An Investigation into the Dietary and Health Behaviours of Pregnant Women in Ireland

Maternal obesity increases the risk of metabolic complications in pregnancy such as gestational diabetes mellitus (GDM). Effective weight management following childbirth may reduce long-term metabolic risks among women of child bearing age. The aim of this study was to investigate the diet and health behaviours of pregnant and postpartum women in Ireland. Accurate dietary assessment in pregnancy is often difficult to achieve. We have shown that dietary under-reporting is more likely among pregnant women who are younger, materially deprived, obese and who have increased adiposity. These findings suggest that dietary underreporting represents a source of potential bias in obstetric obesity research. Obese pregnant women of low socioeconomic status may require more specialised dietary assessment methods. Technology increasingly dictates the way in which we collect and communicate information, highlighting the potential utility of innovative web-based dietary assessment and intervention tools. We compared dietary quality scores from a newly developed online Dietary Assessment Tool against nutrient intakes derived using the recently validated Willett Food Frequency Questionnaire. The relatively good agreement between these two dietary assessment methods suggests that our food-based dietary quality scores are reflective of important nutrient intakes in pregnancy. Nutritional manipulation based on dietary intervention does not appear to prevent GDM. Neither food group nor macronutrient intakes in the periconceptional period were associated with fasting plasma glucose (FPG) levels in our cohort of pregnant women. Obesity in early pregnancy was the main predictor of elevated FPG levels, highlighting the potential value of preconceptional weight management interventions in preventing GDM. There is a paucity of data describing maternal weight changes in the postpartum period. We found that maternal weight and body composition trajectories after pregnancy were not linear, and that they differed between women who were obese and those who were not obese in the first trimester. The role of breastfeeding in postpartum weight change is not clear. We found that postpartum changes in maternal weight and percentage body fat were not associated with infant feeding method after adjusting for important confounders such as diet and exercise. Overall, my findings commend the pre-conceptional period as an important window of opportunity in the prevention of GDM and postpartum obesity

An Analysis of Folic Acid Supplementation in Women Presenting For Antenatal Care

Background: Neural tube defects (NTDs) are major congenital malformations that are potentially preventable if the woman takes periconceptional folic acid (FA) supplements. A recent report found that NTD incidence had increased in Ireland. This study examined the usage of FA supplementation in women presenting for antenatal care in a maternity hospital

Duration of Periconceptual Folic Acid Supplementation in Women Booking for Antenatal Care

Objective: To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices. Design: Cross-sectional observational study. Women’s clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher. Setting: A large university maternity hospital, Republic of Ireland, January 2014–April 2016. Subjects: Women (n 856) recruited at their convenience in the first trimester. Results: While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44% of women who were supplementing with FA preconceptionally, 44% (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed. Conclusions: As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed

The relationship between early pregnancy dietary intakes and subsequent birthweight and neonatal adiposity

Background: Maternal nutrition intakes may influence neonatal birthweight and adiposity; however, inconsistencies within the literature exist. The relationships between maternal dietary intakes in early pregnancy and both birthweight and neonatal adiposity requires elucidation. This study examined the relationship between early pregnancy dietary intakes and subsequent birthweight and neonatal adiposity. Methods: Women were recruited at their convenience after sonographic confirmation of a singleton pregnancy. Women completed a Willet food frequency questionnaire evaluating habitual food and nutrient intakes at their first antenatal visit. Neonatal body composition was measured using air-displacement plethysmography. Results: Of the 385 mother-neonate dyads, mean maternal age was 30.8 ± 5.3 years, mean Body Mass Index (BMI) was 24.5 ± 4.8 kg/m2 and 41.8% (n = 161) were nulliparous. There were no relationships between maternal food intakes and birthweight (P \u3e 0.05) (n = 385). On multivariable analysis there was a positive relationship between polyunsaturated fat and neonatal fat mass index (FMI) (beta = 0.015, 95% CI = 0.002-0.028, P = 0.04) (n = 80). Conclusion: Dietary intakes of polyunsaturated fat in early pregnancy are positively associated with neonatal FMI at birth on multivariable analysis. Further longitudinal studies need to explore this association and the long-term implications for the neonate

The Relationship between Socioeconomic Status and Nutritional knowledge in Women during Pregnancy

Epidemiological data have shown that socioeconomic status affects nutritional knowledge and dietary quality(1). Irish national food surveys have also suggested that socioeconomic differences in food group, nutrient intakes, dietary attitudes and health behaviours exist (2,3). It is known that pregnancy can enhance a women’s nutritional awareness (4). The aim of the present study was to assess whether nutritional knowledge in pregnant women in Ireland is affected by socioeconomic status. One hundred and sixteen pregnant women aged 16–41 years (mean age of 29.5 years) were recruited at their initial antenatal booking visit (10–15 weeks gestation) at a large Dublin maternity hospital. Formal education and material deprivation were used to assess the socioeconomic status of respondents. The women were classified into three educational categories: no formal education to lower secondary education, upper secondary education and third level education. Deprivation status was assessed by determining the number of basic necessities(5) respondents had had to forego in the previous year due to lack of money, with respondents categorised into three groupings: low(none), medium(1–2) and high (3 + ). The women’s level of nutritional knowledge was assessed using a self-administered questionnaire of 12 multiple choice questions. The questions were formulated from the Best Practice for Infant Feeding in Ireland guidelines published by the Food Safety Authority of Ireland in 2012(6). The questionnaire assessed respondents’ knowledge regarding essential food groups and nutrients in pregnancy as well as lifestyle factors such as smoking and exercise. Each respondent received a score out of 12 on their nutritional knowledge questionnaire (max. = 11, min. = 1), with participants then categorised as having high (score \u3e7) or low (scor

