Power 4 a Healthy Pregnancy-intervention

A healthy diet is crucial during pregnancy for the health of both mother and child. However, pregnant women often do not meet the nutritional requirements due to several challenges. Pregnancy, however, is a unique transition in which women are more receptive to changing dietary patterns compared to other phases in life. Nutrition promotion by midwives is promising to make use this window of opportunity. Although midwives feel the responsibility to provide nutritional advice, they encounter barriers in providing nutrition communication. As a result, nutrition communication in antenatal care generally remains suboptimal. Empowerment is an important concept in midwifery care since midwives use their expertise to empower pregnant women to help them tackle health issues. This project implements and evaluates the P4HP-intervention, created for and with pregnant women. In this intervention we use an empowerment approach, because empowering pregnant women to improve their dietary quality is expected to improve their health, as they are supported to make healthy choices. This intervention will contribute to enduring new-borns with a healthy, successful start of life and has the potential to improve health across generations.

The primary objective of the study is to investigate the impact of the P4HP-intervention on pregnant women’s empowerment, dietary quality and health-related outcomes. Our hypothesis is that the P4HP-intervention will have a beneficial effect on diet quality and empowerment.

The secondary objective of the study is to investigate the effect of empowerment and diet quality on various health outcomes – sense of coherence (SOC-3), quality of life (QoL VAS) and self-rated health (GSRH). We hypothesize that empowerment, improved dietary quality and health outcomes will have a mutually reinforcing, invigorative effect on each other – depicted by the double-sided arrows.

Intake/baseline measurements (T0) (online)
Demographics Intake Questionnaire
Diet quality - Eetscore/DHD-15 adjusted to pregnant women
Empowerment - Pregnancy-Related Empowerment Scale (PRES)
Sense of Coherence (SoC) - SOC-3
Quality of life - Global quality of life VAS
Self-rated health - Single question GSRH

Post-intervention (T1) (online)
Diet quality - Eetcore/DHD-15 adjusted to pregnant women
Empowerment - Pregnancy Related Empowerment Scale (PRES)
Sense of Coherence (SoC) - SOC-3
Quality of life - Global quality of life VAS
Self-rated health - Single question GSRH

Optional interview (T1) (optional) (online, by telephone or in real-life)
+/- 30 minutes
Main questions:
- How was your experience?
- What could be improved?

P4HP-intervention.
P4HP is a non-invasive empowerment intervention and consists of four extra moments for pregnant women to discuss nutrition with their midwife and a dietician. P4HP distinguishes itself from standard birth care by its empowering approach towards improving diet quality during pregnancy. The intervention is free of charge for the women and takes place in an individual or group setting (via CenteringPregnancy). P4HP is designed to be flexible, meaning that the professional has the freedom to adapt to what the individual or group needs at each session. This research is in line with current Dutch policy regarding empowerment, dietary guidelines, and prevention.

The participants in the intervention group have a consult about nutrition with the midwife or dietician at 4 moments during pregnancy. No specific diet or behavioral change is imposed on the pregnant woman.

The first meeting with the midwife takes place at the beginning of the pregnancy around 8-10 weeks of the pregnancy. This conversation is about the context of the pregnant woman's diet. For example, it is discussed what the pregnant woman herself thinks is going well in terms of nutrition, what is important to her, what she would like to change, and where she sees opportunities for improvement.

The second conversation about nutrition takes place with the dietician, around 12 weeks of the pregnancy. As a nutrition expert, the dietitian can go deeper into what the pregnant woman encounters, such as nausea or fatigue. Here too, the specific situation of a pregnant woman and what she herself finds important is central. This consult lasts 30-45 minutes.

At around 22 weeks and 32 weeks, the pregnant woman reflects with the midwife about nutrition in the past weeks. They discuss what helped to eat healthier, what was difficult, and how the pregnant woman can deal with this in the future. The midwife supports the
pregnant woman in coming up with solutions and options that suit her and her capabilities.

Pregnant women who follow CenteringPregnancy (CP) can also participate in this study. In that case, the discussions with the midwife and dietician take place in groups. The intake also takes place individually at CP. The first moment with the midwife is therefore identical to the individual trajectory.

The second conversation about nutrition, which takes place with the dietitian, is embedded in the first CP group meeting. During this meeting, 90 minutes are reserved to discuss nutrition and lifestyle during pregnancy and to set goals. Together with the midwife, the dietitian facilitates working methods in which women discuss what they encounter and what options there are for dealing with challenges related to food during pregnancy. Learning from each other and contact with fellow sufferers are additional empowering factors in this process. However, it is less easy for the dietitian to deal with individual situations in a group setting.

The reflection moments can be incorporated in the third CP meeting (20-24 weeks) and the seventh CP meeting (30-34 weeks). The topics discussed in these meetings, such as breastfeeding and the first days after birth, invite reflection on the diet of the pregnant
woman to be integrated.