Empowering pregnant women to improve diet quality: a RCT among pregnant women in the Netherlands

Abstract Objective A healthy diet during pregnancy is crucial for the health of both mother and child, but pregnant women often do not meet the nutritional requirements. Empowering pregnant women to improve their diet quality could play a significant role in improving maternal nutrition and health. However, empowerment has been rarely used in nutritional interventions. Based on research and input from stakeholders, we developed Power 4 a Healthy Pregnancy (P4HP). P4HP consists of four additional consults by the midwife or dietician to discuss nutrition with the pregnant women from an empowerment perspective. This study aims to evaluate the effectiveness of P4HP on diet quality, empowerment, and health of pregnant women. Methods A cluster randomized controlled trial started in January 2022 in 14 Dutch midwifery practices, with a total of 175 pregnant women in both the control and intervention groups (N = 350). Women in the intervention group follow P4HP in addition to their usual birth care. Measurements are carried out at the beginning and end of pregnancy. Diet quality is measured using the Dutch Healthy Diet index 2015, specifically adapted for pregnancy. Empowerment is assessed using the Pregnancy-Related Empowerment Scale, Sense of Coherence (SOC) using the SOC-3 scale, Self-Rated Health using a General Self-Rated Health question, and Quality of Life using a Visual Analogue Scale. Results will be analyzed using Linear Mixed Models to analyze the treatment effect of clustered data. Results Baseline results of 100 pregnant women indicate that they do not meet the Dutch dietary guidelines. We hypothesize that P4HP will lead to improvements in diet quality, empowerment, and health among the intervention group compared to the control group. Conclusions Our findings will show the effect of P4HP on pregnant women’s diet quality, empowerment, and health. We expect to present our preliminary results during the congress. Key messages • Our findings will show the effect of four additional nutritional consultations from an empowerment perspective on pregnant women’s diet quality, empowerment and health. • Empowering pregnant women to improve their diet quality could play a significant role in improving maternal nutrition and health.


Background:
There is an important interaction between sexuality and many life factors. A good sexual education at school can improve knowledge and behaviour in young people giving them a healthy sexual life. Unlike most European countries, sexual education in Italy is not compulsory in the school curriculum, so this study explored the Italian regional initiatives realised over a span of 15 years.

Methods:
A review of grey literature was conducted on Public Health Administrations/Regions websites of each Italian region, focusing on official documents containing training catalogues for schools. The search was conducted in December 2021, including documents produced between 2006 and 2021. We used the topics recommended by UNESCO as quality markers for the projects found.

Results:
Among the 20 Italian regions, 12 had at least one programme. A total of 39 projects were found. All UNESCO topics were covered, with notable differences between north, centre and south of Italy, which had the lowest number of projects. Most of the projects (23) were carried out only once, the others were repeated at least for two years in a row. Contraception, along with love, marriage, partnerships, and family, were the main topics discussed during sexual education programs in schools (92%), followed by biological aspects, body awareness, and anatomy (83%); birth, disability, human rights, and online media were less common (33%). Regarding the target, disability, human rights, and mutual consent were deepened only for middle and high school students.

Conclusions:
Considering the fundamental importance of sexual education, there is an important lack in promotion and planning in Italy. There is a large discrepancy between the northern and southern regions and it is necessary to implement and standardize the offer of sexual education programs in schools.

Key messages:
Unlike the European average, In Italy there is an important lack on sexual education, whit large discrepancies between the northern and southern regions, putting the latter at disadvantage. Contraception, marriage, couples, and family were the main topics discussed during sexual education programs in schools; birth, disability, human rights, and online media the least.

Objective:
A healthy diet during pregnancy is crucial for the health of both mother and child, but pregnant women often do not meet the nutritional requirements. Empowering pregnant women to improve their diet quality could play a significant role in improving maternal nutrition and health. However, empowerment has been rarely used in nutritional interventions. Based on research and input from stakeholders, we developed Power 4 a Healthy Pregnancy (P4HP). P4HP consists of four additional consults by the midwife or dietician to discuss nutrition with the pregnant women from an empowerment perspective. This study aims to evaluate the effectiveness of P4HP on diet quality, empowerment, and health of pregnant women.

Methods:
A cluster randomized controlled trial started in January 2022 in 14 Dutch midwifery practices, with a total of 175 pregnant women in both the control and intervention groups (N = 350). Women in the intervention group follow P4HP in addition to their usual birth care. Measurements are carried out at the beginning and end of pregnancy. Diet quality is measured using the Dutch Healthy Diet index 2015, specifically adapted for pregnancy. Empowerment is assessed using the Pregnancy-Related Empowerment Scale, Sense of Coherence (SOC) using the SOC-3 scale, Self-Rated Health using a General Self-Rated Health question, and Quality of Life using a Visual Analogue Scale. Results will be analyzed using Linear Mixed Models to analyze the treatment effect of clustered data. 15th iii589

Results:
Baseline results of 100 pregnant women indicate that they do not meet the Dutch dietary guidelines. We hypothesize that P4HP will lead to improvements in diet quality, empowerment, and health among the intervention group compared to the control group.

Conclusions:
Our findings will show the effect of P4HP on pregnant women's diet quality, empowerment, and health. We expect to present our preliminary results during the congress. Key messages: Our findings will show the effect of four additional nutritional consultations from an empowerment perspective on pregnant women's diet quality, empowerment and health.
Empowering pregnant women to improve their diet quality could play a significant role in improving maternal nutrition and health.

Background:
The overall aim of the Bloom Trial is to develop and test a program promoting healthy weight development during infancy within the community health nurse setting in Denmark. Many interventions are poorly implemented, and to ensure adequate implementation support, previous studies have suggested to assess barriers and organizational readiness before intervention start. The aim of the present study is to assess barriers for implementing and sustaining the Bloom Trial among program adopters and implementers.

Methods:
Telephone interviews with managing health nurses (adopters) and health nurses (implementors) from twenty Danish municipalities were carried out (n = 22) in 2017. Moreover, two workshops with health nurses, and continuously meetings with implementation science experts were conducted in 2021-2022.

Results:
Barriers were identified on different levels. Organizational barriers within the work of health nurses included lack of time, economic resources, project fatigue, and political priority. Furthermore, health nurses lacked relevant tools to guide parents about promoting healthy weight development.
Interpersonal barriers between health nurses and parents were identified as the difficulties of having conversations about healthy weight development, especially if the parents or health nurses were overweight themselves. Cultural differences including language barriers and different perceptions of for example healthy food choices were also found.

Conclusions:
The findings are central for ensuring that the Bloom Trial is relevant and applicable to the setting of health nurses in Danish municipalities. This is crucial for ensuring successful adoption, implementation, and prolonged sustainability.

Key messages:
The study pinpoints key barriers (e.g. lack of time, project fatigue and cultural factors) of implementing an intervention promoting healthy weight in the community health nurse setting in Denmark. Involving community health nurses' perceptions aim at increasing the chances of producing a relevant and successful implementation strategy.