Eating Vegetarian for Pregnant Women (The Concise Collections)
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Informing Nutrition Care in the Antenatal Period: Pregnant Women's Experiences and Need for Support
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Selection of nutrition-related information in many cases was often swayed by the women's views and practices. The acquired inaccurate information had the potential to negatively influence the women's dietary behaviours if they acted upon it. Support for women to develop the skills to judge nutrition information is required. Being exposed to such information with limited or no skills and in the absence of any obvious guidelines from an authoritative domestic source may result in several consequences, including increased confusion and uncertainty, increased misperceptions, or a growth in trust in non-evidence-based sources.
This in turn may lead women to question evidence-based guidelines. Others have also identified that, without proper guidance, information on the Internet can be harmful, confusing, and overwhelming [ 37 ]. Women's confidence in their ability to source information varied. Women's competence in different knowledge areas also was variable, both in terms of translating advice into practical food preparation and also in being able to judge their own levels of knowledge. Misplaced confidence in their level of knowledge may impact the effectiveness of their interactions with HCPs.
In this study, women were both motivated and confident in their search for information. According to Lagan et al. This can be problematic, depending on the quality of the resources accessed. Women's increased confidence may act as a barrier to effective nutrition education strategies if the information accessed is inaccurate [ 9 ], especially if they do not have the ability or the knowledge necessary to distinguish between what was accurate and what was not.
Too much or too little information increased the risk of uncertainty and confusion and may impact the translation of women's high motivation for a healthy diet and their practices. Too much information left pregnant women feeling overwhelmed, often with most of their questions unanswered or with answers of varying or dubious value.
This may impact the amount of information that could be acted upon effectively [ 9 ]. Pregnant women's information seeking experience also was limited in terms of gaining reliable nutrition knowledge, which is consistent with other studies [ 27 , 34 ].
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Most interviewees did not discuss the information they accessed from the Internet with their HCPs, a finding which was consistent with a previous literature review [ 40 ]. This was especially the case if they felt confident in the not necessarily accurate information obtained and when their HCPs had not been initially forthcoming in providing information.
HCPs may not, therefore, be aware of women's possession of potentially inaccurate information or their mistaken beliefs about pregnancy and diet. The HCPs would be unable to re address such misinformation unless the women were comfortable about raising the matter with their HCPs and were given the time to do so, and their HCPs had time to respond adequately.
Women's experiences in relation to accessing nutrition information during pregnancy were influenced by their perceived knowledge and level of confidence in their knowledge. This model has been used in training in business settings [ 41 ] and used in medical education settings [ 42 , 43 ]. The Conscious Competence Learning Model focuses on two main aspects of individuals' thinking during the process of learning a new skill: awareness consciousness and skill level competence.
The knowledge of their ignorance or lack of skill motivates them to acquire a skill in this case relevant knowledge. Then, they begin the slow acquisition of understanding and skills, until they are able to consciously utilise these skills conscious competence. Results of this study reflected the first three stages of Burch's model. Additionally, some pregnant women misperceived their knowledge and did not recognise that they did not have the correct information. Women in this situation may even deny the need for information or its value, which may result in inaccurate conclusions and poor decision-making.
The results of this study identified that individual pregnant women may pass from one competence space to another within the same knowledge area. For example, a woman may pass from unconscious incompetence to conscious incompetence and when motivated by knowledge of her limitations may seek accurate information and then put that information into practice conscious competence. However, the outcome of learning in the stage of conscious incompetence may depend on the information women accessed and the support they received to confirm the accuracy of the information.
In this study, only a few women were identified as proceeding to the conscious competence stage. They succeeded by accessing continuous support from their dietitian or diabetic educator or by conducting formal research on a specific topic such as omega-3 fatty acids. Knowledge acquisition and implementation can be uneven and different stages can coexist in different knowledge domains in a single person. To increase the effectiveness of women's practices, HCPs require skills to identify pregnant women's levels of confidence and competence in relation to nutrition knowledge and provide information and support that matches women's needs.
Interviewees' dietary choices were often framed by pragmatic choices. For example, although women's knowledge in regard to general food safety issues was the highest compared to other nutrition-related domains [ 16 ], there was considerable confusion regarding specific details about high-risk foods. Other studies report similar findings [ 26 ]. To protect their unborn babies, some women chose to overly restrict their diet. Such restrictions may place a burden on pregnant women and needlessly deprive them of a food they prefer and one that is necessary. Unnecessary food restriction can jeopardise pregnant women's intake of particular nutrients [ 46 ].
