Health is a precious commodity, especially when two people are concerned as in the case of pregnancy. During this important moment, women are open to considering healthy behaviours. This represents a significant opportunity that should not be missed.

During pregnancy, alcohol consumption, smoking, sedentary lifestyle, unbalanced nutrition, and no influenza vaccination may cause serious short and long term health problems to both mother and child. Alcohol and tobacco consumption may lead to miscarriages, premature birth, dysmorphic or polymalformation syndromes or fetal alcoholism syndrome. Sedentary behaviours and unbalanced nutrition may favour weight gain that could lead to gestational diabetes, malformations, macrosomia, arterial hypertension, premature birth and increased risk of caesarean section.

On the contrary, a diet rich in green leafy vegetables, fruits, fibres, calcium and omega 3 fatty acids has beneficial effects on pregnancy. This shows the importance of prevention efforts in order to acquire beneficial health behaviours. Unfortunately, pregnant women with low income status accumulate these risk factors and thus pay a heavy tribute to these pathologies.

Identifying risk factors

One study has attempted to identify risk factors and behaviours in a cohort of 22,604 pregnant Americans between the ages of 18 and 44 years in 2001 and to follow their evolution until 2009¹. Each year, 2,000 to 2,900 women were examined. The age adjusted prevalence for both leisure physical activities and influenza vaccination increased significantly (p<0.05). There was a non-significant decrease in alcohol consumption (p<0.065). No significant variation in binge drinking, smoking and fruits and vegetables consumption (≥ 5 times/day) was observed.

Encouraging Healthy Behaviour

During the nine-year follow-up study, the percentage of pregnant women with four healthy behaviours (no smoking, no alcohol consumption, regular leisure physical activities and influenza vaccination) steadily increased from 7.3% in 2001 to 21.2% in 2009 (p<0.001).

Socio demographic factors influence behaviours. Thus in this study, pregnant women with high or satisfactory incomes were more likely to begin a physical activity. Similarly, women who perceive their health status as satisfactory are more inclined to eat over five fruits and vegetables per day.

Much remains to be done. The recent literature review by Blumfield² showed that dietary quality remained insufficient with respect to recommendations in pregnant women. The consumption of saturated fatty acids and lipids remained high and the consumption of carbohydrates, fibres, calories and polyunsaturated fatty acids was insufficient. Several studies have attempted to identify the levers for change.

In a recent cross-sectional study, Gardner et al³ have shown that pregnant women with elevated lipid and carbohydrate consumption were paradoxically more willing to reduce these foods. However, the perceived benefits to both mother and child would seem to increase their motivation to eat more fruits and vegetables, less fat and slightly less sugar. Threats, barriers or societal norms had no impact.

Testing Awareness and Assistance

Awareness and dietary assistance are two actions that have been tested. In a Dutch study⁴, nutritional education was proposed to multiparous women of child bearing age who either did or did not wish to conceive at the time or were in their 1st, 2nd or 3rd trimester of pregnancy. Pregnant women were much more sensitive to nutritional messages than women in the other group, regardless of their pregnancy stage. There was no difference in impact between the groups of nulliparous women. A dietary assistance program in the form of vouchers for fruits and vegetables was instigated in 602 pregnant Americans⁵ for six months and then followed for an additional period of six months. The intervention led to increased fruit and vegetable consumption that was sustained during the following six months. Interventions occurred near supermarkets or near local farmer’s markets. Consumption increased by 0.8 portions in the former case, and by 1.4 portions in the latter. Both results were statistically significant.

Thus, nutrition in pregnant women can be significantly improved and this is a very positive message.