Improving the diet of pregnant women: a mixed methods study

1.背景英国每年约有80万名婴儿出生。饮食是每一次怀孕决定婴儿健康和发育的重要因素。NHS提供了关于避免或限制鱼类和野味/猎鸟的摄入量的在线指导，以将汞和铅的摄入量分别降至最低(关于大米产品的指导，以尽量减少砷的摄入量，目前仅针对儿童)。这一信息的证据基础很差，而且还没有对该指南的宣传方式的效果进行任何评估，也没有对怀孕不同阶段的女性遵守该建议的程度进行任何评估。我们对这些食物对体内金属量的影响也知之甚少。这些信息对于确保指南提供正确的信息，并以最大的影响进行宣传是必不可少的。目的我的目的是了解NHS关于怀孕期间避免或限制哪些食物以避免污染物，特别是有毒金属的指导意见的有效性。我想知道孕妇对含有少量有毒金属的食物--鱼、猎物/猎鸟和大米/大米产品--的建议了解多少，以及她们从哪里获得信息。我还想知道这一指导是否会影响女性实际摄入的这些食物中的多少，以及这如何影响她们体内的金属量。我希望让女性能够基于关于这些食物的科学证据，自信地做出明智的选择，这样她们未出生的婴儿就能充分发挥其潜力。设计和方法我将招募400名即将迎来第一个孩子的女性。在第一次产前就诊时(大约10周)，我会要求助产士额外采集一些血液(大约半茶匙)来测量汞和铅的水平。我会让这些女性在家里填写一份电子或纸质问卷，询问她们吃一次特定食物的频率。我还会询问他们对限制或避免食物的建议了解多少，以及他们从哪里获得这些信息。我会重复这一切，以配合后来的诊所访问(大约28周)，并提供额外的尿样来测量砷。此外，其他六名孕妇将被邀请参加三组焦点小组会议，谈论她们对指导的了解，以及她们从哪里获得更详细的信息。我还将招募100名助产士完成一份电子问卷，内容是她们对指导的了解，以及她们如何将这一指导告知女性。我将邀请两组助产士，每组六人，更详细地告诉我们这一点。病人/公众参与在整个项目期间(每隔2至3个月)，我会定期咨询病人/公众咨询团体，以确保我们的问卷是可行和可接受的，同时仍然回答我们感兴趣的问题。这些小组还将被用来帮助我们最大限度地增加参与并完成这项研究的女性人数。将使用在线论坛来询问需要更快响应的问题。授精我将与政府顾问合作，他们为孕妇制定指导的细节，以确保建议基于良好的证据，并且准确、清晰和易于遵循。我还将与助产士、健康护理人员、妈妈网和其他在线网站合作，以确保指南易于访问，并在最佳时间提供给女性，使其能够吸收和跟踪信息。

1. BackgroundThere are about 800,000 babies born in the UK each year. Diet is an important factor for every pregnancy in determining the health and development of the baby. The NHS provides online guidance on avoiding or limiting intakes of fish and game/gamebirds to minimise intakes of mercury and lead, respectively (guidance on rice products to minimise arsenic intakes is currently only for children). The evidence base for this information is poor, and there has not been any evaluation of the effect of the ways that the guidance is publicised, or how closely women follow the advice at different stages of pregnancy. We also know very little about the effects of these foods on the amounts of the metals in their bodies. This information is essential to ensure that the guidance gives the right messages, and is publicised for maximum impact.2. Aim My aim is to find out about the effectiveness of NHS guidance on which foods to avoid or limit during pregnancy to avoid pollutants, specifically toxic metals. I'd like to find out how much pregnant women know about the advice on the foods that contain small amounts of these toxic metals - fish, game/gamebirds and rice/rice products - and where they get their information from. I'd also like to know whether the guidance affects how much of these foods women actually eat and how that affects the amount of the metals in their bodies. I want to enable women to make informed choices, based on scientific evidence about these foods, with confidence so that their unborn baby can develop fully to its potential.3. Design and methods usedI'll recruit 400 women who are having their first baby. At the first antenatal clinic visit (about 10 weeks), I'll ask the midwife to take some extra blood (about half a teaspoon) to measure the levels of mercury and lead. I'll ask the women to fill in an electronic or paper questionnaire at home asking about their about how often they eat particular foods. I'll also ask about what they know about the advice on foods to limit or avoid and where they got their information from. I'll repeat all this to coincide with a later clinic visit (about 28 weeks), with an additional urine sample to measure arsenic. In addition, three groups of six other pregnant women will be invited to take part in a focus group meeting to talk about what they know about the guidance and where they get their information from in more detail. I'll also be recruiting 100 midwives to complete an electronic questionnaire on their knowledge of the guidance and how they inform women about it. I'll invite two groups of six midwives to tell us about this in greater detail.4. Patient/Public involvementI will consult patient/public advisory groups regularly during the whole project (every 2 to 3 months) to ensure that our questionnaires are feasible and acceptable while still answering the questions that we are interested in. The groups will also be used to help us to maximise the number of women who take part in the study and complete it. An online forum will be used to ask about issues that need a quicker response.5. DisseminationI'll be working with the government advisors who develop the details of the guidance for pregnant women to make sure the advice is based on good evidence, and is accurate, clear, and easy to follow. I'll also work with midwives, health-carers, and MumsNet and other online sites to make sure the guidance is easy to access and given at the best time for women to able to absorb and follow the information.