on GWG was often discordant with IOM recommendations, and the topic was viewed as more unpleasant to talk about than PA and nutrition.

The role of antenatal education for the prevention of excessive weight gain during pregnancy

BACKGROUND

Excessive weight gain (EWG) during pregnancy is associated to adverse maternal-fetal outcomes. The aim of this study was to analyze the situation in a single high intensity care center in Eastern Piedmont, north of Italy.

METHODS

This is a cohort study including 715 patients classified into four classes corresponding to pregestational BMI values. Based on the WHO's weight gain for each class, women were subdivided into three groups: inadequate, adequate and excessive increase.

RESULTS

EWG was significant in overweight (43.9%) and obese women (37.3%). There was a significant correlation with gestational diabetes (P=0.046), hypertension (P=0.0001), preterm birth (P=0.047), intake of antihypertensive drugs (P=0.0001), maternal study degree (P=0.005), profession (P=0.015), civil status (P=0.003), parity (P=0.039) and paternal ethnicity (P=0.027). Participation at antenatal education for childbirth (AEC) had a positive impact leading to an appropriate weight gain (P=0.004).

CONCLUSIONS

If adequately counselled, women understand the consequences of excessive weight gain during pregnancy, comply more to therapy and modify their lifestyle.

Mothers' and fathers' cognitive and affective responses to epigenetics concepts

Advances in our understanding of epigenetics present new opportunities to improve children's health through the counseling of parents about epigenetics concepts. However, it is important to first evaluate how parents respond to this type of information and determine the consequences of educating parents about epigenetics. We have taken an initial step toward this goal by assessing parental responses to an epigenetics learning module. Parents (n = 190, 126 mothers) responded to pre- and post-module survey questions. Prior to the module, parents reported that mothers' lifestyles prior to conception were more important for children's health than fathers' lifestyles prior to conception (t = 4.49, df = 316.5, P < 0.0001). However, after the module, there was no difference between ratings of the importance of mothers' and fathers' preconception lifestyles (t = 1.18, df = 319.8, P = NS). Furthermore, after viewing the module, parents increased their ratings of the importance of both mothers' (t = -5.65, df = 294.8, P < 0.0001) and father's (t = -9.01, df = 287.2, P < 0.0001) preconception lifestyles for child health. After viewing the module, most parents reported feelings of guilt and negativity regarding epigenetics (78 and 55%, respectively). When compared with lean parents, parents with overweight more often reported feelings of guilt (χ ² =10.27, P = 0.001). This work represents an important first step in evaluating parental responses to epigenetics concepts.