Barriers and Facilitators to the Uptake of Healthy Eating Messages by Pregnant African Immigrants Living in the UK: Perspectives of Women and Midwives.

This study is concerned with exploring the perception of pregnant African migrant women living in the United Kingdom (UK) towards healthy eating messages and midwives perception of providing healthy eating advice to these women. The prevalence of obesity among women of reproductive age (15-49 years) including pregnant women is increasing nationally and internationally. Maternal obesity has adverse consequences for both mother and child including higher risks of perinatal mortality, Caesarean sections, preterm birth, postpartum weight retention, increased risk of macrosomia, stillbirth, congenital malformation, childhood overweight and obesity.

Currently postpartum weight retention is a significant contributor to the general obesity epidemic and obesity is a significant contributor to chronic disease burden worldwide and a public health concern. Presently, the United Kingdom (UK) has the highest level of maternal obesity in Europe with approximately 46% of women classified as either obese (20%) or overweight (26%) at their booking appointment. Non-Hispanic black women make up a significant proportion (32%) of this population. With migration rates increasing, and black Africans being considered the fastest growing ethnic group in the UK (73% of the UK population growth), the rates of obesity in the population is expected to increase. Studies have shown pre-pregnancy weight to be a significant predictor of weight changes in pregnancy and postpartum weight retention certain studies have found that more African women are overweight before pregnancy and experience more weight retention after pregnancy than Caucasian women.

However, pregnancy has been indicated as a time when public health nutrition messages can be communicated and an "opportunity for change", with women showing an inclination to modify behaviour. Therefore, globally and in the UK, there has been an increased interest in dietary/healthy eating interventions in pregnancy (sometimes in addition to physical activity) to improve folic acid intake, improve fruits and vegetables intake, limit gestational weight gain, and prevent postpartum weight retention. With systematic reviews of dietary clinical trials showing that dietary interventions in pregnancy resulted in reduction in maternal gestational weight gain and improved pregnancy outcomes. Furthermore, current clinical guidelines in the UK advocate a healthy weight before pregnancy, a healthy diet and being physically active, returning to a healthy weight post pregnancy with healthy eating guidelines provided. Midwives are also recommended and ideally placed to provide healthy eating, weight management and physical activity support to help women eat well and manage their weight during pregnancy and beyond.

Studies evaluating healthy eating adherence in pregnancy show that although a majority of pregnant women in the studies believed that their diet was healthy, just a fraction of them met the recommended dietary intake for all the food groups in pregnancy. There is very little known about the uptake of healthy eating messages/interventions and adherence to healthy eating guidelines in pregnancy amongst pregnant African migrant women living in the UK. Considering also that the healthy eating guideline is made to suit the cultural preferences of the host nation, it is imperative that dietary interventions and/or healthy eating messages targeted at this group are conducted. Following a review of literature, and discussions with practitioners, there has been no known dietary intervention in pregnancy in the UK particularly targeting pregnant migrant African women.

Evidence from systematic reviews and meta-analysis suggests that culturally adapted health interventions are effective in ethnic minority population, including those targeted at smoking cessation, physical activity and healthy diet. Health is also said to be influenced by culture-linked behaviours. Such behaviours are transmitted from elders to children and continue through generations which are evident in patterns of food selection, food preparation and mental constructions of body shape, size, functions and disease processes. Cultural adaptation involves a consideration of language, culture and context in an intervention such that it suits cultural patterns, meanings and values of the target population.The need for cultural adaptation of healthy eating messages for pregnant Africans is further buttressed by the fact that dietary behaviours of pregnant Africans post migration are not completely changed from traditional dietary practices.