The Problem:
During pregnancy there is an increased need for not only calories and macronutrients but also many micronutrients as well in order to keep the mother healthy and also to develop a growing fetus throughout the 9 month gestational period. According to Milman, et al. (2016), numerous deficiencies can develop from inappropriate nutrition of the mother which can impair placental function and also perform a role in preterm delivery, preeclampsia, miscarriage, and intrauterine growth restriction. In addition, Brown (2017) states that although many people believe the fetus’ needs are met first, it is not ‘a parasite’; the mother’s needs come first and vitamin and mineral deficiencies have been observed in newborns when there were no signs of any deficiency in the mother. Also, looking further down the road into adulthood, Lowensohn, et al., (2016) states that the risk for development of adult-onset disease is partly determined by the mother’s nutritional status before and during pregnancy as well as during beginning infancy. The problem that will be addressed in this nutrition education program will be to decrease the incidence of disease risk in newborns due to inadequate micronutrient status of the mother during pregnancy.
When looking at infant mortality rates in the United States and Europe in 2014, the Unites States has the highest mortality rate of 6.1 per 1,000 births as opposed to the lowest being Finland and Japan at only 2.3 (Brown, 2017); which is almost triple the amount. It is true that not all of these deaths are due to micronutrient deficiencies, yet these deficiencies have been shown to play a role in increasing risk. When looking at birth rates in California as compared to the United States, 6.7% of baby are born at a low birth rate as opposed to 8.0% while 1.1% as compared to 1.4% are very low birthweight respectively (CHCF, 2016). Also, 8.3% of births are preterm in California as compared to 9.6% in the U.S. while 1.3% are very preterm as compared with 1.6% respectively (CHCF,2016). Although California rates end to be lower than the U.S. average, it is not by much which shows we do have educational needs to address. Many preterm births and low birthweight births can be prevented by adequate prenatal nutrition.
The Need:
Several micronutrients of interest are folic acid (also folate), iron, calcium, and vitamin D. Folic acid needs increase by 200mcg while pregnant and breastfeeding from 400mcg to 600mcg which is hard to achieve from food alone according to medlineplus.gov. It has been stated by Lowensohn, et al. (2016) that folic acid should not only be supplemented prior to conception but also through the first month of pregnancy in order to prevent neural tube defects. Although data has shown that current supplementation and fortifications of folic acid (0.4mg in addition to diet) has dropped incidence of neural tube defects by 20%, Lowensohn, et al. (2016) mentions that calculations predict if supplementation were increased to 4 mg/day the incidence would drip by 82% which is an astonishing difference. Iron is important for growth and development and needs increase to 27mg per day (DHHSOWH, 2020) from the normal 18mg needed for adult women ages 19-50 (NIH, 2019), low iron status can potentially cause anemia and low birthweight. Anemia and iron deficiency is found in about 12% of nonpregnant women in the United States and jumps to 18% in those who are pregnant according to Lowensohn, et al. (2016). Proper vitamin D status is necessary to make sure the maternal response to the fetus’ bone mineral accretion calcium demands is sufficient (Lowensohn, et al., 2016). Calcium needs become 1000mg per day when pregnant and vitamin D needs increase to 600 IU which are both important for development of bones and teeth (DHHSOWH, 2016). Many studies cited by Lowensohn, et al. (2016) have shown that 30-96% of pregnant women have deficient serum vitamin D levels (less than 50 nmol/L).
