Elsevier

Public Health

Volume 128, Issue 7, July 2014, Pages 647-653
Public Health

Original Research
Pregnant immigrant Nigerian women: an exploration of dietary intakes

https://doi.org/10.1016/j.puhe.2014.05.001Get rights and content

Abstract

Objective

The aim of the study is to explore the dietary intakes of a prominent ethnic minority group of women from Sub-Saharan Africa during pregnancy, in order to identify nutritional issues of concern which may impact on pregnancy outcomes and whether different food based dietary guidelines may be required to meet their needs.

Study design

This is an observational study with quantitative assessment of nutrient intakes and an exploration of meal composition and food choices.

Methods

Fifty-two Nigerian pregnant women in their second or third trimester of pregnancy were recruited from antenatal clinics in the National Maternity Hospital, Dublin, Ireland. Early pregnancy weight was measured and body mass index recorded. A 24 h dietary recall was used to assess food and nutrient intakes.

Results

Eighty-nine per cent of the study population were classified as overweight or obese. These women appear to be maintaining traditional African dietary habits and have a healthy macronutrient composition in the diet. The intake of key pregnancy micronutrients such as calcium, vitamin D and folate may be insufficient from diet alone to meet requirements and supplements may be inadequately utilized in a timely manner.

Conclusions

These women represent a vulnerable obstetric group that may be at risk of adverse pregnancy outcomes due to high obesity rates and inadequate micronutrient status in early pregnancy. Provision of dietary advice should be tailored to suit their cultural dietary practices and food preferences. Pre-conception counselling on healthy lifestyle and appropriate supplement usage may be beneficial, although larger studies are required to assess the need for specific nutrition policy recommendations.

Introduction

Pregnancy is a critical stage of development during which optimal maternal nutrition can positively influence obstetric and neonatal outcomes.1, 2 Dietary guidelines and advice for pregnant women are often tailored to suit the cultural food preferences of the nation from where they are produced. For example, in Ireland, pregnant women are advised to consume five portions of fruit and vegetables and five portions of dairy products each day, and oily fish once per week.3 A study which analysed the dietary patterns in a predominantly Irish pregnant cohort identified a ‘health conscious’ dietary pattern, which was characterized by greater compliance to dietary guidelines, lower intake of total and saturated fat and higher intake of folate, iron and vitamins A and C, compared to women identified as part of the ‘unhealthy’ cluster.4 However, with increasing migration trends worldwide, obstetric populations now consist of mixed ethnic groups with varying dietary practices and what is considered a healthy dietary pattern for one ethnic group, may not be applicable to another. Cultural and religious beliefs, as well as different taste preferences, are some of the factors which influence dietary habits among ethnic minority groups. Poor knowledge among healthcare professionals of ethnic diets and nutritional needs of minority populations, particularly during critical life stages such as pregnancy, may be a barrier to the provision of appropriate and effective dietary advice.5

Consideration of traditional foods and cultural and religious factors that affect dietary choices were highlighted in a recent review of studies describing the provision of dietary advice to type 2 diabetic patients from ethnic minority groups.6 Furthermore, a pilot study of dietary approaches to the treatment of gestational diabetes among a multi-ethnic pregnant cohort reported that the provision of ethnic-specific meal plans improved pregnancy outcomes compared to standard dietary advice.7 Given the importance of maternal nutrition for optimal health and pregnancy outcomes, there is a need to identify women from minority ethnic groups that may be at risk of marginal nutritional status in the preconception and antenatal periods, and to adapt established nutritional policies and dietary advice to meet their individual and cultural needs.

Migrant women from developing countries, such as those in Sub-Saharan Africa (SSA), are one such ethnic group at risk of poor pregnancy outcomes, arising from a background of poverty, food insecurity, suboptimal healthcare facilities, frequent infections and frequent pregnancies.8 Nigerians are the most prevalent African population living in several developed countries, including the United States,9 United Kingdom10 and Ireland.11 Studies conducted among pregnant Nigerian women living in Nigeria have revealed a high prevalence of both under- and over-nutrition, various micronutrient deficiencies and subsequent obstetric complications including hypertension, anaemia, low birth weight and maternal and perinatal mortality.12 However, there are few published studies to date which describe the pregnancy outcomes of immigrant Nigerian women living in Western countries, and no studies to our knowledge which examine the link between nutrition, diet and pregnancy outcomes among this immigrant group.

Although there is a paucity of literature on the dietary habits of pregnant immigrant Nigerian or other SSA women living in developed countries, this ethnic minority group in the UK has been identified as being at high risk of obesity and deficiencies of calcium, iron and vitamin D outside of pregnancy.5 If such nutritional issues translate into pregnancy, it would be imperative that these women receive appropriate nutritional and antenatal care to reduce their risk of adverse pregnancy outcomes. The current study aims to explore the dietary intakes of a sample of Nigerian pregnant immigrant women living in Ireland, in order to identify any nutritional issues of concern and whether different food-based dietary guidelines may be required to meet their needs.

Section snippets

Methods

The study group comprised of Nigerian women in the second and third trimesters of pregnancy, attending antenatal clinics at the National Maternity Hospital, Dublin, Ireland. Healthy, non-diabetic women, of Nigerian ethnicity, aged ≥18 years and >12 weeks gestation were recruited into the study. Exclusion criteria were diabetes (gestational or pregestational), patients attending the clinic as an emergency case, non-Nigerian ethnicity, age <18 years, ≤12 weeks gestation and poor understanding of

Results

Of 56 Nigerian women that were approached and invited to participate in the study, 52 women gave consent and four women declined. The demographic details of the study participants are presented in Table 1. Seven women were late-bookers to the antenatal clinic and thus, BMI was not calculated for these women. The mean BMI of the remaining 45 women was 31.2 kg/m2, which falls into the obese category according to the World Health Organisation (WHO).28

Ninety per-cent of the entire study population (

Discussion

To our knowledge, the present study is the first of its kind to investigate the dietary intakes of pregnant immigrant women from a Sub-Saharan African country. Overall, it appears that traditional African dietary practices remain in this population group, despite the majority having lived in Ireland for several years. The distribution of macronutrient intakes as a percentage of total energy reveals a healthy dietary pattern which is compliant to healthy eating guidelines.19, 20 However, after

Acknowledgements

The authors would like to thank all mothers who participated in the study.

Ethical approval

Full ethical approval was granted for this study from the National Maternity Hospital Ethics Committee.

Funding

This study was funded by the Health Research Board, Ireland, grant number R10909. The funder had no role in the study design; collection, analysis and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication.

Contribution to authorship

KL Lindsay recruited participants, conducted dietary assessments,

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