Study protocol: Why pregnant women eat what they eat. Socio-ecological determinants of antenatal diet and development of an intervention tool

摘要

Background: Although the importance of maternal nutrition is evident, pregnant women - especially in lower socioeconomic status (SES) populations - do not meet nutrition guidelines sufficiently. Healthy nutrition promotion in midwifery practice is promising as antenatal diet affects both maternal and child health, pregnant women are open to dietary changes during this critical transition and midwives are their first and most important source of information. Unfortunately, nutrition communication by Dutch midwives is currently limited and focuses primarily on risks and problems. To provide nutrition advice, insight into the multiple personal, cultural and environmental factors that influence dietary intake (i.e. contextual dietary intake) is needed. Moreover, midwives need knowledge, skills and feasible tools to assess contextual dietary intake and optimize antenatal nutritional status in collaboration with dietitians. This research will contribute to the (further) development of a tool that can be used by midwives and/or dietitians to assess and optimize contextual dietary intake of pregnant women and their families. The overall goal of this project is improvement of nutritional status of low SES pregnant women in the Netherlands. Methods: To map socio-ecological determinants of dietary intake during pregnancy, literature studies will be performed as well as interviews and focus groups with pregnant women and their partners. Midwives will be interviewed to gain insight in their current knowledge, needs and practice. Recruitment will be directed at pregnant women with low SES, through midwives working in low SES areas. Data on dietary intake will be obtained by trained research dietitians using the dietary history method and used to develop a dietary tool. About 100 extra individual consultations and 20 extra Centering Pregnancy group meetings will be organised, video-recorded and qualitatively evaluated to investigate barriers and facilitating factors for using the newly developed tool/method. A realist evaluation perspective will be used to identify key combinations of contextual factors and mechanisms that trigger outcomes of interest. Dietary histories will be transcribed into food codes using the Dutch food composition database and amounts using information on standard Dutch food portion sizes. Total energy and nutrient intakes will be calculated in Compleat~? by multiplying intakes by nutrient composition using the same food composition database. Additionally, biomarker data on folate and vitamin D status will be obtained. Discussion: This study is scientifically and socially relevant as low SES pregnant women's contextual dietary intake is studied in depth from an ecological perspective on health and subsequently piloted in real-life practice. Innovatively, midwives, dietitians and pregnant women are engaged in research activities, resulting in context-sensitive usable knowledge that will increase implementation chances. The obtained results will lead to recommendations for multidisciplinary strategies to promote healthy antenatal nutrition in low SES populations.