Prenatal Nutrition in Team-Based Care: Current Practices and Opportunities for Optimization of Care
Publication: Canadian Journal of Dietetic Practice and Research
7 February 2019
Abstract
Purpose: To describe prenatal nutrition care currently delivered by Family Health Teams (FHTs) and Community Health Centres (CHCs) in Ontario, from the perspectives of health care providers, and to identify opportunities for improving care.
Methods: Ten 1-hour, interdisciplinary focus groups were conducted in FHTs and CHCs, involving a total of 73 health care providers. Focus groups ranged in size from 3 to 11 team members, and at least 3 different professions participated in each group. The shared perspectives and experiences on prenatal nutrition care were collected using a semi-structured interview guide and analyzed using thematic analysis.
Results: Limited time was spent on prenatal nutrition education and counselling. Two themes emerged describing gaps in care: (i) providing care in “borderline” high-risk pregnancies (i.e., impaired glucose tolerance) and (ii) providing care around gestational weight gain. Providers envisioned improving services offered by increasing preventative care, empowering providers to provide more nutrition care, facilitating patient self-care, and building a 1-stop shop “medical home”.
Conclusions: This study’s findings can guide strategies to mobilize current nutritional knowledge into routine prenatal care, and the shared vision for improvement will inform the routes for new practice that are supported by health care professionals.
Résumé
Objectif. Décrire les soins en nutrition prénataux actuellement offerts par les équipes de santé familiale (ESF) et les centres de santé communautaire (CSC) de l’Ontario, du point de vue des fournisseurs de soins de santé, et recenser les possibilités d’améliorer les soins.
Méthodes. Dix groupes de discussion interdisciplinaires d’une heure ont été menés dans les ESF et les CSC, pour un total de 73 fournisseurs de soins de santé. La taille des groupes variait de 3 à 11 membres, et au moins 3 professions différentes étaient représentées dans chaque groupe. Les perspectives et expériences sur les soins en nutrition prénataux ont été recueillies à l’aide d’un guide d’entrevue semi-structurée puis analysées au moyen d’une analyse thématique.
Résultats. Peu de temps était consacré au counseling et à l’éducation en matière de nutrition prénatale. Deux thèmes sont ressortis et décrivent des lacunes dans les soins : (i) la prestation de soins dans les « cas limite » de grossesse à haut risque (c.-à-d. intolérance au glucose) et (ii) la prestation de soins liés au gain de poids gestationnel. Les professionnels envisageaient d’améliorer les services offerts en augmentant les soins préventifs, en donnant aux prestataires les moyens d’offrir davantage de soins en nutrition, en aidant les patients à se prendre eux-mêmes en charge et en instaurant un guichet unique pour les soins médicaux.
Conclusions. Les résultats de cette étude peuvent orienter les stratégies visant à intégrer les connaissances actuelles sur la nutrition dans les soins prénataux courants. De plus, l’objectif commun d’améliorer ces soins ouvrira la voie à de nouvelles pratiques appuyées par les professionnels de la santé.
Get full access to this article
View all available purchase options and get full access to this article.
Financial support: Canadian Foundation for Dietetic Research.
Conflicts of interest: The authors declare that they have no competing interests.
References
1
Jen V, Erler N, Tielemans M, Braun K, Jaddoe V, Franco O, et al. Mothers’ intake of sugar-containing beverages during pregnancy and body composition of their children during childhood: the Generation R Study. Am J Clin Nutr. 2017;105(4):834–41.
2
Crider KS, Qi YP, Devine O, Tinker SC, and Berry RJ. Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention? Am J Clin Nutr. 2018;107(6):1027–34.
3
Siega-Riz A, Viswanathan M, Moos M, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1–14.
4
Oken E, Rifas-Shiman SL, Field AE, Frazier AL, and Gillman MW. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol. 2008;112(5):999–1006.
5
Brantsaeter AL, Haugen M, Samuelsen SO, Torjusen H, Trogstad L, Alexander J, et al. A dietary pattern characterized by high intake of vegetables, fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women. J Nutr. 2009;139(6):1162–8.
