Lenka Malek

Adherence to the Australian dietary guidelines during pregnancy: evidence from a national study

OBJECTIVE To assess dietary intake of pregnant women against the Australian Dietary Guidelines with respect to the Five Food Group recommendations and determine predictors of adherence to the recommendations. DESIGN Cross-sectional web-based survey. Data were analysed using descriptive statistics and logistic regression. SETTING Pregnant women living in Australia. A national sample was recruited using an online panel provider and a South Australian sample was recruited through the antenatal clinic of a large public maternity hospital. SUBJECTS A total of 857 pregnant women. RESULTS Fifty-six per cent, 29% and less than 10% of women met the recommendations for the fruit, dairy and other core food groups, respectively. None of the women met the recommendations for all Five Food Groups. Women who were born overseas and who were less physically active pre-pregnancy were less likely to adhere to the fruit and dairy recommendations. Women who smoked during pregnancy, were overweight pre-pregnancy and had lower household incomes were also less likely to meet the fruit recommendations; and women living in metropolitan areas were less likely to meet the vegetable recommendations. Sixty-one per cent believed their diet during this pregnancy was healthy. CONCLUSIONS The majority of pregnant women in Australia perceive their diets to be healthy yet they do not consume the recommended daily servings from the Five Food Groups. Intervention strategies are warranted, particularly those that increase womens ability to evaluate their diet and also encourage positive dietary changes. These strategies may increase adoption of dietary guidelines and optimise pregnancy and other long-term health outcomes.

Poor adherence to folic acid and iodine supplement recommendations in preconception and pregnancy: a cross-sectional analysis

Objective: To determine pregnant womens knowledge of and adherence to the recommendations for periconceptional folic acid supplementation (PFS) and iodine supplementation (IS). Secondary objectives include determining predictors of adherence, and identifying influential nutrition information sources.

Understanding Drivers of Dietary Behavior before and during Pregnancy in Industrialized Countries

A comprehensive understanding of the factors influencing womens dietary choices is central to motivating positive dietary behavior before, during and after pregnancy. Findings are synthesized from 34 studies which assessed modifiable individual and environmental factors influencing dietary behavior during preconception and pregnancy. Influencing factors included: perceptions regarding benefits, risks and need; psychological factors; self-efficacy and control beliefs; nutrition knowledge; financial constraints; social environment and perceived social pressure; healthcare providers (HCPs), and the food environment. Studies consistently found that the key factors influencing positive dietary behavior were womens desire to optimize maternal and fetal health and advice received from HCPs. HCPs are in a unique position to encourage healthier choices at a time when women are strongly motivated to make positive change. Therefore, strategies targeting the education of HCPs to ensure they have the knowledge and resources to support women to act on evidence-based dietary recommendations are of key importance. Other strategies include: using persuasive communication methods to aid in educating and influencing young women and the wider community; providing pregnant women with automated daily feedback regarding their adherence with dietary recommendations, and changing the food environment to make healthy choices easier. A collaborative, multidisciplinary approach is required to further develop, test and implement the suggested strategies which have the potential to improve maternal and child nutrition beyond the immediate prenatal period.

The Assessment of Diet Quality and Its Effects on Health Outcomes Pre-pregnancy and during Pregnancy

Overweight and obesity pre pregnancy or during pregnancy is associated with an increased risk for maternal obstetric and fetal complications. Diet is one modifiable risk factor that women may be motivated to improve. General healthy eating guidelines, micronutrient sufficiency and macronutrient quantity and quality are important nutrition considerations pre and during pregnancy. With regards to specific nutrients, health authorities have recommendations for folate and/or iodine supplementation; but not consistently for iron and omega-3 despite evidence for their association with health outcomes. There are modest additional requirements for energy and protein, but not fat or carbohydrate, in mid-late pregnancy. Diet indices and dietary pattern analysis are additional tools or methodologies used to assess diet quality. These tools have been used to determine dietary intakes and patterns and their association with pregnancy complications and birth outcomes pre or during pregnancy. Women who may unnecessarily resist foods due to fear of food contamination from listeriosis and methylmercury may limit their diet quality and a balanced approached is required. Dietary intake may also vary according to certain population characteristics. Additional support for women who are younger, less educated, overweight and obese, from socially disadvantaged areas, smokers and those who unnecessarily avoid healthy foods, is required to achieve a higher quality diet and optimal lifestyle peri conception.

