Nutrition and maternal health: What women want and can we provide it?

Aim: Maternal dietary behaviours are associated with some maternal and infant health outcomes during and after pregnancy. However, effective Maternal Health Dietetic models of care are limited. The aim of this study was to benchmark our services against other Australian Maternal Health Dietetic services and to describe nutrition knowledge and use of dietetic services in a major Australian women's hospital. Method: During 2008, 15 Australian tertiary Maternal Health Dietetic services were surveyed collecting staffing and service delivery information. Patients in a maternity hospital were also surveyed to assess nutrition knowledge, attitudes, behaviour, education preferences and dietetic service awareness. Results: The benchmarking survey response rate was 73%. There was considerable variation in staffing levels and services delivered. Individual antenatal inpatient and outpatient counselling dominated dietetic time. Few evidence-based models of care or guidelines were used by dietitians. Of the 309 antenatal (RR 24%) and 102 postnatal (RR 17.4%) patients surveyed, half were primiparous; over one-third had prepregnancy body mass indices > 25.9 kg/m2, and average pregnancy weight gain was 14.1 +/- 6.7 kg. Few antenatal women knew their recommended pregnancy weight gain range. Excessive weight gain occurred in 33.3% to 100% of women (per body mass index range). Women had poor diet quality, despite identifying healthy eating as a personal priority. Nutrition education delivery preferences were identified. Conclusion: Considerable variation exists in Australian Maternal Health Dietetic services and referral guidelines. There is a role for Maternal Health Dietitian/Nutritionists to advocate for improved staffing levels and for the implementation and evaluation of evidence-based services. Potential service delivery improvements are suggested, including a model of dietetic care.