6
O’Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, et al. Canadian consensus on female nutrition: adolescence, reproduction, menopause, and beyond. J Obstet Gynaecol Can. 2016;38(6):508–54.e18.
7
Fowler JK, Evers SE, and Campbell MK. Inadequate dietary intakes: among pregnant women. Can J Diet Pract Res. 2012;73(2):72–7.
8
Nash DM, Gilliland JA, Evers SE, Wilk P, and Campbell MK. Determinants of diet quality in pregnancy: sociodemographic, pregnancy-specific, and food environment influences. J Nutr Educ Behav. 2013;45(6):627–34.
9
Szwajcer EM, Hiddink GJ, Maas L, Koelen MA, and van Woerkum CM. Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: evidence for the life course perspective. Fam Pract. 2008;25(Suppl. 1):i99–104.
10
Wilkinson SA and Tolcher D. Nutrition and maternal health: what women want and can we provide it? Nutr Diet. 2010;67(1):18–25.
11
Lucas C, Charlton K, and Yeatman H. Nutrition advice during pregnancy: do women receive it and can health professionals provide it? Matern Child Health J. 2014;18(10):2465–78.
12
Whitaker K, Wilcox S, Liu J, Blair S, and Pate R. Patient and provider perceptions of weight gain, physical activity, and nutrition counseling during pregnancy: a qualitative study. Womens Health Issues. 2016;26(1):116–22.
13
White DE, Fraser-Lee NJ, Tough S, and Newburn-Cook CV. The content of prenatal care and its relationship to preterm birth in Alberta, Canada. Health Care Women Int. 2006;27(9):777–92.
14
Health Force Ontario. Family medicine compensation and practice models in Ontario; 2017 [cited 2018 Aug 1]. Available from: http://www.healthforceontario.ca/en/Home/All_Programs/Practice_Ontario/Resources.
15
Levesque J, Haggerty JL, Hogg W, Burge F, Wong ST, Katz A, et al. Looking backward to move forward: a synthesis of primary health care reform evaluations in Canadian provinces; 2012 [cited 2018 Aug 1]. Available from: https://www.inspq.qc.ca/pdf/publications/1439_RegarderArriereMieuxAvancer_SynthEval ReforSoins1Ligne_VA.pdf.
16
Alliance for Healthier Communities. CHC fact sheet; n.d. [cited 2018 Aug 1]. Available from: https://www.aohc.org/chc-fact-sheet.
17
Ontario Ministry of Health and Long-Term Care. Family Health Teams; 2016 [cited 2018 Aug 1]. Available from: http://www.health.gov.on.ca/en/pro/programs/fht/.
18
Glazier R, Zagorski B, Rayner J. Comparison of primary care models in Ontario by demographics, case mix, and emergency department use, 2008/09 to 2009/10; 2012 [cited 2018 Aug 1]. Available from: https://www.ices.on.ca/Publications/Atlases-and-Reports/2012/Comparison-of-Primary-Care-Models.
19
Neuman WL, Robson K. Basics of social research: qualitative and quantitative approaches. 2nd ed. Toronto, ON: Pearson Education Canada; 2011.
20
Bonilla C, Brauer P, Royall D, Keller H, Hanning R, and DiCenso A. Interprofessional dietary assessment practices in primary care: a mixed-methods study. J Interprof Care. 2016;30(1):77–82.
21
Sargeant J, Loney E, and Murphy G. Effective interprofessional teams: “contact is not enough” to build a team. J Contin Educ Health Prof. 2008;28(4):228–34.
22
Soklaridis S, Oandasan I, and Kimpton S. Family health teams: can health professionals learn to work together? Can Fam Physician. 2007;53(7):1198–9.
23
Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
24
Morse JM. Critical analysis of strategies for determining rigor in qualitative inquiry. Qual Health Res. 2015;25(9):1212–22.
25
Goldman J, Meuser J, Lawrie L, Rogers J, and Reeves S. Interprofessional primary care protocols: a strategy to promote an evidence-based approach to teamwork and the delivery of care. J Interprof Care. 2010;24(6):653–65.
