Pregnant women at risk for inadequate nutrition
Many pregnant women may not be getting adequate nutrition as advised by dietary guidelines, researchers of an Australian study found.
“Only one woman’s diet during pregnancy in the present study met the Australian Dietary Guideline recommendations for daily servings of food groups, indicating a greater need for pregnancy nutrition education, not only for pregnant women, but also the general population,” said the researchers.
Using data from the Asking Questions about Alcohol in pregnancy cohort study, researchers assessed dietary intake of 1,570 pregnant women with a singleton pregnancy (<19 weeks pregnant) who attended seven metropolitan public health hospitals in Melbourne, Australia, between July 2011 and 2012. A 74-item food frequency questionnaire was used to identify the women’s daily dietary intake which was compared with that recommended by the 2013 Australian Dietary Guidelines.
Most women were aged 30–34 years (39.9 percent), Caucasian (79.4 percent), and in their first pregnancy (47.7 percent).
Women were most likely to meet the recommendations for fruit intake (65.7 percent), followed by dairy products (55.2 percent) and meat or meat alternatives (31.1 percent). About 10 percent of women met the recommendations for vegetable intake, while just 1.8 percent met the requirements for grains. [Midwifery 2018;67:70-76]
Most women (83.8 percent) consumed up to 2.5 servings of discretionary foods (eg, soft drinks, fast food, processed meats) per day regularly, with about one in six women exceeding this intake.
Just one woman met the minimum recommended daily requirements for all five food groups, 3.5 percent of women met the minimum recommendations for four or five food groups, and 45.5 percent met the daily requirements for one or none of the food groups.
The risk of inadequate dietary intake (meeting one or no recommended daily food group serving) was more common among women who were obese (BMI ≥30 kg/m2; adjusted odds ratio [adjOR], 2.13, 95 percent confidence interval [CI], 1.53–2.95; p<0.001), while women with a university degree were less likely to have inadequate dietary intake (adjOR, 0.63, 95 percent CI, 0.50–0.78; p<0.001).
Women who were obese had a high likelihood of meeting the requirements for fruit (51.3 percent) and dairy products (49.6 percent), but a low likelihood of meeting the requirements for meat and meat alternatives (18.7 percent), vegetables (6.1 percent), and grains (0.4 percent). They also had a tendency to consume discretionary foods regularly (88.7 percent).
Not meeting the recommendations for vegetable intake may lead to gestational weight gain, while the reduced fibre intake due to low vegetable and grain intake may lead to constipation, said the researchers.
“The recommendations for pregnancy are designed to optimize maternal nutrition, provide the growing fetus with the best possible nutritional environment for growth and development in utero, and prevent adverse pregnancy outcomes. [A]n optimal fetal nutritional environment [may also] support optimal growth and development throughout childhood and adulthood,” said the researchers.
“Understanding what women in Australia eat during pregnancy can help to target healthy eating programmes that aim to positively change food choice and behaviour,” they said, suggesting morning sickness, constipation, and heartburn as potential barriers to healthy eating. Pregnant women may also not be aware of updated nutritional guidelines, while the high intake of discretionary foods may be ‘replacing’ healthier options, they said.
“[I]t would be highly advantageous for women either planning pregnancy or who are pregnant to be given nutrition education as part of routine pregnancy care,” they added.
“Given obese women … are at the most risk of undernutrition, it is important that providers assist with facilitating dietary behaviour changes that will align with dietary guideline recommendations and subsequently lead to healthier outcomes for both the mother and infant,” they said.
They acknowledged that women in this study may have been more adherent to the 2003 Guidelines which differed from the 2013 ones in terms of recommendations for fruit and meat or meat alternatives. The findings may also not be generalizable to women living in rural settings or those not proficient in English (non-English speaking women were excluded) who may have diets that differ culturally, they said.