ItPrePlate: Developing the Italian Pregnancy Plate, a Healthy Eating Tool for Italian Pregnant Women

INTRODUCTION: Quality and balanced diet becomes very crucial to the health of woman during and after pregnancy. Therefore, the study was focused on the nutritional behaviour and dietary pattern of women during pregnancy.
 MATERIALS AND METHODS: Cluster random sampling was adopted. Total 336 pregnant women were selected, out of which 224 were pregnant women (cases) and 112 were non-pregnant healthy women (controls). Maternal demographics information was collected by a structured questionnaire. Data was entered into MS Excel and analyzed using SPSS version 20. Chi-square test was used. The p-value (p< 0.05) was considered statistically significant.
 RESULTS: Among pregnant women, 27.23%, 32.58%, 30.95% and 9.82% women consumed meat daily, twice per week, once per week and none respectively while among non-pregnant women the consumption of meat was 25.89%, 50.89%, 17.85% and 5.35% respectively. The association of consuming meat twice per week and fish among pregnant and non-pregnant women was noted statistically significant (p=0.005). More number of study participants drank tea and milk daily. The co-relation between pregnant and non-pregnant women regarding drinking (tea and milk) daily was statistically insignificant (p=0.881 and p=0.122) respectively. However, the relation between pregnant and non-pregnant women for intake of juice was statistically significant (p=0.007).
 CONCLUSIONS: Thus, the findings of this research suggest the need for a balanced nutritional diet among Nepalese pregnant women for proper foetal growth, good health of pregnant women and to avoid complications during pregnancy. Nutrition education programs in the community should be launched.

Care of Women with Obesity in Pregnancy

Background During pregnancy, the maternal immune system plays a central role in maintaining health and preventing disease. Attaining a healthy daily diet contributes to adequate immune fitness, maintaining health, and preventing disease. This pilot study evaluated the relatively underexplored relationships between the stage of pregnancy, immune fitness and the dietary patterns of pregnant women. Methods An online survey was conducted among n = 20 pregnant Turkish women. They reported the number of weeks that they were pregnant and completed the single-item Healthy Diet Scale (HDS) to determine to what extent they considered their daily diet to be healthy. Immune fitness was assessed with a single-item scale ranging from 0 (very poor) to 10 (excellent). Spearman’s correlations (including bootstrapping to account for the small sample size) were computed between weeks pregnant, daily diet scores, and immune fitness. Results A significant negative correlation was found between weeks pregnant and immune fitness ( r = −0.449, p = .047), and a significant negative correlation was also found between weeks pregnant and the percentage of daily diet considered healthy ( r = −0.642, p = .002). A significant positive correlation was found between immune fitness and the percentage of the daily diet considered healthy ( r = 0.622, p = .003). Discussion With progressing pregnancy, poorer immune fitness and a shift towards a less healthy diet were reported. The data suggest that attaining a healthy diet significantly contributes to maintaining adequate immune fitness, which is of particular importance to pregnant women. Future studies in larger cohorts should confirm these findings.

Introduction: Iodine deficiency during pregnancy can cause hypothyroidism and goiter; in schoolchildren, it can cause reduced intelligence quotient. In excess, iodine can cause thyroiditis, goiter, and Hashimoto's hypothyroidism. Currently, schoolchildren and pregnant women are classified as risk groups for excessive iodine intake and iodine deficiency, respectively. Thus, determining iodine from all sources of consumption is important for intervention planning.Objective: To construct a theoretical model for the iodine intake of schoolchildren and pregnant women of a city in the Zona da Mata Mineira region, considering a healthy diet, salt consumption and water intake.Methodology: The dietary iodine intake of pregnant women was analyzed based on a dietary iodine table compiled from an international database. A dietary plan was prepared following the Brazilian Food Guide. Iodine concentration of different salt brands sold in local establishments was checked, and drinking water samples from healthcare facilities were analyzed. A descriptive and exploratory statistical analysis was performed and the results were presented in absolute and relative frequencies, and measures of central tendency and dispersion.Results: According to the proposed diet, pregnant women and schoolchildren would have a daily intake of 71.6 μg and 71 μg, respectively. Thirteen salt brands were evaluated, 69.2% complied with the legislation and the mean iodine content was 29.88 mg. The mean concentration of iodine in water was 25 μg iodine/liter and 14 μg iodine/liter, respectively, in summer and autumn. Considering the intake of food, salt, and drinking water according to the proposed dietary plan, the daily intake for pregnant women would be 279.5 and 253.5 μg for schoolchildren.Conclusion: The daily iodine intake of schoolchildren and pregnant women according to this theoretical model was excessive, considering a healthy dietary pattern. This theoretical model can guide actions and public policies aimed at targeting all forms of iodine intake.