Overconsumption is a further risk. For example, women can access nutrition messages that encourage meat consumption to improve iron intake during pregnancy but do not know the amount by which to increase their intake, thus leading to intake that exceeds the recommendations [ 9 ]. Some women find restrictions very challenging, especially when it interferes with their favourite or everyday foods and where they are unsure of the level of risk posed by particular foods. This echoes the results of previous studies that have reported the need for justification as intense and necessary for pregnant women to legitimise their eating behaviours when their deviance has called into question their ability to provide the ideal prenatal environment for their baby [ 27 , 45 ].
In most cases, women in our study did not utilise a scientific basis to justify their decisions. Although women still can enjoy their preferred foods by following safe procedures, nonrational justifications can be a concern as women might unintentionally risk their baby's health. On the other hand, a few women exhibited positive dietary changes. This was in response to accurate information that was provided by their HCPs. This emphasises the important role HCPs may play in promoting healthy eating and the importance of their accurately ascertaining and meeting women's needs.
HCPs need to improve communication skills to maximise information impact. Women identified a number of aspects which should be considered in order to improve nutrition communication strategies in antenatal care. Besides the extensively described limited support from antenatal HCPs, a lack of nutrition-related knowledge and cooking skills, time and cost constraints, and physiological factors e. Women also considered a lack of family support, friends' undesirable comments about their dietary practices, and difficulty in accessing a healthy diet including transport and geographical location among the environmental barriers to healthy eating.
The women identified several mechanisms that could improve their levels of nutrition knowledge with most relating to strengthening the role of HCPs. From this perspective, knowledge is considered to be valid and important not necessarily in its accuracy but in its relation to the particular setting [ 47 ]. However, in relation to nutrition to prevent misperceptions and deleterious outcomes, accuracy also is important.
The women interviewed preferred to get the information as soon as they knew about their pregnancy. Some would even prefer to learn about the nutrition in the preconception periods. This proposal may reflect the level of education and overrepresentation of health-related qualifications among interviewees.
Women's suggestions for improved communications involved mainly practically oriented knowledge and skills, together with some factual information to understand the relevance and importance of the information supplied. Consistent with previous studies [ 19 , 30 , 31 ], women needed further information, more time with their healthcare professional allocated for nutrition communication, and a tailored approach to care provided in an interactive environment that allowed for women's dynamic participation.
The main requested information was on general healthy eating for pregnancy in a holistic context, including GWG management, and vegetarian and other dietary plan provisions. This study identified that HCPs may need to reflect on their interactions with pregnant women, not only in terms of nutrition content and skills but also in terms of building women's confidence and competence in accessing, assessing, and applying such information. Most women also showed a desire to be directed to reliable additional support using interactive approaches via phone technology e.
This was believed to provide continuous access to reliable information to meet their immediate need. The major strength of this study is that it provides a holistic view of the process from women's involvement in gaining nutrition information to the steps they take regarding dietary change. This study explores not only the barriers and the enablers to healthy eating but also the reasons for misalignment between the high motivation and effort made to gain that knowledge and the low level of accurate knowledge as well as their ultimately poor eating behaviour.
It is this in-depth exploration of women's experience of the process of gaining information and identification of the gaps in their method of gaining information not just the gaps in the information itself that makes this study's unique contribution to the literature on this topic.
It investigated not only the influence of motivation and gaining information on women's dietary behaviour but also the influence of individual and environmental factors. This was followed by an exploration of women's perceptions of their needs for nutrition advice, support, and communication during pregnancy. Included are women's perceptions of what were negative factors in their experience of information access and also, from their perspective, what could support better experience and behavioural outcomes. Unlike many studies, information sought from pregnant women was not restricted to a single topic such as GWG or food safety or supplementation but was more general and included all aspects of nutrition and GWG.
In relation to the study method, drawing the sample from the earlier quantitative study which comprehensively investigated women's motivation, attitudes, nutrition knowledge, and dietary practice allowed us to collect in-depth information about what characterises women's dietary behaviour. Moreover, the sample was a group of women from five Australian states which allowed us to gain insight into women's experience from different states. All participating women, however, were informed previously about the study aim and this initial knowledge may have created a recruitment bias.
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The results of this study cannot be generalised due to an overrepresentation of highly motivated women who were middle-class, highly educated, English-speaking, and very interested in nutrition. Again, the majority of participants were from metropolitan or major regional centres, so the experiences of pregnant women in rural and remote areas may be underrepresented as are the experiences of less educated, working-class, non-English-speaking women. Their experiences could be explored in follow-up studies. In this article, attention been brought to the mechanism by which poor dietary behaviour can be a product of pragmatism in decision-making.