26
Morgan L, Carson G, Gagnon A, and Blake J. Collaborative practice among obstetricians, family physicians and midwives. CMAJ. 2014;186(17):1279–80.
27
Harris SJ, Janssen PA, Saxell L, Carty EA, MacRae GS, and Petersen KL. Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. CMAJ. 2012;184(17):1885–92.
28
Diabetes Canada. 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42:S1–326.
29
American College of Obstetricians and Gynecologists (ACOG). Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121(1):210–2.
30
Kominiarek MA and Peaceman AM. Gestational weight gain. Am J Obstet Gynecol. 2017;217(6):642–51.
31
Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, and Gerbert B. Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling? J Womens Health. 2010;19(4):807–14.
32
McDonald SD, Pullenayegum E, Taylor VH, Lutsiv O, Bracken K, Good C, et al. Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy. Am J Obstet Gynecol. 2011;205(4):333.e1–6.
33
Galea G, Breda J, Lazdane G, Schumann NL, Robertson A, Sørensen TB, et al. Good maternal nutrition—the best start in life. Copenhagen, Denmark: World Health Organization Regional Office for Europe; 2016.
34
Duquette MP, Payette H, Moutquin JM, Demmers T, and Desrosiers-Choquette J. Validation of a screening tool to identify the nutritionally at-risk pregnancy. J Obstet Gynaecol Can. 2008;30(1):29–37.
35
Holtrop JS, Luo Z, Piatt G, Green LA, Chen Q, and Piette J. Diabetic and obese patient clinical outcomes improve during a care management implementation in primary care. J Prim Care Community Health. 2017;8(4):312–8.
36
Martin-Misener R, Valaitis R, Wong S, Macdonal M, Meagher-Stewart D, Kaczorowski J, et al. A scoping literature review of collaboration between primary care and public health. Prim Health Care Res Dev. 2012;13(4):327–46.
37
Aggarwal M, Hutchison B. Toward a primary care strategy for Canada. Ottawa, ON: Canadian Foundation for Healthcare Improvement; 2012.
38
Desai J, Solberg L, Clark C, Reger L, Pearson T, Bishop D, et al. Improving diabetes care and outcomes: the secondary benefits of a public health-managed care research collaboration. J Public Health Manag Pract. 2003;9:S36–43.
39
Margolis P, Stevens R, Bordley W, Stuart J, Harlan C, Keyes-Elstein L, et al. From concept to application: the impact of a community-wide intervention to improve the delivery of preventive services to children. Pediatrics. 2001;108(3):e42.
40
Larson K, Levy J, Rome M, Matte T, Silver L, and Frieden T. Public health detailing: a strategy to improve the delivery of clinical preventive services in New York City. Public Health Rep. 2006;121(3):228–34.
41
Hutchison B, Levesque JF, Strumpf E, and Coyle N. Primary health care in Canada: systems in motion. Milbank Q. 2011;89(2):256–88.
42
Anderson C. Presenting and evaluating qualitative research. Am J Pharm Educ. 2010;74(8):141.
Information & Authors
Information
Published In
Canadian Journal of Dietetic Practice and Research
Volume 80 • Number 3 • September 2019
Pages: 96 - 103
History
Version of record online: 7 February 2019
Copyright
© 2019.
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
MartinaTownMSc, RD, OlgaSmoliakPhD, PaulaBrauerPhD, RD, FDC, and LauraForbesPhD, RD. 2019. Prenatal Nutrition in Team-Based Care: Current Practices and Opportunities for Optimization of Care. Canadian Journal of Dietetic Practice and Research.
80(3): 96-103. https://doi.org/10.3148/cjdpr-2018-043
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
Cited by
1. Prenatal Nutrition Care in Alberta: The Perspectives of Pregnant Women and Registered Dietitians
2. Identifiable Dietary Patterns of Pregnant Women: A Canadian Sample
View Options
Login options
Check if you access through your login credentials or your institution to get full access on this article.
Subscribe
Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research
