Vegetable and fruit intake and diet quality changes in women who participate in prenatal programming involving a dietitian: A scoping review.

Background: Nutrition during pregnancy has a major impact on the developing fetus. Research and review articles exist regarding the influence of various nutrients on fetal development and how gestational weight gain is linked to birth outcomes. Currently in Canada, it is not standard to have dietitians involved as care providers in pregnancy, despite the roles dietitians can play in promoting wellness by helping people make nutritious choices. As well, to date, no review articles have examined changes in dietary intake by prenatal women who participate in programming involving a dietitian during pregnancy. This information would be helpful to explore dietitian services in pregnancy and to help identify future directions for dietitian services in Canadian prenatal care and research (including future reviews) in this area. Research question: The research question guiding this scoping review was: What is known from existing peer-reviewed literature about vegetable and/or fruit intake and/or diet quality changes of pregnant women who participate in prenatal programming involving a dietitian in high income countries? Methods: The methodological framework by Arksey and O’Malley was used to guide this scoping review. A database search was done on April 7th, 2023, in Medline, CINAHL, Embase, Web of Science after consultation with the Health Sciences Librarian (nursing and nutrition). Five key dietetics journals were also searched, along with the reference lists and citations of included articles. Articles were included if they met the following eligibility criteria: published in peer reviewed journals, included prenatal care or counselling by a licensed nutrition professional (e.g., dietitian), included information regarding changes in vegetable and/or fruit intake and/or diet quality scores, conducted in a high-income country as classified by the World Bank (2023) and written in English. No date restrictions were used. A summary of relevant data was prepared in tables and a narrative synthesis was created to describe the included articles. Results: Overall, 22 articles were included. Most studies were conducted in three main geographical locations: Europe (n=8), Australia (n=6) and North America (n=5). All but two studies were conducted after 2010 and most were randomized controlled trials (n=14). The frequency with which participants interacted with a dietitian varied, with interaction frequency ranging from one interaction to over 100. Nutrition information provided in the studies was generally consistent, with most studies providing general healthy eating recommendations as per national nutrition guidelines or a reputable healthy eating pattern such as the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) diet. Eighteen studies included control groups that received usual prenatal care, with three of those 18 studies also including intense dietitian interventions with the control group participants. Only two studies included teenagers; the average age of participants in 15 of the 22 included studies was 30.0-34.9 years. Pre-pregnancy body mass index (BMI) categories were used as eligibility criteria in 16 studies, with 15 studies focusing on participants living with overweight, obesity and/or a history of gestational diabetes. Only two studies initiated participant involvement solely in the first trimester, one initiated involvement in any trimester while the rest began the intervention sometime in the first or second trimester. Diet assessment to examine changes in dietary intake was mainly done by food frequency questionnaires (n=12 studies) and food records (n=7 studies) and various ways to report vegetable and/or fruit intake (e.g., servings/day, grams/day, times/day, kcals/day) as well as diet quality (e.g., various HEI scores, researcher-developed measures) were used. In general, a positive effect occurred with the nutrition intervention on vegetable and/or fruit intake and/or diet quality. Of the 22 included studies, 16 found a statistically significant positive change after the intervention, meaning participants improved their diets. There were five studies that found no change, while one found a decrease in calories consumed from vegetables and fruit after the intervention. For the nine studies that looked at diet quality between intervention and usual care control groups, eight found significant improvements of diet quality scores in the intervention group, and one study found an improvement but it was not significant. Conclusion: Dietitian involvement in prenatal care was found to be diverse in terms of frequency and type of intervention, and was overall seen to have a positive association on the vegetable and/or fruit intake and/or diet quality scores during pregnancy in the studies included in this review. Future research to better understand the optimal frequency and type of dietitian involvement, as well as the type and timing of the dietitian intervention during pregnancy could enhance the understanding of dietary changes made by prenatal women who participate in prenatal programming involving a dietitian.

Name thesis:degree_name

Master of Science (M.Sc.)

Level thesis:degree_level

Masters

Discipline thesis:degree_discipline

Nutrition

Grantor

University of Saskatchewan

Year dc:date.issued

2025

Author dc:creator

• Boyer, Audrey

Advisor dc:contributor.advisor

• Lieffers, Jessica

Committee members dc:contributor.committeemember

• Cammer, Allison
• Jorgensen, Derek
• Vatanparast, Hassan

• nutrition, nutritionist, dietitian, prenatal, pregnancy

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10388/16693

OAI identifier oai:identifier

oai:harvest.usask.ca:10388/16693