The article highlights the influence of women's unconscious incompetence and uncertainty and unattained needs on decision-making and draws attention to women's high motivation as wasted momentum when it fails to result in the acquisition of accurate knowledge and adoption of healthy eating practices. It focuses on specific factors that influence women's momentum to adopt a healthy diet. Limitations in the provision of nutrition information and support by HCPs were identified as were the potential negative ramifications, including women's increased confusion, their risk of acting on inaccurate information or failing to act, and, for a few, an increased tendency to dismiss scientific advice after accessing unsound non-evidence-based but persuasively presented information.
Nevertheless, faced with the need to feed their families, women make pragmatic decisions on dietary choices, with potentially negative consequences. The key concepts of women's confidence and competence the two not necessarily positively relate in relation to nutrition knowledge were identified. The results of the study provide valuable insights that can inform antenatal practices and contribute to better health outcomes for mothers and their babies. For most pregnant women, HCPs are at the apex of the reliability hierarchy, which implies a considerable potential for their promotion of healthy dietary behaviour among pregnant women.
Being the first and regular contact with pregnant women increases the opportunity to support women to improve their diet and provide them with necessary information. GPs, for example, have been reported to have the potential to provide nutrition information and care that will reduce risk factors and improve pregnant women's nutrition behaviour and reduce poor nutrition-related outcomes for both the women and their babies during pregnancy and subsequently. Pregnancy is a critical period for individuals with lifestyle-related chronic disease and for the vast majority of mothers and babies who have the potential to develop such diseases as they age [ 48 ].
However, to meet pregnant women's needs, HCPs should consider women's preferences and their need for nutrition advice. Even women who express confidence and superficial satisfaction must be checked on by proactively engaging in discussion to address nutrition misperceptions that might otherwise go undetected. This study indicates that women are motivated, do value their nutrition during pregnancy, and seek nutrition-related information.
They identified a number of barriers and enablers to enhance their experience in gaining such information. Clearly, HCPs have an important role to play in supporting pregnant women and enhancing nutrition care during pregnancy. Further studies are needed to investigate HCPs' views about how they could address women's needs and enhance nutrition care provided to pregnant women.
These could be supplemented by research into educational interventions for women as well as the design, content, and timing of nutrition information provided for, as this research has shown, it is not simply a matter of information alone but of when you provide it and how you provide it. It must respond to each woman's needs across pregnancy.
National Center for Biotechnology Information , U. Journal List Biomed Res Int v. Biomed Res Int. Published online Aug Author information Article notes Copyright and License information Disclaimer. Received Apr 3; Accepted Jun This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract This study aimed to provide insights into Australian women's experiences in gaining nutrition information during pregnancy.
Introduction Poor nutrition has the potential to negatively impact mothers' and babies' health, contributing to poor maternal and infant outcomes. Methods 2. Sampling The 88 pregnant women who had completed the nutrition knowledge survey in an earlier cross-sectional online study and agreed to be contacted to take part in this study were invited to participate via invitation emails and a follow-up phone call. Data Collection All women were interviewed individually by the primary investigator using a semistructured interview guide Table 1.
Table 1 Summary of key questions used as interview guide. How do you think it could be improved? In person? SMS messages? Open in a separate window. Data Analysis All interviews were audio-recorded and transcribed verbatim. Findings 3. Participants A summary of interviewees' characteristics is presented in Table 2. Table 2 Participants' characteristics. Women's Experiences of Gaining Nutrition Information For most women interviewed, the health of their babies and themselves had a high priority. Sources of Nutrition Information Most of the pregnant women reported they had received some level of nutrition advice during their antenatal care, which varied in terms of topics, format, clarity, and adequacy.
Sophia The women constantly looked for more comprehensive and practical information using other resources. Amelia At different stages of pregnancy either at pregnancy confirmation or during antenatal appointments , HCPs often handed out pamphlets, brochures, and booklets published by government bodies but without any discussion with the women. Ava Some women reported that they had initiated conversations about nutrition-related topics but their HCPs appeared unconcerned. Allison As part of antenatal care at the study sites public hospitals , women saw a number of HCPs, usually not the same one at each visit, each of whom had different interests and views about maternal nutrition issues.
Emily In addition, some women complained about receiving inaccurate and impractical advice that did not take into consideration their specific food preferences often ethically or religiously based. Zoe In spite of the identified limitations in HCP-provided nutrition advice, more than half of the participants stated that they were generally satisfied with the information they received. Popular Media Acknowledging the importance of healthy food for the baby and accepting responsibility for obtaining the desired information, more than three-quarters of participants actively sought information from different sources, often in response to unmet needs.
Amelia On the other hand, some women expressed some concern about the Internet as they found some information inaccurate, inconsistent, not culturally relevant e. Emily Other participants had been exposed to international dietary practices and were confused by variation in dietary advice between countries. Zoe Primiparous women were more involved in the process of information seeking and used books more often than multiparous women.
