Adherence to nutritional guidelines in pregnancy: evidence from the Growing Up in New Zealand birth cohort study

Abstract

Objective: To determine adherence to nutritional guidelines by pregnant women in New Zealand and maternal characteristics associated with adherence.

Design: A cohort of the pregnant women enrolled into New Zealand's new birth cohort study, Growing Up in New Zealand.

Setting: Women residing within a North Island region of New Zealand, where one-third of the national population lives.

Subjects: Pregnant women (n 5664) were interviewed during 2009-2010. An FFQ was administered during the face-to-face interview.

Results: The recommended daily number of servings of vegetables and fruit (≥6) were met by 25 % of the women; of breads and cereals (≥6) by 26 %; of milk and milk products (≥3) by 58 %; and of lean meat, meat alternatives and eggs (≥2) by 21 %. One in four women did not meet the recommendations for any food group. Only 3 % met all four food group recommendations. Although adherence to recommendation for the vegetables/fruit group did not vary by ethnicity (P=0·38), it did vary for the breads/cereals, milk/milk products and meat/eggs groups (all P<0·001). Adherence to recommendations for the vegetables/fruit group was higher among older women (P=0·001); for the breads/cereals group was higher for women with previous children (P<0·001) and from lower-income households (P<0·001); and for the meat/eggs group was higher for women with previous children (P=0·003) and from lower-income households (P=0·004).

Conclusions: Most pregnant women in New Zealand do not adhere to nutritional guidelines in pregnancy, with only 3 % meeting the recommendations for all four food groups. Adherence varies more so with ethnicity than with other sociodemographic characteristics.

Fig. 1

Adherence to the New Zealand Ministry of Health nutritional guidelines in pregnancy by maternal demographics among pregnant women (n 5664) enrolled in the Growing Up in New Zealand birth cohort study, 2009–2010. (a) Adherence by maternal ethnic group (, European; , Māori; , Pacific Peoples; , Asian; , other). Ethnic group associations within food groups as follows. Vegetables/fruit group: none (P trend=0·18); breads/cereals group: in comparison with European women, a larger proportion of Māori (42 % v. 20 %) and Pacific (48 % v. 20 %) women were adherent (P trend<0·001); milk/milk products group: adherence >50 % for all ethnic groups (European 62 %, Māori 63 %, Pacific 52 %, other 55 %) except Asian (44 %; P trend<0·001); meat/eggs group: in comparison with European women, a larger proportion of Pacific (38 % v. 13 %) and Asian (38 % v. 13 %) women were adherent (P trend<0·001). (b) Adherence by maternal age group (, <20 years; , 20–29 years; , 30–39 years; , 40+ years). Age group associations within food groups as follows. Vegetables/fruit group: adherence increased with increasing age (P trend<0·001); breads/cereals group: adherence highest in those <20 years old (41 %) and lowest in those aged 30–39 years (23 %; P trend<0·001); milk/milk products group: none (P trend=0·66); meat/eggs group: adherence lower in those aged 30–39 years (19 %) than in younger (<20 years 27 %, 20–29 years 24%) or older (40+ years 27 %) age groups (P trend<0·001). (c) Adherence by maternal education (, primary; , secondary; , tertiary). Educational group associations within food groups as follows. Vegetables/fruit group: adherence increased with increasing education (P trend<0·001); breads/cereals group: adherence decreased with increasing education (P trend<0·001); milk/milk products group: for all levels of maternal education recommendations were met by >50 % of the pregnant women (P trend=0·005); meat/eggs group: adherence decreased with increasing education (P trend<0·001). (d) Adherence by area-level socio-economic deprivation, measured using the NZ Index of Deprivation (NZDep06), grouped as quintiles^{( 28 , 29 )} (, Dep 1–2 (least deprived); , Dep 3–4; , Dep 5–6; , Dep 7–8; , Dep 9–10 (most deprived)). Socio-economic deprivation associations within food groups as follows. Vegetables/fruit group: adherence decreased with increasing household deprivation (P trend=0·009); breads/cereals group: adherence increased with increasing household deprivation (P trend<0·001); milk/milk products group: none (P trend=0·11); meat/eggs group: adherence increased with increasing household deprivation (P trend<0·001). P trend determined using the χ ² test for trend