Dietary guidance during pregnancy and iodine nutrition: a qualitative approach

Abstract

Iodine is important for the formation of thyroid hormones and infant neurodevelopment; however iodine intake, knowledge and awareness remain low amongst UK mothers (1)(2)(3) . Using qualitative study design, we aimed to explore mothers' perceptions of nutrition in pregnancy, focussing on points pertinent to iodine nutrition.Women were recruited by snowball sampling using advertisements (in social media, relevant websites and places in the community) and word of mouth (May to November 2015). Inclusion criteria included UK residency, fluent English and being pregnant, having a child (younger than 2 years old) or trying to conceive. All participants were interviewed individually by phone or face-to-face using a topic guide. Interviews were transcribed verbatim and analysed with thematic analysis, using NVivo version 11 (QSR International).Participants (n = 48) were pregnant (38 %), breastfeeding (35 %), planning to conceive (10 %) and 17 % had a baby or toddler. Four main themes emerged from the interviews: i) dietary guidance received; ii) iodine awareness, iii) acceptance of iodine rich products, difficulties and barriers towards consumption and iv) desirable characteristics of dietary guidance.An emerging theme in women with multiple pregnancies (n = 11) was assumption of prior knowledge by health professionals, leading to less information being provided. This is an issue, considering that most participants were unaware of the importance of iodine, its sources and recommended intake, as previously shown (3) . Only women with nutrition/medical backgrounds were aware of the importance of iodine, its sources and recommended intake -information both surprised and concerned women once handed from the researcher. Written dietary advice was received by most during the first antenatal care appointment (around 12-14 weeks gestation), with an overt focus on foods to avoid and supplements ("I had very little directions from [the] doctor so I've been on the internet."). However, a clear theme of trust in the health services emerged, with midwives and general practitioners considered experts in pregnancy nutrition.Attitude to dairy products was generally positive. Milk was recognised to alleviate heartburn symptoms and to be craved for pregnancy. In cases of dislike, women still tried to increase milk consumption via yogurts and/or cheese. The main barriers towards dairy consumption included taste (mainly for milk), (true or perceived) lactose intolerance or health conditions associated to dairy products (e.g. eczema), morning sickness and perceptions of unhealthiness associated with cheese products (fat, processed foods). It was perceived difficult to increase or maintain fish and/or seafood consumption, the main barrier to which was the general dislike of these foods, exacerbated by heartburn, morning sickness and change of taste and smell during pregnancy. Other stated reasons of fish exclusion were partner's and family preferences, lack of cooking skills, cost implications, low availability and habit of not buying/ eatin...

A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals

“…Table 1 shows a summary of the findings from studies of patient iodine knowledge in the UK. Key themes from studies in the UK were that iodine knowledge is low among women of child-bearing age, they are unsure of dietary sources of iodine and they are not consistently provided with relevant information from HCPs (34)(35)(36)(37) .…”

Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation

“…Similar were our findings from the interviews of forty-eight women in preconception, pregnancy and new mothers. Women reported rarely discussing iodine with their HCP, and lacking knowledge of dietary sources and importance of iodine for fetal development (43) . In Australia, a country with mild iodine insufficiency in pregnancy and mandatory iodine fortification of salt and bread as well as recommendations for iodine supplementation in pregnancy, knowledge regarding the adverse outcomes of ID and the importance of iodine has been found to be consistently poor in pregnant women (52,(57)(58)(59)(60) .…”

“…In our interviews with women in the perinatal period, taste and heartburn have been described as the main drivers for inclusion or exclusion of fish, seafood and dairy products in the diet. Fish consumption is only well accepted during pregnancy by <20 % of the population, with taste and smell the main barriers ( 43 ) . Most believe that eating fish is beneficial for health (94 %; survey of 329 people in the USA with benefits attributable to n -3 oils according to 45 %).…”

“…These recommendations focus on following a balanced diet with limited specific practical recommendations on foods to include/increase/decrease/exclude or portion sizes ( 50 ) . The first antenatal appointment usually happens around the 12th week of pregnancy, with the content of the discussion varying between cases, dependent on both midwife's and woman's knowledge, education and personal interest in nutrition ( 43 ) .…”

“…Iodine-rich sources in the diet are varied, and our qualitative study has shown that women of childbearing age are receptive to dietary and lifestyle changes as long as guidance and support is provided, inviting strategies in this area. However, dietary guidance during antenatal care is perceived to be insufficient and confusing, driving women to use other sources of information, sometimes less credible ( 43 ) . A clear need for empowerment in pregnancy emerges, as women are willing to follow specific and comprehensive dietary advice in pregnancy.…”