Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives' perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) "If they eat healthily it will bring their weight down": Midwives Misunderstood; (b) "I don't think we are experienced enough": Midwives Lack Resources and Expertise; and (c) "BMI of 32 wouldn't bother me": Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives.

Background: Optimum nutrition and gestational weight gain (GWG) are vital for successful pregnancy outcomes. Despite this, pregnant women often describe poor information regarding referral to support services and/or a perception that the intervention will not meet their needs; hence, many support services report poor attendance and engagement (1) . 'Patient and Public Involvement' (PPI) aims to empower those most affected by an intervention, to play a part in shaping the intervention (2, 3) . The aim of this study was to conduct PPI to gain insight into the experiences of healthy eating and GWG advice received during pregnancy with the purpose of using these findings to inform future interventions. Methods: We recruited two PPI representatives (former service users), who assisted in all aspects of the study: the design, interview questions, the recruitment of other PPI members and collection/analysis of feedback. As a PPI study, exempt from ethical approval, the PLRs approached pregnant/postnatal women to participate. As part of the PPI workshop procedure, women gave verbal consent for their views and possible verbatim quotes to be used in publications or grant applications. Feedback was collected via notetaking during four group discussions (approximately 1 hour in duration), all held in community locations -two in Liverpool (n = 10 & 5), two in Derry (n = 7 & 9) and an interview (n = 1, in Derry). The research team collated the transcripts and subjected them to repeated reading. Data were subjected to thematic analysis, informed by Braun and Clarke's step-by-step guide (4) to explore the patterned meaning across the data. The authors discussed the analysis to aid triangulation, ensure quality and this process identified three themes. Results: The three main themes were as follows: 1) Weight gain is inevitable in pregnancy; 2) Healthy eating advice is important but currently lacks consistency and depth; and 3) Expectations regarding the type of knowledge/support. Women described advice received as 'minimal' and only at the booking-in appointment. Many were advised not to 'eat for two', but consultations mainly focused on food safety and foods to avoid as opposed to positive messages about what they should be eating: UK NHS health care: a systematic review.

What is already known about the subjectMaternal obesity is a risk factor for adverse maternal and foetal perinatal outcomes.The Institute of Medicine gives recommendations for weight gain during pregnancy based on initial body mass index (BMI) category, but the effects of these weight changes on pregnancy outcomes has not been adequately described. What this study adds: This study supports an association between gestational weight gain and adverse outcomes in obese pregnant women. Older and primiparous women in the cohort had the highest rates of weight gain, while socioeconomic deprivation did not influence weight changes. Women were recruited into the study at their antenatal booking visit and had weights measured throughout pregnancy. Patterns of weight gain were described and related to maternal and neonatal outcomes.Main outcome measure: The primary outcome was a composite measure consisting of any of twelve adverse maternal and fetal outcomes. This was compared by categorised pregnancy weight gain (<0 kg, 0-5 kg, 5.1-9 kg and >9 kg). patterns of weight gain varied widely and missing data was common and non-random.There was a significant association between increased weight gain during pregnancy and poor maternal and fetal outcome.Conclusions: Weight gain in obese women during pregnancy can be highly variable. Our study supports an association between increased weight gain in pregnancy and adverse perinatal outcomes.

Good maternal nutrition is key to optimal maternal and foetal health. A poor-quality diet is often associated with obesity, and the prevalence and severity of maternal obesity has increased significantly in recent years. This study observed dietary intakes in pregnant women living with obesity and assessed the quality of their diet. In total, 140 women with a singleton pregnancy, aged > 18 years and BMI ≥ 35 kg/m2, were recruited from antenatal clinics, weighed and completed food diaries at 16-, 28- and 36-weeks’ gestation. Clinical data were recorded directly from the women’s medical records. Nutrient intake was determined using ‘MicrodietTM’, then compared to Dietary Reference Values (DRVs). Energy intakes were comparable with DRVs, but intakes of sugar and saturated fatty acids were significantly higher. Intake of fibre and several key micronutrients (Iron, Iodine, Folate and Vitamin D) were significantly low. Several adverse obstetric outcomes were higher than the general obstetric population. Women with obesity, often considered ‘over nourished’, may have diets deficient in essential micronutrients, often associated with poor obstetric outcomes. To address the intergenerational transmission of poor health via poor diets warrants a multi-disciplinary approach focusing away from ‘dieting’ onto positive messages, emphasising key nutrients required for good maternal and foetal health.

Nutrition and the use of multivitamin and mineral supplements during pregnancy and lactation http://researchonline.ljmu.ac.uk/4016/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. A pregnant women's dietary can have profound effects on pregnancy outcomes and adult disease risk in offspring. This is particularly so of some vulnerable groups of pregnant women including adolescents, vegetarians and vegan, underweight women, obese women and women who have undergone bariatric surgery. These groups present nutritional challenges and require additional supervision during pregnancy. This paper discusses the effects of dietary supplements in relation to the specific needs of the aforementioned groups in comparison to the needs of the general pregnant population.