Improving the diet of pregnant women: a mixed methods study

1.英国每年大约有80万婴儿出生。饮食是决定婴儿健康和发育的重要因素。国民保健制度提供了关于避免或限制摄入鱼和野味/猎鸟的在线指导，以分别最大限度地减少汞和铅的摄入量（关于大米产品的指导，以最大限度地减少砷的摄入量，目前仅针对儿童）。这些信息的证据基础很差，也没有对指导宣传方式的效果或妇女在怀孕的不同阶段如何密切遵循建议进行任何评估。我们对这些食物对他们体内金属含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至关重要，并被公布以产生最大的影响。目的我的目的是了解NHS指导的有效性，即在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。我想知道孕妇对含有少量有毒金属的食物（鱼、野味/野味鸟和米/米制品）的建议了解多少，以及她们从哪里得到这些信息。我还想知道该指南是否会影响女性实际食用的这些食物的数量，以及这如何影响她们体内的金属含量。我想让女性能够根据这些食物的科学证据做出明智的选择，充满信心，这样她们未出生的婴儿就能充分发挥其潜力。设计和使用的方法我将招募400名妇女谁是他们的第一个孩子。在第一次产前门诊（大约10周），我会要求助产士采取一些额外的血液（约半茶匙），以测量汞和铅的水平。我会让这些妇女在家填写一份电子或纸质问卷，询问她们吃特定食物的频率。我还会问他们对限制或避免食物的建议了解多少，以及他们从哪里得到这些信息。我将重复这一切，以配合稍后的诊所访问（约28周），与额外的尿液样本来测量砷。此外，将邀请另外三组六名孕妇参加一个焦点小组会议，讨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，调查他们对指导的了解以及他们如何告知妇女。我将邀请两组6名助产士更详细地告诉我们这一点。病人/公众参与在整个计划期间，我会定期（每两至三个月）谘询病人/公众谘询小组，以确保我们的问卷是可行和可接受的，同时仍能回答我们感兴趣的问题。这些小组还将帮助我们最大限度地增加参与研究并完成研究的妇女人数，并将利用在线论坛询问需要更快答复的问题。我将与政府顾问合作，他们为孕妇制定指导的细节，以确保建议是基于良好的证据，准确，清晰，易于遵循。我还将与助产士、医疗保健人员、MumsNet和其他在线网站合作，确保这些指导很容易获得，并在最佳时间提供，以便妇女能够吸收和遵循这些信息。

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.