Nutrition counselling during pregnancy
Biological, behavioural and contextual rationale
The nutritional status of women when becoming pregnant and during pregnancy can have significant influence on both fetal, infant and maternal health outcomes.1-3 Micronutrient deficiencies such as calcium, iron, vitamin A and iodine can lead to poor maternal health outcomes and pregnancy complications which put the mother and baby at risk.2,4-7 Poor maternal weight gain in pregnancy due to an inadequate diet, increases the risk of premature delivery, low birthweight and birth defects.2,3,8
Nutrition education and counselling seek to improve nutrition practices before and during pregnancy to improve maternal nutrition and reduce the risk of poor health outcomes in both mothers and their children.1 Nutrition education and counselling focus on enhancing the quality of the diet, by educating women on which foods and what quantities they need to consume in order to achieve optimal dietary intake. This can also include counselling on the use of micronutrient supplements recommended during pregnancy, such as multiple micronutrient supplements containing iron and folic acid. Nutrition education and counselling can be provided as part of a comprehensive package of health education including components such as stress/anxiety management, smoking cessation and the dangers of alcohol and drug use and can be delivered via a number of channels including home visits and clinic- or other health care facility-based sessions.
A systematic review of studies which provided antenatal dietary advice with the aim of increasing protein and energy intake found that nutrition advice alone was sufficient to improve protein intakes during pregnancy, reduce the risk of preterm birth by 54% and increase head circumference at birth.9 However, there were no significant effects on any other pregnancy outcomes.
Another systematic review and meta-analysis of 34 studies providing nutrition education and counselling (including 11 studies in low- and middle-income countries), with and without nutrition support in the form of food baskets, food supplements or micronutrient supplements found that nutrition education and counselling improved gestational weight gain by 0.45kg, reduced the risk of anaemia in late pregnancy by 30%, increased birth weight by 105g and lowered the risk of preterm delivery by 19%.10 The effects of nutrition education and counselling were greater when mothers were also provided with nutrition support such as food or micronutrient supplements or nutrition safety nets. The effect of nutrition education and counselling alone on risk of low birth weight was not significant, however a significant effect of nutrition education and counselling alone was observed for gestational age in high-income settings. The latter observation may be a result of women in high-income settings generally having access to high-quality foods, enabling them to act on the advice they receive. In low-income settings where household food security may be compromised, nutrition education and counselling alone may not be sufficient for pregnant women to improve their diets. The effect of nutrition education and counselling on anaemia also appeared to be setting specific: subgroup analysis demonstrated a significant effect only in low- and middle-income countries.
Evidence suggests that nutrition education and counselling is most likely to show greatest benefit in low and middle-income countries when provided in conjunction with nutrition support. Additional research continues to be needed for large, well-designed randomized controlled trials to clarify the added benefit and sustainability of providing nutrition education and counselling with nutrition support and/or safety nets, especially in resource-limited settings, where food insecurity and gender bias may limit women’s capacity to act upon nutrition advice. Nutrition education and counselling strategies that do not consider the multiple real-world dimensions of decision-making around food and supplements will likely limit their effectiveness.10 However, where nutrition education and counselling strategies are feasible, they are likely to have beneficial outcomes on maternal and foetal outcomes.
- Rush D. Nutrition and maternal mortality in the developing world. American Journal of Clinical Nutrition. 2000, 72:212S-40S.
- Black RE et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013, S0140-6736(13)60937-X.
- Bhutta ZA et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013, S0140-6736(13)60996-4.
- Pharoah PO, Buttfield IH, Hetzel BS. Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. Lancet. 1971, 1:308-10.
- Ritchie L, King J. Dietary calcium and pregnancy-induced hypertension: is there a relationship? American Journal of Clinical Nutrition. 2000, 71:1371S-4S.
- Stoltzfus R, Mullany L, Black R. Iron deficiency anaemia. In: Ezzati M, Lopez A, Rodgers A, Murray C, editors. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization; 2004.
- Christian P. Micronutrients, birth weight, and survival. Annual Review of Nutrition. 2010, 30:83-104.
- Abu-Saad K, Fraser D. Maternal nutrition and birth outcomes. Epidemiologic Reviews. 2010, 32:5-25.
- Ota E, et al. Antenatal dietary advice and supplementation to increase energy and protein intake. Cochrane Database of Systematic Reviews. 2012, CD000032.
- Girard AW, Olude O. Nutrition education and counselling provided during pregnancy: effects on maternal, neonatal and child health outcomes. Paediatric and Perinatal Epidemiology. 2012, 26:191-204.
The named authors alone are responsible for the views expressed in this document.
Declarations of interests
Conflict of interest statements were collected from all named authors and no conflicts were identified.