Post on 30-Mar-2015
A Workshop on Obesity and Pregnancy A Dietary History in
TWO Minutes!(Can it be done?)
Susan van Maanen Dietitian, Diabetes in PregnancyNutrition ServicesAuckland City HospitalAugust 2011
What do Pregnant Women Eat in NZ?
Eat more than recommended: Fat, especially saturated fat and sugar
Eat less than recommended: Vegetables & fruit leading to less fibre and
folate eaten than recommended Calcium, Iron, Zinc and Selenium
504 pregnant women, 1x24hr diet recall, 3x1 day food records, 2 day activity record, Ht, Wt, skinfolds, blood sample at mth 5, demographic, medical and lifestyle details
Nutrition in Pregnancy- Report to MoH. Watson P. 1999
What do Pregnant Women Eat in Australia?
Women (52%) are piling on extra weight & keeping on the weight gained, post-natally
Choosing fatty food over vegetables & fruit
Iron, calcium & folate requirements not met
50 overweight and obese pregnant women, diet history at 12, 28, 36 wks, food frequency questionnaire, Ht, Wt – prepregnancy, 12, 28, 36 wks and 6 weeks P/N
Nutrition and Dietetics. De Jersey et al. Vol. 68, No 1,P 53-59 March 2011
My Clinical Observations: Women are shocked at how little weight gain is
recommended in pregnancy & that no-one had told them sooner what was appropriate
Women want to do well for their baby & family but don’t know how to eat well
They feel they will never achieve weight loss post-natally
Embarrassment & feelings of hopelessness
Observations:
Eating too much!
Poor food choices (finances)
No exercise
Skipping meals, hunger, then over eating
The Challenge: How to give personally relevant advice?
Diet history Food record Food frequency
questionnaire 24 hour dietary
recall
Taking a Diet History:
Compared to giving out a generic pamphlet, personally relevant advice has been shown to:
Be remembered
Effect change more readily
Build confidence and rapport so that disclosure is more likely
A Diet History will Identify: The adequacy of the woman’s usual food/ nutrient intake
Frequency of eating: regular meals and snacks?
Takeaways?
Excess energy from added sugars/drinks, cooking & spreading fat
Portion sizes?
Who cooks?
Easy Portion Measures:
Healthy Eating Plate:
Dietary History-Advantages:
Identify where changes can be made
Negotiate ‘actual’ change See through their ‘outside’ layer
Disadvantages: Relies on honesty
Underestimates intake Not precise
What is the goal?
To gain enough information to advise the woman on achieving: Nutritionally adequate diet Appropriate weight gain in pregnancy Encourage weight loss post-natally &
future disease prevention - Diabetes, Cardiovascular Disease
Healthy baby Positive attitude to health - now & for
the future.
A Dietitian’s Request to Midwives:
Please weigh women every visit if you can (including out of pregnancy if appropriate), so they know how they are progressing
Failing to receive any weight gain advice during pregnancy favours excessive weight gain!
Remember PREVENTION is easier than CURE
Food for a Healthy Mother and Baby:Lean Meat, Chicken, Fish etc- 2 servings/dayBread & Cereals - 6 servings/dayVegetables & Fruit - 6 servings/dayMilk & Milk Products - 3 servings/dayDrink plenty of fluids every day - 9 cupsChoose & prepare foods low in Fat, Salt & SugarKeep ActiveFood Safety
Eating for Healthy Pregnant Women. MoH. August 2010.
So - do you think you can do aDietary History in TWO minutes
Self completed questionnaires:
Advantages: Save health professionals time Bring to clinic completed or complete
while waiting in clinic
Disadvantages: Needs to be short and simple or
women will lose interest Literacy barriers
Handbook for Lead Maternity Caregivers. Canterbury District Health Board. 2004
A Nutrition Guide for Health Professionals, Resources Tool Kit, ADHB. 2011.
A Nutrition Guide for Health Professionals, Resources Tool Kit, ADHB. 2011.
Time Well Spent:
Whatever method you use,I recommend spending as much time as you can, getting information on the woman’s usual eating habits and giving sensible nutrition advice.
Your time will never be wasted!
Websites/ Resources Available:
www.dietitians.org.nzwww.moh.govt.nzwww.healthpoint.co.nz
Eating for Healthy Pregnant Women
Healthy Eating for South Asian People
Thank You