Power 4 a Healthy Pregnancy-intervention: the impact on empowerment and diet quality of pregnant women

A healthy diet during pregnancy is crucial 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 of 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 to improve their diet quality. In this
intervention, we use an empowerment approach because empowering pregnant women
to improve their diet quality is expected to improve their health, as they are
supported to make healthy choices. This intervention will contribute to
enduring newborns with a healthy, successful start of life and has the
potential to improve health across generations.

The objective of the study is to measure the impact of the P4HP intervention on
the empowerment and diet quality of pregnant women.

The research will be conducted in the form of a cluster randomized trial. Each
participating midwifery practice is randomly assigned to the intervention or
control group and thus forms one cluster. All participants in a midwifery
practice are therefore in either the intervention or control group. It is
possible within a practice to guide participants for individual consultations
and participants for CP consultations. Due to practical reasons and possible
bias, it is not possible to blindly conduct this study for the healthcare
professionals, participants and researchers involved.

The P4HP intervention differs from standard maternity care by discussing the
topic of nutrition at multiple moments during pregnancy with an empowering
approach, with the aim of improving diet quality during pregnancy. As the
intervention is embedded in a practice's processes and is different within each
midwifery practice and population dependent, the P4HP intervention is designed
to provide flexibility and customization. Involved professionals have the
freedom to adapt to what the individual or group needs during each session. The
researchers will discuss the best course of action with each participating
practice to ensure that the intervention protocol is followed as closely as
possible.

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 an additional empowering factor 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.

There are no risks associated with participating in the study. Regular birth
care is also not endangered. The burden of the research will be kept as low as
possible, for example by integrating the intervention into regular
consultations. The only burden the study entails is the time investment for the
questionnaires at the start and the end of the study.