A healthy diet, based on the Food Standards Agency’s Eatwell plate, is a diet based on starchy foods, fruit and vegetables, with some meat, fish and alternatives, some milk and dairy foods, and a small amount of food and drink high in fat and/or sugar. Healthy eating should be promoted and encouraged to all pre-pregnant, pregnant and breastfeeding women and children.
Women may be more willing to make healthy changes to their diet or lifestyle when pregnant and should be supported and encouraged to do so by practitioners in any setting. It is important for practitioners working with pregnant women, and women trying to conceive, to promote the key elements of a healthy lifestyle during pregnancy including appropriate weight gain, healthy eating, taking required vitamin supplements, and avoiding alcohol, tobacco and other harmful substances.
It is also important to highlight the future nutritional needs of the infant and to give women clear and unbiased information on infant feeding to enable them to make an informed choice about how they will feed their baby.
Nutrition and health inequalities in pregnancy
Maternal obesity, poor diet and vitamin D and folic acid deficiencies are associated with poor health outcomes for mothers and their children and are more common in deprived and vulnerable groups.
There is good evidence on interventions that can improve outcomes.
Quick links
- how do inequalities relate to nutrition in pregnancy?
- what are the risks from poor nutrition and weight management in pregnancy?
- identifying those at risk
How do inequalities relate to nutrition in pregnancy?
- Mothers in deprived areas, on low incomes, younger mothers, and those with lower educational attainment are less likely to take the recommended nutritional supplements before and during pregnancy or to have a healthy diet. (Improving Maternal and Infant Nutrition: A Framework for Action - Introduction (external link)
- The Infant Feeding Survey in 2011 showed that most mothers (94%) reported that they took folic acid either before or during pregnancy. More than a third (37%) said they took folic acid before they were pregnant, increasing to 79% who reported taking it during the first three months of pregnancy, while 23% took it later on in pregnancy. However, for women who had never worked uptake was 82% during pregnancy and 15% prior to pregnancy. The survey also shows that 60% of mothers in Scotland took some form of vitamin or mineral supplements (apart from folic acid by itself) during their pregnancy. Across the UK there was variation in uptake e.g. 71% of mothers from managerial and professional occupation groups took some form of dietary supplements compared with 59% of mothers from routine and manual occupations and 58% of those who had never worked. Younger mothers were less likely to have taken supplements during pregnancy than older mothers (54% of mothers aged under 20 compared with 68% of mothers aged 30-34 and 69% of mothers aged 35 or older.)
- 33.3% of mothers living in the most deprived areas of Scotland are classified as obese, compared with 20.1% in the least deprived areas (Scottish Health Survey 2008 - 7.8.1 (external link). Since 2008 rates of overweight and obesity have remained relatively stable with 29.4% of women ages 16 – 64 being obese; 58.6% being either overweight or obese and 35.7% of 16-24 year olds being overweight or obese (both sexes).
- In 2004-5, 9% of babies born to mothers in the most deprived fifth of thepopulation had a low birth weight, compared to 5% of those born to mothers living in the most affluent areas (figure from Equally Well). Recent data from ISD shows that this continues to show that more low birthweight babies are born to mothers in the most deprived families in Scotland.
Meanwhile, women from vulnerable groups are less likely to access antenatal services and other sources of support before and during pregnancy - a high risk factor for maternal and infant mortality.
What are the risks from poor nutrition and weight management in pregnancy?
We now know a lot more about the importance of nutrition both before and during pregnancy on the future health of the infant. The Scientific Advisory Committee on Nutrition states “Many determinants of fetal growth are established before conception. A mother’s nutritional status at the start of pregnancy influences her ability to meet the demands of her fetus and her baby through dietary intake and nutrient reserves. Ongoing supply is required for a range of nutrients for which there is little reserve in storage. (The influence of maternal, fetal and child nutrition on the development of chronic disease in later life 2011)
Folic acid deficiency increases the risk of foetal neural-tube defects; iron deficiency can lead to anaemia for the mother; vitamin D and calcium deficiencies affect bone formation in the foetus.
Maternal obesity can lead to problems including gestational diabetes and hypertension and is associated with a high intervention rate in labour and birth, and lower rates of breastfeeding success.
Identifying those at risk
Because those at risk can be difficult to identify, particularly in first pregnancies, it's important to link with other professionals who may know more about the family and their circumstances, e.g. carers, GPs, social workers, and voluntary sector agencies.
A range of risk factors should be considered, including socioeconomic circumstances, literacy and education levels, substance misuse and relationship issues.
A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families.