Allison The perception of the trustworthiness of the information women found on the Internet or in published resources books, magazines was affected by how they assessed the information. Amelia Only one in four women compared the Internet-sourced information from nongovernment sites against information on government websites.
Emma Larger, well-known, and most frequented websites were also trusted by about one-quarter of interviewees. Social Network Friends and Family Members Using family and friends as a resource was considered the least reliable and was least frequently relied upon. Madison Some participants expressed a concern about being overwhelmed by the amount and the different sources of information being accessed, which made it hard to use information. Women's Responses to Nutrition Information Participants reported that they were eager to not cause any harm to their unborn babies and to nourish them well.
Olivia When women had accessed reliable information sources, a positive result was evident and they expressed confidence in their knowledge and capability of making a sound decision and taking appropriate action. Olivia Another interviewee knew that she did not know how to manage her GWG and at the same time enjoy healthy food. Mia Women who actively sought information from different sources could become confused in terms of their knowledge but subsequently were pragmatic in making decisions about their dietary intake because they still needed to eat and feed their family.
Barriers to Applying Knowledge A number of factors, environmental and individual, were identified by participants as barriers to the application of knowledge. Aubrey Common individual barriers to healthy diets pertained to a lack of nutrition knowledge and cooking skills and time and cost constraints. Olivia Time was a major constraint for full-time working women and women with family commitments. Women's Perceptions of Their Needs for Nutrition Information and Appropriate Support and Nutrition Care Most participants believed that knowing about nutrition was important and they had a desire to nourish and protect their unborn babies.
Cara Other specific information requests related to an optimal vegetarian diet during pregnancy, omega-3 fatty acids and safe fish options, including dispelling the conflicting messages about the type and amount of fish able to be safely eaten. Olivia Pregnant women particularly wished that their HCPs would be more proactive and forthcoming in providing them with nutrition-related advice.
Josie The interviewees suggested that their HCPs could provide them with information that was related to women's more frequently asked questions or direct them to other reputable information sources. Sophia A number of interviewees indicated a specific interest in linking advice on healthy eating to more information about recommended GWG and some practical ideas on how to combat excess weight gain and cravings.
Abigail For many women, confusion about high-risk foods needed to be dispelled and risks very clearly spelt out. Aubrey Most interviewees indicated that they were often very busy with either full-time employment or family commitments and, hence, they showed a strong preference for receiving simple, easy-to-understand. Charlotte Time for providing nutrition information and that information's timeliness were identified as important.
Emily The concept of written materials was not rejected but the content and language would need to be carefully gauged. One interviewee suggested the following: …some kind of phone service that you could ring up for some information that would be, that would be good. Abigail A few interviewees were interested in receiving practical lessons to develop their skills in healthy food shopping.
Discussion This study is the first of its kind in Australia. Figure 1. Figure 2. Observed women's perceived knowledge per Conscious Competence Learning Model. Strengths and Limitations The major strength of this study is that it provides a holistic view of the process from women's involvement in gaining nutrition information to the steps they take regarding dietary change.
Conclusion In this article, attention been brought to the mechanism by which poor dietary behaviour can be a product of pragmatism in decision-making. Suggestions for Further Research This study indicates that women are motivated, do value their nutrition during pregnancy, and seek nutrition-related information. Conflicts of Interest The authors declare that they have no conflicts of interest.
References 1. Renault K. Intake of sweets, snacks and soft drinks predicts weight gain in obese pregnant women: detailed analysis of the results of a randomised controlled trial.
Langford A. Does gestational weight gain affect the risk of adverse maternal and infant outcomes in overweight women? Maternal and Child Health Journal. Rasmussen K. Institute of Medicine. Langley-Evans S. Nutrition in early life and the programming of adult disease: a review.
Journal of Human Nutrition and Dietetics. During the first six months of breastfeeding, you need calories more than you did before you became pregnant. This drops to additional calories during the second six months of breastfeeding.
T. Colin Campbell, PhD
Protein needs are the same as during the second and third trimesters of pregnancy. Food for Life classes teach you how to improve your health with a plant-based diet. Find a Class. Calorie Needs Calorie needs increase only modestly during pregnancy. Nutrient Needs During pregnancy, your nutrient needs increase. Protein Pregnant women should aim for about 70 grams of protein per day during the second and third trimesters. Calcium Include plenty of calcium-rich plant-based foods in your diet, like tofu, dark green leafy vegetables, beans, figs, sunflower seeds, tahini, almond butter, and calcium-fortified soy milk, cereals, and juices.
Vitamin D The natural source of vitamin D is sunlight. Iron Iron is abundant in plant-based diets. Breastfeeding The guidelines for breastfeeding mothers are similar to those for pregnant women. Fish intake during pregnancy increases risk for childhood obesity.