Nutrition Choices for Pregnant Women Fail to Meet Recommendations
One of the keys to a healthy pregnancy is good nutrition. What pregnant women eat during pregnancy can affect not only their own health, but also the risk of undesirable birth outcomes and the health of the fetus. In general, nutrition guidelines include specific recommendations for pregnant women to ensure that they receive adequate energy, protein, fat and micronutrients during pregnancy to support both themselves and their offspring, and also to avoid foods that carry specific health risks. For example, in the US, recommendations are greater during the duration of pregnancy for carbohydrates, dietary fiber, protein, choline, folate, niacin, vitamins B1, B2, B5, B12, iodine, iron, magnesium and zinc, compared to women of childbearing age who are not pregnant.
The best way to meet these requirements is to follow recommendations for a healthy diet. But how well do pregnant women’s diets really meet recommendations? Recently, Morton and colleagues looked at the diets of 5600 pregnant women living in New Zealand to see how healthy they were. Women mostly in the third trimester of pregnancy were administered a Food Frequency Questionnaire about their normal food consumption. Their normal food intakes were matched to Australian and New Zealand Ministry of Health daily dietary guidelines:
* 6 servings of fruit and vegetables
* 6 servings of whole grain cereal products
* 3 servings of low-fat dairy products
* 2 servings of lean meat, meat alternatives or eggs
The results show that most pregnant women fail to meet all the recommendations, and a small proportion do not meet any of the recommendations. For example, 30% of pregnant women consume one serving of vegetables or less per day, and 20% consume one serving of fruit or less per day. While 20% of women consume 6 or more servings of whole grain cereal products, 24% do not consume any servings of whole grain cereal products (they consume non-whole grain cereal). 20% of women consume 3 servings of dairy, but 48% of women consume no low fat dairy (they consume full-fat products). 30% of women consume less than one serving of lean meat or meat alternatives. All in all, only 3% met all guidelines, and 24% did not meet any of the guidelines.
The authors also report that 20% of women consume confectionary once or twice per day, and other foods that should be consumed in limited quantities such as French fries, processed meats, soft drinks, and crisps are consumed by at least 5% of pregnant women more than 5 times per week. Particular foods should also be avoided by pregnant women, such as raw or smoked fish and seafood, ham and other cold cuts, non-pasteurized soft cheeses, and paté. Although 87% of women avoided foods from at least one of these categories, less than half of pregnant women avoided food from any one category: only 17% of women avoided sushi, only 35% avoided ham and cold cuts, and only 31% avoided soft cheeses.
These results are echoed in studies around the world. For example, Fowler and co-workers conducted a similar study in pregnant Canadian women and found that similar percentages failed to meet dietary recommendations. George and associates report that the majority of low-income pregnant US women fail to meet recommendations. Pregnant women living in societies undergoing nutrition transition, such as in the southern Bedouin of Israel, were found to be both at risk of low intake of important micronutrients and greater risk of obesity resulting from their food choices, according to Abu-Saad et al. And in nearby Australia, Blumfield and colleagues report that no pregnant women met national guidelines for healthy eating in their analysis of the diets of Australian women.
It is clear that pregnant women’s diets need to improve. The lack of adherence to nutrition guidelines for certain food groups increases risk of deficiency. For example, low intakes of whole grain cereals affects intakes of vitamins such as folate, and low fiber intakes mean that women may be at risk of uncomfortable yet common conditions in pregnancy such as constipation. Low intakes of meat and alternatives compromise protein, niacin, vitamins B2, B5, B12, iron and zinc intakes, while low antioxidant intakes arising from low fruit and vegetable consumption could place women at a higher risk of pre-eclampsia. In addition, consumption of energy-dense foods increase risk of obesity and complications such as gestational diabetes. Nutrition professionals working with or for pregnant women need to ensure that women are given the knowledge and skills to improve nutrient intakes in this group at nutritional risk. Clearly something is not working here.
Susan MB Morton, Cameron C Grant, Clare R Wall, Polly E Atatoan Carr, Dinusha K Bandara, Johanna M Schmidt, Vivienne Ivory, Hazel M Inskip, Carlos A Camargo Jr. Adherence to nutritional guidelines in pregnancy: evidence from the Growing Up in New Zealand birth cohort study. Public Health Nutrition. FirstView April 9, 2014. http://dx.doi.org/10.1017/S1368980014000482
Abu-Saad K, Shahar DR, Fraser D, Vardi H, Friger M, Bolotin A, Freedman LS. Adequacy of usual dietary intake and nutritional status among pregnant women in the context of nutrition transition: the DEPOSIT Study. Br J Nutr. 2012 Nov 28;108(10):1874-83. http://www.ncbi.nlm.nih.gov/pubmed/22264559
Blumfield ML, Hure AJ, Macdonald-Wicks LK, Patterson AJ, Smith R, Collins CE. Disparities exist between National food group recommendations and the dietary intakes of women. BMC Womens Health. 2011 Aug 8;11:37. http://www.ncbi.nlm.nih.gov/pubmed/21819627
Fowler JK, Evers SE, Campbell MK. Inadequate dietary intakes among pregnant women. Can J Diet Pract Res. 2012 Summer;73(2):72-7. http://www.ncbi.nlm.nih.gov/pubmed/22668840
George GC, Hanss-Nuss H, Milani TJ, Freeland-Graves JH. Food choices of low-income women during pregnancy and postpartum. J Am Diet Assoc. 2005 Jun;105(6):899-907. http://www.ncbi.nlm.nih.gov/pubmed/15942539