BackgroundA healthy dietary intake during pregnancy is important for maternal and child health. However, pregnant women with a low socio-economic status often fail to meet dietary guidelines and requirements for healthy nutrition. Dietitians may play an important role in providing nutritional advice during pregnancy because midwives often experience a lack of nutritional knowledge, time and skills to provide adequate advice. However, there is limited research on the support that dietitians can offer in antenatal care practices for pregnant women. Therefore, this study aims to explore the opportunities for dietitians to support pregnant women with a low socio-economic status in concurrent antenatal care practices in the Netherlands.MethodsIn-depth interviews were conducted with 14 pregnant women with a low socio-economic status and 13 dietitians to identify barriers for healthy eating for pregnant women and the associated opportunities for dietitians to support these women in making healthy dietary changes.ResultsFour opportunities for dietitians to support pregnant women in making dietary changes could be discerned: (1) creating awareness of healthy and unhealthy eating patterns, (2) providing reliable and personally relevant information, (3) help identifying barriers and solutions for healthy eating and (4) making healthy eating manageable. Dietitians indicated that supporting pregnant women with a low socio-economic status in consuming a healthy diet requires the investment of sufficient time, effort and money.ConclusionsDietitians are trained and well-equipped to provide extensive support to pregnant women to promote a healthy dietary intake, especially when the complex interplay of barriers that pregnant women with a low socio-economic status experience for healthy eating needs to be addressed. In addition, there is a strong need for strengthening the collaboration between dietitians and midwives because midwives are the primary care provider for pregnant women in the Netherlands, but they often lack sufficient opportunities to provide adequate nutrition support. Strengthening this collaboration could promote that nutrition becomes a recurring and standard topic in antenatal care.

Introduction: Nutritional guidelines in prenatal care can influence the pregnant woman's eating behavior, reducing the risks for the mother-baby binomial. Objective: To analyze adherence to the 10 steps for healthy eating during pregnancy and its association with maternal and socioeconomic factors in pregnant women in Espírito Santo, Brazil. Methods: Data were obtained through an electronic questionnaire widely publicized on social networks. Socioeconomic, prenatal and eating behavior data were collected from 368 participants. The 10 Steps to Healthy Eating during pregnancy, adapted from the Brazilian Ministry of Health, using the Praise-Guide-Recommend System (EOR) were used as evaluation criteria. Pearson's chi-square test and Fisher's exact test were used to analyze differences between proportions. The binary logistic regression model was used to investigate the association between independent variables and steps towards healthy eating. A significance level of 5% and a confidence interval of 95% were adopted. Results: Most pregnant women reported adherence of 3 to 5 steps (78.5%), fitting into the O-Orientation category. It was observed that receiving nutritional guidance during prenatal care increased adherence in step 4 (OR: 1.99; 95%CI: 1.26-3.15), in step 5 (OR: 2.02; 95%CI: 1 .26-3.24) and step 9 (OR: 1.66; 95%CI: 1.66-2.58). Conclusion: The results suggest the need to strengthen prenatal actions, mainly related to guidelines on encouraging healthy and adequate eating habits.

The objectives of the KKN Stikes Muhammadiyah Cirebon activity are 1. To find out the knowledge of pregnant women about ultrasound examinations and compliance with the use of Fe 2 tablets. To increase the knowledge of pregnant women about the fetus about the importance of ultrasound examination and its consumption of Fe. The importance of a healthy and nutritious diet. The specific goals to be achieved include increasing public knowledge, understanding and awareness, especially pregnant women and children, about healthy diets. The results that Salam Village, Sarewu Village RW 03, Pancalang District, Kuningan Regency, especially pregnant women with ultrasound knowledge and agricultural counseling, were held on February 13 and 15, 2023 at the Sarewu Village Health Center and Sarewu Elementary School, targeting pregnant women and elementary school children. The enthusiasm of pregnant women and students is quite good, some pregnant women have had ultrasounds and take Fe tablets. Primary school students also responded quite positively, showing optimal cognitive development and most had a stable weight despite experiencing growth. Family participation plays a very important role in caring for and assisting pregnant women and children in meeting the nutritional needs and development of pregnancy.

Barriers and enablers toward healthy eating and weight gain among pregnant women in Vietnam: A qualitative study with analysis informed by the theoretical domains framework and COM-B model

