© Borgis - New Medicine 3/2010, s. 75-78
*Wojciech Chalcarz1, Agnieszka Marzęcka2, Sylwia Merkiel1, Natalia Popierz-Rydlewska1, Renata Godyń-Swędzioł2
Nutritional knowledge of pregnant women from Kraków. Part 1. General principles of nutrition during pregnancy**
1Food and Nutrition Department of the Eugeniusz Piasecki University School of Physical Education in Poznań
Head of the Department: dr hab. Wojciech Chalcarz, prof. nadzw. AWF
2Gabriel Narutowicz City Specialist Hospital in Kraków
Director: dr n. med. Renata Godyń-Swędzioł
Summary
Introduction. Assessment of nutritional knowledge in a pregnant woman is a very important and still underestimated issue of nutrition science. Monitoring their nutritional knowledge is of vital importance since it is known that imbalanced diet during pregnancy adversely affects foetus development.
Aim. The aim of this study was to assess knowledge about general principles of nutrition during pregnancy in a pregnant woman from Kraków.
Material and methods. Questionnaires on general principles of nutrition during pregnancy were filled in by 115 a pregnant woman from Kraków. Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer programme. The studied population was divided according to the trimester of pregnancy.
Results. Answers to only one question, concerning attending a school of birth, were statistically significantly different depending on the trimester of pregnancy. No significantly differences were observed in the answers to questions concerning nutritional knowledge. The most correct answers, to seven questions, were given by the women in the third trimester of pregnancy.
Conclusions. The studied a pregnant woman were characterised by a high level of knowledge about general principles of nutrition during pregnancy. Despite the lack of statistically significant differences, the women in the third trimester of pregnancy had the highest level of knowledge about general principles of nutrition during pregnancy.
INTRODUCTION
Pregnancy is a very important period both for mother and the developing foetus (1). The woman's dietary behaviour during this period has a decisive influence on the course of pregnancy. In particular, it is of vital importance to prepare the woman's organism for pregnancy. Before conception, which should be planned, the woman should assess her dietary habits and nutritional status, but first and foremost she should use folic acid supplementation (2, 3, 4, 5, 6). Assessment of a pregnant woman's nutritional knowledge is of great value since the studies on a pregnant woman's dietary habits (7) and nutritional knowledge published so far showed that they make numerous nutritional mistakes and their nutritional knowledge is poor (8, 9, 10).
AIM
The aim of this study was to assess knowledge about general principles of nutrition during pregnancy in a pregnant woman from Kraków.
MATERIAL AND METHODS
Questionnaires on general principles of nutrition during pregnancy were filled in by 115 a pregnant woman from Kraków who were admitted to Gabriel Narutowicz City Specialist Hospital in Kraków. Questions on general information about the studied women were also included.
This study was approved by the Bioethics Committee of the Poznan University of Medical Sciences.
Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer programme. The studied population was divided according to the trimester of pregnancy. Qualitative variables were presented in contingency tables. Statistical significance was determined using Pearson's chi-square test, except for the variables with more than 20% of cells with an expected frequency of less than five. In this case, the Kruskal-Wallis H test was used. The level of significance was set at p≤0.05.
RESULTS
Table 1 shows general information about the studied a pregnant woman according to the trimester of pregnancy. Statistically significant differences were found for the answers to the question concerning attending a school of birth. None of the women in the first and the second trimester of pregnancy attended a school of birth whereas 50.0% of women in the third trimester attended such a school.
Table 1. General information about the studied pregnant women. Results given in [%].