Preferences of women for web-based nutritional information in pregnancy

Objectives During pregnancy, women are increasingly turning to web-based resources for information. This study examined the use of web-based nutritional information by women during pregnancy and explored their preferences. Study design Cross-sectional observational study. Methods Women were enrolled at their convenience from a large maternity hospital. Clinical and sociodemographic details were collected and women\u27s use of web-based resources was assessed using a detailed questionnaire. Results Of the 101 women, 41.6% were nulliparous and the mean age was 33.1 years (19–47 years). All women had internet access and only 3% did not own a smartphone. Women derived pregnancy-related nutritional information from a range of online resources, most commonly: What to Expect When You\u27re Expecting (15.1%), Babycenter (12.9%), and Eumom (9.7%). However, 24.7% reported using Google searches. There was minimal use of publically funded or academically supported resources. The features women wanted in a web-based application were recipes (88%), exercise advice (71%), personalized dietary feedback (37%), social features (35%), videos (24%) and cooking demonstrations (23%). Conclusions This survey highlights the risk that pregnant women may get nutritional information from online resources which are not evidence-based. It also identifies features that women want from a web-based nutritional resource

Use of a web-based dietary assessment tool in early pregnancy

Background Maternal diet is critical to fetal development and lifelong health outcomes. In this context, dietary quality indices in pregnancy should be explicitly underpinned by data correlating food intake patterns with nutrient intakes known to be important for gestation. Aims Our aim was to assess the correlation between dietary quality scores derived from a novel online dietary assessment tool (DAT) and nutrient intake data derived from the previously validated Willett Food Frequency Questionnaire (WFFQ). Methods 524 women completed the validated semiquantitive WFFQ and online DAT questionnaire in their first trimester. Spearman correlation and Kruskal–Wallis tests were used to test associations between energy-adjusted and energy-unadjusted nutrient intakes derived from the WFFQ, and diet and nutrition scores obtained from the DAT. Results Positive correlations were observed between respondents’ diet and nutrition scores derived from the online DAT, and their folate, vitamin B12, iron, calcium, zinc and iodine intakes/MJ of energy consumed derived from the WFFQ (all P\0.001). Negative correlations were observed between participants’ diet and nutrition scores and their total energy intake (P = 0.02), and their percentage energy from fat, saturated fat, and non-milk extrinsic sugars (NMES) (all P B 0.001). Median dietary fibre, beta carotene, folate, vitamin C and vitamin D intakes derived from the WFFQ, generally increased across quartiles of diet and nutrition score (all P\0.001). Conclusions Scores generated by this web-based DAT correlate with important nutrient intakes in pregnancy, supporting its use in estimating overall dietary quality among obstetric populations

Breast-feeding and Postpartum Maternal Weight Trajectories

We examined whether breast-feeding, and in particular exclusive breast-feeding, was associated with maternal weight and body composition changes at 4 months postpartum independently of other maternal variables

An Estimation of Periconceptional Under-reporting of Dietary Energy Intake

Background The purpose of this cross-sectional study was to examine periconceptional misreporting of energy intake (EI) using the Willet food frequency questionnaire (WFFQ). Methods Women were recruited in the first trimester. Women completed a semi-quantitative WFFQ. Maternal body composition was measured using eight-electrode bioelectrical impedance analysis. Under-reporters were those whose ratio of EI to their calculated basal metabolic rate fell below the calculated plausible threshold for their physical activity category. Results The mean age was 30.1+5.3 years (n ¼ 524). The mean body mass index (BMI) was 25.4+5.6 kg/m2 , and 16.6% were obese (BMI 30.0 kg/m2 ). Under-reported EI was observed in 122 women (23.3%) with no over-reporters in the sample. Under-reporters were younger (P , 0.001), less likely to have a normal BMI (P ¼ 0.002) and more likely to be obese (P , 0.001) than plausible reporters. Under-reporters had higher percentage of body-fat and lower percentage of body fat-free mass (P , 0.001), were more likely to be at risk of relative deprivation (P ¼ 0.001) and reported a higher percentage of EI from carbohydrate (P ¼ 0.02) than plausible reporters. Conclusions Observed differences between under-reporters and plausible reporters suggest that the exclusion of these under-reporters represents an important potential source of bias in obesity research among women in the periconceptional period

Maternal Nutrient Intakes From Food and Drinks Consumed in Early Pregnancy in Ireland

Background: The aim of this observational study was to measure food, macronutrient and micronutrient intakes of women presenting for antenatal care and assess compliance with current nutritional recommendations