Improving the diet of pregnant women: a mixed methods study

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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.