Predicting healthy eating intention and adherence to dietary recommendations during pregnancy in Australia using the Theory of Planned Behaviour

This study aims to aid in the development of more effective healthy eating intervention strategies for pregnant women by understanding the relationship between healthy eating intention and actual eating behaviour. Specifically, the study explored whether Theory of Planned Behaviour (TPB) constructs [attitude, subjective-norm, perceived-behavioural-control (PBC)] and additional psychosocial variables (perceived stress, health value and self-identity as a healthy eater) are useful in explaining variance in womens 1) intentions to consume a healthy diet during pregnancy and 2) food consumption behaviour (e.g. adherence to food group recommendations) during pregnancy. A cross-sectional sample of 455 Australian pregnant women completed a TPB questionnaire as part of a larger comprehensive web-based nutrition questionnaire. Womens perceived stress, health value and self-identity as a healthy eater were also measured. Dietary intake was assessed using six-items based on the 2013 Australian Dietary Guidelines. Hierarchical multiple linear regression models were estimated (significance level <0.05), which explained 70% of the variance in healthy eating intention scores and 12% of the variance in adherence to food group recommendations. TPB constructs explained 66% of the total variance in healthy eating intention. Significant predictors of stronger healthy eating intention were greater PBC and subjective norm, followed by positive attitude and stronger self-identity as a healthy eater. Conversely, TPB constructs collectively explained only 3.4% of total variance in adherence to food group recommendations. These findings reveal that the TPB framework explains considerable variance in healthy eating intention during pregnancy, but explains little variance in actual food consumption behaviour. Further research is required to understand this weak relationship between healthy eating intention and behaviour during pregnancy. Alternative behavioural frameworks, particularly those that account for the automatic nature of most dietary choices, should also be considered.

Segmentation of Australian meat consumers on the basis of attitudes regarding farm animal welfare and the environmental impact of meat production

While public concern over the welfare of farm animals is believed to have intensified across Australia in recent years, no empirical research has sought to examine and quantify the heterogeneity in farm animal-welfare (FAW) concerns among Australian meat consumers. The present study is the first to address this knowledge gap. Data were collected in 2015 by using a comprehensive online survey instrument completed by a representative sample of 1009 Australian meat consumers. Sample quotas were set for age, gender and location. Using these data, we were able to segment meat consumers according to their attitudes towards FAW and perceptions regarding the environmental impact of meat production. Six unique segments were identified and characterised by purchase behaviour, livestock-management knowledge, farming background and experience, beliefs regarding the consumer/farmer implications of improved FAW, influential information sources, participation in FAW-related activities and socio-demographic variables. Our findings showed that the majority of Australian meat consumers (70%) hold neutral views regarding FAW. However, there are two segments, termed ‘concerned-FAW’ (10%) and ‘anti-FAW’ (20%), which expressed strong views with respect to FAW. Overall, consumer knowledge regarding livestock-management practices was low across all segments, with only 11–42% of consumers indicating that they felt sufficiently informed about FAW. This insight into perceptions of FAW by different segments and the impact of meat production on the environment can assist the industry in developing targeted information campaigns to address consumer concerns and allow better-informed meat purchase decisions.

2.8 Nutrition in Pregnancy and Lactation

• Appropriate gestational weight gain is determined by the pre-pregnancy body mass index • Most nutritional requirements of most pregnant and lactating women can be met by consuming a variety of foods according to government-endorsed guidelines • There are almost universal recommendations for periconceptional folic acid supplementation to prevent neural tube defects. Supplementation with iodine during pregnancy and lactation, and with iron during pregnancy, is also recommended in different countries. Additional nutrient supplementation may be required for vegetarians, women having multifetal pregnancies and women diagnosed with deficiencies • High-listeria-risk foods and alcohol should be avoided during pregnancy, and caffeine intake should be limited