Midwives' perspectives on women's dietary intake during pregnancy: A systems thinking approach

Prenatal nutrition status and maternal dietary behaviours are known to impact maternal and child health outcomes.

We aimed to inform strategies for improving prenatal diet quality and their integration into pregnancy care.

Group Model Building (GMB) workshops were conducted with midwives from six health services. A Causal Loop Diagram (CLD) was developed to illustrate how the factors contributing to poor nutrition during pregnancy were interconnected and influenced each other and to identify priority action areas. Workshops were recorded and transcripts thematically analysed to provide a deeper understanding of the challenges of dietary advice provision and intervention opportunities.

The GMB process created a CLD that included 51 factors that were perceived to be driving poor dietary intake in pregnancy. These were grouped into five priority areas for action: knowledge and education, food availability and access, personal and family circumstances, health system, and care. Thematic analysis of the workshop transcripts revealed four major themes related to midwives' perspectives on the challenges associated with delivering dietary advice in pregnancy care: hospital service provision, pregnancy care clinicians, psychosocial factors affecting women, and maternal diet and health. Intervention targets were identified as continuity of care, nutrition education, guidelines and resources, personalised dietary advice, dietary data collection, and dietitian referrals.

Midwives' perspectives on the drivers of poor prenatal nutritional intake were multifaceted, spanning the personal, environmental and health system levels. Nutrition interventions should consider the health system and service context, along with pregnant women's dietary knowledge and education, access to healthy food, social, cultural, and personal circumstances, and clinical care experience.