What we did: We surveyed 388 pregnant women across Australia about what they ate, their food knowledge, and their confidence in their food knowledge. Their motivation, attitudes towards healthy eating, and attempts to adopt and maintain a healthy diet were measured. We looked at how their beliefs and practices matched Australia’s healthy eating guidelines for major food groups, including fruit and vegetables. How did we do it: We adapted a well-known questionnaire and made it available online and at antenatal clinics and public locations.

women highly motivated to eat healthily when pregnant

The majority of women (72%) were ready and willing to make changes to what they ate and very confident that they could do this (65%). Only 2% thought dietary change did not apply to them. Three quarters were trying to adopt or maintain a healthy diet during their pregnancy. They thought that knowing about eating healthily (based on the major food group guidelines) was very important during pregnancy. The majority also indicated that they were not confused about these topics. However, their other responses contradicted this.
While the women thought they knew a lot about what was important in healthy eating in pregnancy and were quite confident in their practice, the survey results indicated that in some areas there was little reason to be confident. In terms of what they ate, 93% ate less than the recommended level for vegetables, and 90% ate less than the recommended level for fruit. Their knowledge about the recommended intake of the five major food groups, including fruit and vegetables, was poor (55% were unaware of the correct fruit and vegetable intake).

Broadly speaking, none of the pregnant women – despite their strong motivation, assumption of knowledge and confidence about their actions – actually met the recommendations for the five major food groups. There was under-consumption of fruit, vegetables, cereals and bread, and an over-consumption of meat:

• 93% failed to meet recommendations for vegetables
• 90% failed to meet recommendations for fruit
• 52% ate too much meat
• 30% ate too much dairy (although 30% ate the recommended amount – the highest level of any food group)

Women who had the more accurate knowledge of recommended fruit and vegetable consumption were more likely to report that their diet conformed with the relevant recommendations. The more accurate knowledge of the dietary guidelines was associated with better eating habits, with the likelihood of the consumption of selected food groups significantly increased: eight times more likely for fruit and vegetables and 6.8 times for breads and cereals. Women in early pregnancy were also most likely to eat the correct level of fruit and vegetables.

Defining their knowledge levels is highly required

Although the pregnant women were highly motivated and confident about being able to eat healthily and they reported they knew and understood dietary guidelines, the results showed less knowledge than they claimed and low conformity with such guidelines. Such results must be of great concern for health care providers.
A majority of pregnant women consume diets that are less than optimal. This is likely to impact on both their health and that of their babies, now and in the future.Pregnant women who are confident in their nutrition knowledge and ability to maintain a healthy diet may fail to seek information, particularly from authoritative sources such as health professionals. Their confidence is a barrier to accessing health services and resources.

Health care providers could use a brief food frequency questionnaire (e.g. 5-6 items about the five food groups) as a short knowledge screening tool to determine existing knowledge levels. This may assist to initiate a conversation with pregnant women about their nutrition knowledge and healthy eating practices. The use of such a tool could reduce the possibility of a health professional assuming a level of knowledge for an