Dietary guideline adherence during preconception and pregnancy: A systematic review

Abstract

The aim of this study is to determine the level of adherence to dietary guidelines among men and women during preconception, and pregnant women, and factors associated with adherence. Searches were conducted in CINAHL, AMED, EMBASE, and Maternity and Infant Care from inception to March 2018. Observational studies assessing the primary outcome (adherence to dietary guidelines and/or nutritional recommendations) and/or secondary outcome (factors associated with adherence) were eligible. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross‐sectional studies. Men or women (aged ≥18 years) who identified as trying/intending to conceive or were pregnant. Eighteen studies were included. The quality of studies was fair (44%) to good (56%). Most studies indicated preconceptual and pregnant women do not meet recommendations for vegetable, cereal grain, or folate intake. Pregnant women did not meet iron or calcium intake requirements in 91% and 55% of included studies, respectively, and also exceeded fat intake recommendations in 55% of included studies. Higher level education was associated with improved guideline adherence in pregnant women, whereas older age and non‐smoking status were associated with greater guideline adherence in preconceptual and pregnant women. The findings of this review suggest that preconceptual and pregnant women may not be meeting the minimum requirements stipulated in dietary guidelines and/or nutritional recommendations. This could have potential adverse consequences for pregnancy and birth outcomes and the health of the offspring. Major knowledge gaps identified in this review, which warrant further investigation, are the dietary intakes of men during preconception, and the predictors of guideline adherence.

“It only takes two minutes to ask”—a qualitative study with women on using the FIGO Nutrition Checklist in pregnancy

“…Many pregnant women do not follow dietary advice for pregnancy and, as part of this work, we found that most women reported at least one undesirable dietary practice during pregnancy. 10,14 The findings of our study confirm extensive previous research showing that pregnant women welcome diet, weight, and nutrition-related discussions. 8,23 Clinicians working with pregnant women have a responsibility to incorporate brief nutrition and weight discussions into their clinical appointments.…”

“…8,9 The effect of this can be seen in the lack of adherence to recommended healthy dietary intakes for pregnancy internationally. 10 Previous work identified lack of resources and relevant training as barriers to addressing nutrition in practice. [11][12][13] The FIGO (International Federation of Gynecology and Obstetrics) Nutrition Checklist is designed to facilitate brief and relevant nutrition discussions between women and their healthcare professional, in a personalized and consistent manner.…”

Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: multistakeholder feedback to implementation

“…The findings of our study are in line with other research showing that there is poor adherence to pregnancy dietary recommendations, including intakes of vegetables, wholegrains, folic acid, and iron. 15,16 Fruit, vegetables, wholegrains, and fish are key components of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and following this diet has been associated with lower maternal blood pressure, even in women without hypertensive disorders. 17 The most common dietary issue in our study was self-reported fish intake of less than once a week.…”

Dietary Folate Intake and Folic Acid Supplements among Pregnant Women from Southern Italy: Evidence from the “Mamma & Bambino” Cohort

“…Nowadays, developed countries proposed folic acid supplementation as a strategy to ensure the correct fetal growth [17]. However, several lines of evidence showed that folic acid supplementation was often insufficient in the preconception period, with several negative effects on pregnancy and neonatal outcomes [18].…”