Although dietary factors are relevant modifiable risk factors for gestational diabetes mellitus (GDM), the exact association between dietary patterns and GDM remains controversial. Therefore, a systematic review and dose–response meta‐analysis of observational studies were conducted to summarize the association between dietary patterns and risk of GDM. PubMed, Scopus, Web of Science, Cochrane Library, and EMbase databases were systematically searched for publications up to March 10, 2020. All observational studies which assessed the risk of GDM according to the categories of healthy or unhealthy dietary patterns derived by either a priori or a posteriori methods were eligible to be included. Pooled effect sizes for the highest vs. lowest categories of healthy/unhealthy dietary patterns were calculated using the random‐effects model. Linear and nonlinear dose–response analyses were performed to determine dose–response associations. Thirty‐one studies were included, of which 26 studies (80,849 participants) assessed healthy dietary pattern and 15 studies (32,965 participants) assessed the unhealthy dietary pattern. Individuals with a higher adherence to the healthy dietary pattern were less likely to be affected by GDM (RR = 0.86; 95% CI: 0.76–0.96; I2 = 56.2%). There was a marginally significant association between unhealthy dietary patterns and GDM risk (RR = 1.28; 95% CI: 0.99–1.67; I2 = 74.7). Significant linear associations were observed between healthy (p = .011) and unhealthy (p = .009) dietary patterns and GDM risk. Pregnant women with a healthier dietary pattern (a diet rich in fruits, vegetables, and whole grains) had lower risk for GDM. In contrast, higher adherence to an unhealthy dietary pattern was associated with increased risk of GDM. Further longitudinal studies are needed to confirm the results.

High gestational weight gain (GWG) in overweight/obese pregnant women increases maternal-fetal complications. We conducted a 6-week GWG intervention based on an energy balance model that includes theories of planned behavior (TPB) and self-regulation constructs to promote exercise and healthy eating motivation and behaviors. The purposes of this proof-of-concept feasibility study were to examine: (1) the energy balance model constructs over the intervention, and (2) pre-post intervention, weekly, and dose-response changes in study constructs. Methods. Overweight/obese pregnant women (N=17) were randomized to 1 of 6 conditions, increasing in intensity, and included varied combinations of components (exercise sessions, healthy eating demonstrations, etc.). Exercise and healthy eating TPB (attitude, subjective norm, perceived behavioral control, intention), and self-regulation (prospective, retrospective) constructs were collected weekly. Exercise behavior, energy intake, and GWG were collected daily. Results. We observed: (a) significant increases in exercise TPB constructs, healthy eating attitude (limit unhealthy foods), exercise/healthy eating retrospective self-regulation; (b) significant decrease in healthy eating subjective norm (limit unhealthy foods); (c) trending increases for healthy eating perceived behavioral control (limit unhealthy foods), healthy eating prospective self-regulation, and energy intake; (d) significantly higher active time, steps, and energy expenditure at W3 relative to other weeks; (e) no significant increase in GWG; and, (f) a dose response effect such that women in more intensive dosages had greater gains in exercise and healthy eating perceived behavioral control (eat healthy/limit unhealthy foods). Conclusion. Brief exposure to a theoretically-driven, GWG intervention resulted in changes to exercise and healthy eating TPB and self-regulation motivational determinants, no significant increase in GWG, and suggests intervention intensity can strengthen perceived ability to engage in exercise/healthy eating behaviors; offering initial proof-of-concept for the intervention to regulate GWG in overweight/obese pregnant women. Future research will test this intervention over the course of pregnancy to understand long-term impact on maternal-fetal health outcomes.

Streamline maternal health care provision to mitigate the risk for pregnant women under COVID-19 pandemicHong Jiang1, Mu Li2, Huijing Shi1*, Xu Qian11School of Public Health; Global Health Institute; National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai 200032, China;2School of Public Health; China Studies Centre, Room 313, Edward Ford Building, University of Sydney, Sydney 2006, Australia*Corresponding author: Huijing Shi, hjshi@fudan.edu.cn, School of Public Health; Global Health Institute; NHC Key Laboratory of Health Technology Assessment, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai 200032, China;The novel Coronavirus Disease 2019 (COVID-19) outbreak started in Wuhan City China in early December 20191,2, and has rapidly spread across the world. The pandemic has strained health system3, which presents a huge challenge to maintain other essential health services, including maternal health care. As the first country to experience the COVID-19 outbreak, there are lessons could be learnt for establishing a better preparedness mechanism from a service delivery perspective to provide essential maternal health care and mitigate health risk for pregnancy women.First, all health facilities providing antenatal care should apply high standard of precaution to ensure pregnant women are not exposed to the COVID-19 transmission. This includes setting up a triage area to screen for COVID-19 symptoms and contact history with confirmed cases before pregnant women entering antenatal clinics. People with COVID-19 exposure history, suspected cases or COVID-19 patients should be separated from other pregnant women and placed in designated areas. This will also protect antenatal care providers. Appointment is required in advance for antenatal service to ensure adequate social distancing and manage the patient flow in health facilities.Second, as routine service provision might be disrupted, perinatal care availability and any changes to service provision should be disseminated widely, preferably through online platforms4. Women with low risk pregnancy may reduce the risk of contracting COVID-19 by reducing the number of antenatal visits. Women with pregnancy complications and other health conditions should contact their antenatal care provider to seek specific advice. Communication and counselling can be provided to pregnant and postnatal women online, including recognizing warning signs of going to hospital urgently. During movement restriction or self-isolation guidance of keeping healthy diet and physical activity, and mental health support are important for the well-being of pregnant women.Third, balancing the demands of emergency responding to COVID-19 and maintaining essential perinatal health service at national, provincial and local levels. Guidelines on conditions that require continuing antenatal care and those can be delayed should be developed5. Designated hospitals for treating pregnant women with COVID-19 should be enlisted to ensure they will receive appropriate care from a multi-disciplinary team6. At the provincial/regional level, health authorities should adapt to local context and develop uniformed perinatal operational guidelines across all local health facilities and monitor the equitable access to service and service quality. Local health facilities are responsible for disseminating service information via official channels, e.g. account on social media platforms such as WhatsApp, Facebook, and providing services following the provincial/regional operational guidelines.As the pandemic intensifies globally7,8, the experience and lessons of China on the response and streamline health system may help other counties to mitigate adverse impact of the pandemic on maternal and newborns.Disclosure of interestsWe declare no competing interests.