The Program:
In California, 71.9% of the total population is white while 50.3% of the total population is female according to the 2019 Census (USCB, 2019). Meanwhile, 57.2% of women over 16 years of age are in the civilian labor force and 33.3% of the total population has a bachelor’s degree or higher (USCB, 2019). Some of these statistics may not be staggering by any means, but they do show that working women do play a significant role in California. Many women with full-time careers who have a college education do have some nutritional knowledge and ability to seek proper healthcare, however, there are many details that are overlooked by general doctors and word of mouth regarding pre-pregnancy and pregnancy nutrition. I am designing a program that focuses on the important yet overlooked nutritional needs during preconception and throughout pregnancy. The program being proposed will be called, Feeding Me To Feed You. This program will consist of a combination of activities, classes, and a continuing blog series in order to engage and motivate adult women who are either currently pregnant or of childbearing age, to learn about these micronutrients, their effects on their own health as well as the fetus’, and how to make sure they are getting what they need to ensure a happy and healthy baby. These different activities and learning modules will be based on the ideas of the Social Cognitive Theory and will mainly work to encourage collective efficacy which is the shared belief that the participants can act together to produce the specific changes of creating a healthier environment for their pregnancy (McKenzie, Neiger, & Thackeray, 2017). The program will be run in the San Francisco Bay Area and will be available to these women free of charge. A major benefit to this program is a healthy pregnancy and preconception period will help save cost in the future. According to an article by THHS (2020), a healthy preconception will reduce complications further down the road as well as birth defects while also providing for a faster postpartum recovery. That being said, it is also cost-effective to provide good preconception care and knowledge as it has been found that for every $1 spent, anywhere from $1.60 to $5.19 is saved in future fetal and maternal care costs (THHS, 2020). This program could help save not only medical cost, but also cost of the lost employment time due to complications.
Why Support:
This population of educated women, who are already somewhat health conscious, tend to crave more information and the avenues of this program will give them several ways to get the information once motivated. The concept of vicarious reinforcement, which is when participants are able to observe a behavior being done by someone else that is being positively reinforced (McKenzie, Neiger, & Thackeray, 2017), will be pivotal in this target group due to their social nature, this can also be referred to as social modeling. These constructs being utilized from the Social Cognitive Theory along with those of setting expectations, and increasing self-efficacy will be the main elements of the program. These women also tend to travel in large social circles of friends and colleagues and are active in the community which will benefit the program in the idea that they will disseminate information freely which will benefit the community and those around them as well. With more information disseminating throughout the community, more women will be aware of the common deficiencies associated with pregnancy and there is no more motivating factor to them than desiring a healthy pregnancy and baby. A healthier community will prosper and grow which benefits everyone.
References:
Brown, J. E. (2017) Nutrition Through the Lifecycle. 6TH Ed. Cengage Learning. Boston, MA.
California Health Care Foundation (CHCF). June 2016. California Health Care Almanac. Retrieved from: https://www.chcf.org/wp-content/uploads/2017/12/PDF-MaternityCareCalifornia2016.pdf
Department of Health and Human Services Office on Women’s Health (DHHSOWH). Pregnancy and Nutrition. Retrieved June 30, 2020 from: https://medlineplus.gov/pregnancyandnutrition.html.
National Institute of Health (NIH). December 10, 2019. Iron, Fact Sheet for Consumers. Retrieved from: https://ods.od.nih.gov/factsheets/Iron-Consumer/.
Lowensohn, R. I., Stadler, D. D., & Naze, C. (2016). Current Concepts of Maternal Nutrition. Obstet Gynecol Surv. 71(7):413-426. Doi: 10.1097/OGX.0000000000000329.
McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2017). Planning, Implementing, and Evaluating Health Promotion Programs. A Primer. (7th Ed.) United States. Pearson Education, Inc.
Milman, N., Paszkowski, T., Cetin, I., & Castelo-Branco, C. (2016). Supplementation during pregnancy: beliefs and science. Gynecol Endocrinol. 32(7):509-16. Doi: 10.310-9/09513590.2016.1149161
Texas Health and Human Services (THHS). July 13, 2020. The Business Case for Promoting Healthy Pregnancy. Retrieved from: www.dshs.state.tx.us/mch.
United States Census Bureau (USCB). Quick Facts California. July 2019. Retrieved from: https://www.census.gov/quickfacts/CA