1. A Workshop on Obesity and Pregnancy A Dietary History in TWO Minutes! (Can it be done?) Susan van Maanen Dietitian, Diabetes in Pregnancy Nutrition Services Auckland City Hospital August 2011

2. What do Pregnant Women Eat in NZ? Eat more than recommended: Fat, especially saturated fat and sugar Eat less than recommended: Vegetables & fruit leading to less fibre and folate eaten than recommended Calcium, Iron, Zinc and Selenium 504 pregnant women, 1x24hr diet recall, 3x1 day food records, 2 day activity record, Ht, Wt, skinfolds, blood sample at mth 5, demographic, medical and lifestyle details Nutrition in Pregnancy- Report to MoH. Watson P. 1999

3. What do Pregnant Women Eat in Australia? Women (52%) are piling on extra weight & keeping on the weight gained, post-natally Choosing fatty food over vegetables & fruit Iron, calcium & folate requirements not met 50 overweight and obese pregnant women, diet history at 12, 28, 36 wks, food frequency questionnaire, Ht, Wt – prepregnancy, 12, 28, 36 wks and 6 weeks P/N Nutrition and Dietetics. De Jersey et al. Vol. 68, No 1,P 53-59 March 2011

4. My Clinical Observations: Women are shocked at how little weight gain is recommended in pregnancy & that no-one had told them sooner what was appropriate Women want to do well for their baby & family but dont know how to eat well They feel they will never achieve weight loss post-natally Embarrassment & feelings of hopelessness

5. Observations: Eating too much! Poor food choices (finances) No exercise Skipping meals, hunger, then over eating

6. The Challenge: How to give personally relevant advice? Diet history Food record Food frequency questionnaire 24 hour dietary recall

7. Taking a Diet History: Compared to giving out a generic pamphlet, personally relevant advice has been shown to: Be remembered Effect change more readily Build confidence and rapport so that disclosure is more likely

8. A Diet History will Identify: The adequacy of the womans usual food/ nutrient intake Frequency of eating: regular meals and snacks? Takeaways? Excess energy from added sugars/drinks, cooking & spreading fat Portion sizes? Who cooks?

9. Easy Portion Measures:

10. Healthy Eating Plate:

11. Dietary History- Advantages: Identify where changes can be made Negotiate actual change See through their outside layer Disadvantages: Relies on honesty Underestimates intake Not precise

12. What is the goal? To gain enough information to advise the woman on achieving: Nutritionally adequate diet Appropriate weight gain in pregnancy Encourage weight loss post-natally & future disease prevention - Diabetes, Cardiovascular Disease Healthy baby Positive attitude to health - now & for the future.

13. A Dietitians Request to Midwives: Please weigh women every visit if you can (including out of pregnancy if appropriate), so they know how they are progressing Failing to receive any weight gain advice during pregnancy favours excessive weight gain! Remember PREVENTION is easier than CURE

14. F ood for a Healthy Mother and Baby: Lean Meat, Chicken, Fish etc - 2 servings/day Bread & Cereals - 6 servings/day Vegetables & Fruit - 6 servings/day Milk & Milk Products - 3 servings/day Drink plenty of fluids every day - 9 cups Choose & prepare foods low in Fat, Salt & Sugar Keep Active Food Safety Eating for Healthy Pregnant Women. MoH. August 2010.

15. So - do you think you can do a Dietary History in TWO minutes

16. Self completed questionnaires: Advantages: Save health professionals time Bring to clinic completed or complete while waiting in clinic Disadvantages: Needs to be short and simple or women will lose interest Literacy barriers

17. Handbook for Lead Maternity Caregivers. Canterbury District Health Board. 2004

20. A Nutrition Guide for Health Professionals, Resources Tool Kit, ADHB. 2011.

21. A Nutrition Guide for Health Professionals, Resources Tool Kit, ADHB. 2011.

22. Time Well Spent: Whatever method you use, I recommend spending as much time as you can, getting information on the womans usual eating habits and giving sensible nutrition advice. Your time will never be wasted!

23. Websites/ Resources Available: www.dietitians.org.nz www.moh.govt.nz www.healthpoint.co.nz Eating for Healthy Pregnant Women Healthy Eating for South Asian People www.dietitians.org.nz www.moh.govt.nz www.healthpoint.co.nz

24. Thank You