Not just substance use: the critical gap in nutritional interventions for pregnant women with opioid use disorders

Objective: Nutrition in pregnant women influences fetal and maternal health. Nutrition education is used to improve the nutritional status of pregnant women, but currently, there are no guidelines available for this demographic in Indonesia. Therefore, this qualitative study aims to identify topics relevant to healthy eating in pregnant women in Jakarta, Indonesia.
 Methods: The mixed-methods approach included an online survey to understand the problems (relevant to healthy eating) that pregnant women face and the subjects that they lack information about and a review of the relevant literature. The information obtained from both sources was analyzed by a panel of experts with the multi-step Delphi technique, and a list of relevant topics was created.
 Results: The study was conducted from April to September 2019 and included 37 pregnant women and 10 experts in nutrition and obstetrics-gynecology. The 13 relevant topics identified were: (1) importance of healthy eating during pregnancy; (2) food groups and serving sizes; (3) nutrition requirements during pregnancy and use of multivitamins/supplements; (4) foods to be restricted or avoided; (5) substances to be restricted or avoided; (6) weight gain during pregnancy; (7) physical activity requirements; (8) tips for ensuring the safety of food; (9) menu containing healthy foods for pregnant women; (10) pregnancy problems related to eating patterns and solutions; (11) healthy eating tips for women with special conditions; (12) myths and facts about eating patterns during pregnancy; and (13) healthy eating for lactation.
 Conclusion: These topics would be useful for the creation of nutritional education material for pregnant women in Indonesia.

Pregnancy promotes several transformations in the female organism, leading to a greater energetic and nutritional demand. If the demand is not met, there will be a competition between the fetus and the mother, which can cause harm to fetal development. Although widely discussed, it is not very clear how pregnant women see healthy eating and whether they can follow it during their daily life. Therefore, it is important to know how pregnant women understand this theme, whether they are receiving guidance, what they do with the acquired knowledge, and what factors are influencing their dietary choices. The aim of this study was to verify the knowledge of pregnant women assisted in primary health care in Belém, PA concerning healthy eating, such as characterizing the socioeconomic and demographic profile and nutritional status of the participants. This is a quantitative-qualitative study conducted with 27 pregnant women enrolled at MHC Guamá using a questionnaire with socioeconomic and demographic data and a semi-structured form with questions about their perception of healthy eating and self-declared weight, height, and gestational age. Qualitative data were analyzed using the Similitude Analysis and Word Cloud methods. The study pointed out that most pregnant women are young, have a high school education, are single, have one minimum wage income, and know how to achieve a healthy diet. However, several factors influence their food choices such as the conditions of their food, nutrition, and health, and the access and consumption of healthy foods on a daily basis. Regarding nutritional status, the same percentage of eutrophic and overweight pregnant women was observed, which may be related to the various factors that influence their dietary choices.

The number of anemia cases in pregnant women is still high, various precautions have been taken. This study aims to determine anemia prevention actions in pregnant women. The study design used a quantitative descriptive approach . The samples in this study were 84 pregnant women selected using accidental sampling techniques . The research instrument used a questionnaire developed by researchers with a validity test value of 0.679-0.979 and a reliability test with a value of Cronbach alpha 0.965. Univariate data analysis. The results of the study showed that almost all pregnant women had received health education, the majority of pregnant women consumed Fe tablets properly and correctly, consumed a balanced diet, practicing a healthy lifestyle, and almost all routinely performed ANC. Conclusion, anemia prevention efforts in pregnant women are mostly done, listening to health education, conducting ANC and doing a healthy life. It is expected that the health professional would work together and the family would supervise pregnant women in consuming Fe tablets according to the rules and intensively provide counseling about a balanced diet. Keywords: Anemia, pregnant women, prevention.