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