Re‐evaluating the nutritional awareness, knowledge and eating behaviours of women attending a tertiary maternity hospital following iterative service redesign

Abstract

Aim Since the opening of the new Mater Mothers' Hospital in 2008, innovative initiatives were developed, implemented and evaluated to meet women's nutritional needs. This study evaluated changes in women's nutritional awareness, knowledge and behaviours and compared these data with our baseline survey. Methods During 2014–2017, 421 postnatal women were surveyed across nine survey periods. Results were compared with those from our 2008 survey (n = 102). Surveys assessed nutrition knowledge, attitudes, behaviour, education preferences, and dietetic service awareness and were distributed on meal trays. Results A greater proportion of women accessed the nutrition services in 2014–2017 compared with 2008 (19.7% vs 9.9%) and rated the resources favourably (≥3.5 out of 5). A similar proportion rated the importance of eating well postnatally (83.1% vs 92.1%) and returning to their pre‐pregnancy weight (62.4% vs 68.3%) as important/very important. In both periods, women had poor diet quality, despite identifying healthy eating as a high priority. A reduction in median gestational weight gain (GWG) approached significance, 13.0 kg (2014–2017) versus 14.0 kg (2008), P = 0.055. There was a significant association between GWG and cohort with an increase in the proportion of women gaining within their correct guidelines (by 15.4%), a reduction of excessive gain (by 24.7%, P < 0.001) over time. Conclusions Evidence‐based service changes made since 2008 have effected positive change in women's GWG, service preferences, and access. However, women still require awareness‐raising and behaviour change programs to improve diet quality and GWG to ensure optimal pregnancy outcomes.

Influence of dietary intake and decision‐making during pregnancy on birth outcomes

“…Significant positive associations were evident between health factor scores, maternal age and education. Analysis suggests that women of the cohort were more motivated to make healthy dietary choices with advancing age and increasing education, conclusions supported by contemporary research in a comparative population . As such this data may indicate the presence of a nutrition literacy deficit in young women of this cohort, particularly those who have not undertaken a tertiary education .…”

“…Analysis suggests that women of the cohort were more motivated to make healthy dietary choices with advancing age and increasing education, conclusions supported by contemporary research in a comparative population . As such this data may indicate the presence of a nutrition literacy deficit in young women of this cohort, particularly those who have not undertaken a tertiary education . Appropriate dietetic interventions in these women have the potential to influence the development of life‐long dietary behaviours for both themselves and their children …”

Implementation of gestational weight gain guidelines - what’s more effective for ensuring weight recording in pregnancy?

“…Despite the absence of data to compare GWG across the three cohorts, we are able to draw on self-reported data from a smaller population from the same study period to provide a proxy measure of the interventions’ effectiveness [25]. In this paper examining women’s service engagement, health behaviours and GWG across 2014–17 (n421) with a cohort of women surveyed at the opening of the MMH in 2008 (n102) we were able to demonstrate that the proportion of women experiencing correct GWG increased from 23.2 to 38.6% (with excessive GWG decreasing from 57.3 to 32.6%), p < 0.001 [25]. We noted the significant increase in women gaining weight within the recommended IOM guideline ranges was a very promising outcome which was lower than many recent studies that used similar methodologies (E.g.…”

“…38% [26], 39% [27], 42% [28], 47% [4], and 52% [29]). Furthermore, we demonstrated that a greater proportion of women accessed the nutrition services in 2014–17 compared with 2008 (19.7% vs 9.9%) and rated nutrition resources provided and/or viewed favourably (> 3.5 out of 5) [25].…”

Overview of a new eHealth intervention to promote healthy eating and exercise in pregnancy: Initial user responses and acceptability

“…The evidence suggests that many pregnant women have limited knowledge of healthy diet and required physical activity in pregnancy ( de Jersey et al, 2013 ; Wilkinson et al, 2018 ). This is a serious concern as more than half of all women, in developed countries, gain excess weight in pregnancy ( Goldstein et al, 2018 ) and excessive weight gain is linked a number of adverse pregnancy outcomes such as gestational diabetes ( Barton et al, 2015 ; Goldstein et al, 2017 ), pregnancy related hypertension ( Macdonald-Wallis et al, 2013 ) and macrosomia (excessive infant size) ( Heery et al, 2013 ), which predisposes to childhood obesity.…”