| No. | Parameter | Trimester of pregnancy | All women (n=115) |
| The first (n=14) | The second (n=75) | The third (n=26) |
| 1. | Education | Vocational | 0.0 | 5.3 | 3.9 | 4.4 |
| Secondary | 21.4 | 24.0 | 19.2 | 22.6 |
| Higher | 78.6 | 70.7 | 76.9 | 73.0 |
| 2. | The way of performing the job | Sedentary | 61.5 | 47.8 | 41.7 | 48.1 |
| In a standing position | 0.0 | 0.0 | 4.2 | 1.0 |
| Involving movement | 0.0 | 11.9 | 8.3 | 9.6 |
| In a standing position and involving movement | 23.1 | 17.9 | 25.0 | 20.1 |
| Sedentary and involving movement | 15.4 | 22.4 | 20.8 | 21.2 |
| 3. | Marital status | Married | 85.7 | 82.7 | 88.5 | 84.3 |
| Unmarried | 14.3 | 16.0 | 11.5 | 14.8 |
| Divorced | 0.0 | 1.3 | 0.0 | 0.9 |
| 4. | Number of children | None | 64.3 | 73.3 | 84.6 | 74.8 |
| 1 child | 28.6 | 22.7 | 15.4 | 21.7 |
| 2 children | 7.1 | 4.0 | 0.0 | 3.5 |
| 5. | The current pregnancy is | The first | 57.1 | 66.7 | 73.2 | 67.0 |
| The second | 35.7 | 25.3 | 19.2 | 25.1 |
| The third | 7.2 | 8.0 | 3.8 | 7.0 |
| The fourth | 0.0 | 0.0 | 3.8 | 0.9 |
| 6. | The current pregnancy was planned | 78.6 | 86.7 | 84.6 | 85.2 |
| 7. | Attending a school of birth | 0.0a | 0.0b | 50.0a,b | 11.3 |
| 8. | An intention to attend a school of birth* | 57.1 | 54.1 | 65.4 | 57.0 |
Bold type denotes statistical significance at p≤0.05.
Figures with the same superscript letters are significantly different (p≤0.05).
*It denotes the percentage of women who had not attended school of birth.
Table 2 presents the correct answers, according to the trimester, given by the studied a pregnant woman to the questions concerning general principles of nutrition during pregnancy. No statistically significant differences were observed. Women in the third trimester of pregnancy gave the most correct answers to seven questions, including one question to which the percentage of correct answers was equal to those given by women in the first trimester. Women in the first trimester of pregnancy gave the most correct answers to four questions.
Table 2. Correct answers to the questions concerning general principles of nutrition during pregnancy. Results given in [%].
| No. | Correct answers | Trimester of pregnancy | All women (n=115) |
| The first (n=14) | The second (n=75) | The third (n=26) |
| 1. | A pregnant woman should eat a varied diet | 84.6 | 89.3 | 92.3 | 89.5 |
| 2. | A oregnant woman should not eat until the feeling of satiety | 92.3 | 69.3 | 80.8 | 74.6 |
| 3. | A vegetarian diet is not recommended for a pregnant woman | 46.2 | 33.3 | 23.1 | 32.5 |
| 4. | Fish is a healthier source of protein than meat | 76.9 | 81.3 | 73.1 | 78.9 |
| 5. | Dietary fibre is an essential food component, particularly for a pregnant woman | 84.6 | 85.3 | 88.5 | 86.0 |
| 6. | Eating large amounts of glucose is not recommended for a pregnant woman | 69.2 | 72.0 | 88.5 | 75.4 |
| 7. | Female organism cannot adapt to dehydration, that is to limiting or eliminating water | 61.5 | 75.7 | 73.1 | 73.5 |
| 8. | A pregnant woman should drink at least 2 litres of water a day | 84.6 | 85.3 | 80.8 | 84.2 |
| 9. | A pregnant woman should drink beverages in small portions | 7.7 | 32.0 | 30.8 | 28.9 |
| 10. | A pregnant woman should not drink carbonated mineral water | 69.2 | 80.0 | 88.5 | 80.7 |
| 11. | Pregnant women should not drink high-sugar beverages | 92.3 | 93.3 | 96.2 | 93.9 |
| 12. | It is recommended to use vitamin and mineral supplements during pregnancy | 100.0 | 97.3 | 100.0 | 98.2 |
| 13. | It is recommended to use folic acid supplements before conception and during pregnancy | 100.0 | 92.0 | 84.6 | 91.2 |
| 14. | It is recommended to use iodine supplements before conception and during pregnancy | 30.8 | 44.0 | 34.6 | 40.4 |
| 15. | It is recommended to use mineral supplements before conception and during pregnancy | 69.2 | 80.0 | 80.8 | 78.9 |
DISCUSSION
Despite the advantages of attending a school of birth, highlighted in the literature (11), this practice is not common in Poland. A study carried out in schools of birth in Chorzów and Katowice and in maternity wards in Katowice showed that only 29.0% of women attended schools of birth (12). Therefore, it is very favourable that an intention to attend a school of birth was declared by more than 50% of the studied women in the first and in the second trimester of pregnancy and as many as 65.4% of women in the third trimester of pregnancy who had not attended school of birth.
The studied women were characterised by a high level of knowledge about general principles of nutrition during pregnancy. From 91.2 to 98.2% of the studied population knew that it is recommended to use folic acid supplements before conception and during pregnancy (3, 4, 5, 6, 13), that a pregnant woman should not drink high-sugar beverages (14) and that it is recommended to use vitamin and mineral supplements during pregnancy (13, 15, 16). It should be emphasised that all women in the first trimester of pregnancy answered correctly to the question concerning using folic acid supplements and that all women in the first and in the third trimester of pregnancy knew that it is recommended to use vitamin and mineral supplements during pregnancy. On the contrary, among women who attended school of birth in Warsaw (17), only 50.6% knew about the recommendation of using vitamin and mineral supplements during pregnancy.
There is lack of consistent information about using folic acid supplements during pregnancy. Some authors recommend taking 0.6 mg of folic acid a day during pregnancy (4, 6), whereas others advise taking 0.4 mg of folic acid a day (16). Before conception, women should supplement their diets with 0.4 mg of folic acid a day (5, 6), but no more than 1 mg (3). Those women who had given birth to a child with neural tube defects should take 4 mg of folic acid a day (5, 6). The supplementation should be used from one to three months before conception and until the twelfth week of pregnancy (2, 13). Therefore, it was highly favourable that the studied women were characterised by a high level of knowledge about using folic acid supplements before conception and during pregnancy. Recent studies (17) showed an excessive intake of folic acid during pregnancy and revealed that the problem of preventing neural tube defects by taking folic acid supplements before conception remains unsolved.
From 80.7 to 89.5% of the studied women knew that a pregnant woman should not drink carbonated mineral water (14, 18), that a pregnant woman should drink at least 2 litres of water a day (5, 14) and that dietary fibre is an essential food component, particularly for a pregnant woman (14), and that a pregnant woman should eat a varied diet (14). The highest level of knowledge on these issues was found in women in the third trimester of pregnancy. Women who attended school of birth in Warsaw (7) had a similar level of knowledge about the importance of eating varied foodstuffs and choosing foods of high nutritional value in order to provide adequate amounts of nutrients during pregnancy for both the mother and her child.
From 73.5 to 78.9% of the studied women knew that it is not possible for a female organism to adapt to dehydration, that a pregnant woman should not eat until the feeling of satiety, that eating large amounts of glucose is adverse, that fish is a healthier source of protein than meat and that it is recommended to use mineral supplements before conception and during pregnancy (5, 6, 14, 16, 19, 20).
The lowest percentages of correct answers given by the studied women, from 28.9 to 40.4%, were found in case of the questions concerning drinking beverages in small portions, following a vegetarian diet during pregnancy and using iodine supplements before conception and during pregnancy. From 7.7% of women in the first trimester to 32.0% of women in the second trimester of pregnancy were familiar with the recommendation of drinking beverages in small portions. From 23.1% of women in the third trimester to 46.2% of women in the first trimester of pregnancy knew that following a vegetarian diet is not recommended for a pregnant woman. It should be emphasised that a pregnant or lactating woman may follow vegetarian diets on condition that they are well-balanced (21, 22, 23). From 30.8% of women in the first trimester to 44.0% of women in the second trimester of pregnancy were aware of the recommendation of using iodine supplements before conception and during pregnancy (5, 15).
CONCLUSIONS
1. The studied a pregnant woman were characterised by a high level of knowledge about general principles of nutrition during pregnancy.
2. Despite the lack of statistically significant differences, the women in the third trimester of pregnancy had the highest level of knowledge about general principles of nutrition during pregnancy.
**The study was carried out as a part of the grant financed by the city council of Kraków.
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