Exploring Australian women’s level of nutrition knowledge during pregnancy: a cross-sectional study

Figures & data

Table 1 The composition and α coefficient of the five dimensions of nutrition during pregnancy survey

No	Dimension	Total no of itemsa	Type of question	Reference	No of newly added itemsb	No of modified itemsc	α coefficient
1	Women’s reported adherence to the five food groups and extras	6	Open-ended, six-question tool	Hoerr et al^Citation37	3	–	–d
2	Women’s attitudes toward key nutrition topics	17	5-point Likert scale	Worsley et al^Citation36	10	4	0.805e
3	Women’s level of motivation to maintain a healthy diet	4	Three questions: 10-point Likert scale One question: 5-point Likert scale	Skouteris et al^Citation34	–	1	0.807e
4	Women’s knowledge of the AGHE during pregnancy and a range of diet-related matters	70	Multiple-choice questions	Hendrie et al^Citation35 Worsley et al^Citation36 Bondarianzadeh et al^Citation32	15	12	0.801f
5	Women’s knowledge of guidelines for weight gain and its management during pregnancy	12		Hendrie et al^Citation35	8	4	–d

Notes:

a Total number of items, including items that have been taken from the validated surveys without any modification, modified items, and newly added items.

b Number of new items that were devised for this survey.

c Number of items that have been taken from the validated surveys and been modified to suit the study aim.

d Reliability test was not calculated for the first and fifth dimensions because they contained multidimensional scale questions (eg, open-ended questions, multiple-choice questions).

e Cronbach’s alpha was calculated to measure reliability of measurements with scale type of questions.

f K–R 20 was calculated to measure reliability of measurements with dichotomous choices.

Abbreviations: AGHE, Australian Guide to Healthy Eating; K–R 20, Kuder and Richardson Formula 20.

Table 2 The composition of the fourth dimension of nutrition during pregnancy survey: women’s knowledge of the AGHE during pregnancy and a range of diet-related matters

No	Nutrition knowledge domain	Description	No of items	Correct responses (score)
1	Recommended intakes of five food groups and extras	One question asked women if they were familiar with the AGHE for pregnancy	1	NAa
		The recommended number of serves of the five core food groups (fruit, vegetables, dairy foods, meat and its alternatives, and bread and cereals) and extrasb based on AGHE for pregnancy	5	5
2	Food sources of nutrients	Foods high or low in sugar, salt, dietary fiber, and saturated fat Macronutrient (fat) has the highest energy density Food items that are rich sources of vitamin A, iron, iodine, and omega-3 fatty acids	22	22
3	Vitamins and other supplements during pregnancy	Mandatory supplements (ie, folic acid and iodine) during pregnancy Micronutrients that may pose a risk when taken during pregnancy	2	5c
4	Healthy meal proportion and serving size	Identification of food group proportions for a healthy meal pattern Portion size of certain food items from each food group	14	14
5	Choosing everyday food	Healthier and best options for foods that are: – Low-fat, high-fiber, light meal – Healthier serving options for spaghetti Bolognese (more carbohydrate in spaghetti than fat in the sauce) – Low in sugar	3	3
6	Diet–health relationship	Management of pregnancy-related symptoms: – Nausea and vomiting – Heartburn – Constipation	12	12
7	Importance of key nutrients in pregnancy	Nutrient function in the body and risk of nutrients’ deficiency (for iodine and omega-3 fatty acids)	2	2
8	Food safety practice in pregnancy	Safe food to consume in pregnancy Safe and unsafe food preparation and storage practice Perception of listeriosis Safe fish option to consume in pregnancy	9	9

Notes:

a Not applicable as this question was not included in the scoring process; the women were given two answers (yes or no) to choose from.

b Extras or “discretionary choices”, including energy-dense but nutrient-low foods such as confectionery, jam, cakes, meat pies, and pastries.

c These two items had more than one correct response options; the first question had two possible correct answers (folic acid and iodine) and the second one had three possible correct answers (vitamins A, D, and B₆).

Abbreviations: AGHE, Australian Guide to Healthy Eating; NA, not applicable.

Figure 1 The study recruitment strategy.

Abbreviation: NSW, New South Wales.

Table 3 Characteristics of the study sample

Characteristics	Entire sample (N=400)	%
Prior pregnancies
None	196	49
One	129	32.2
Two and more	75	18.8
Stage of pregnancy
First trimester	40	10
Second trimester	151	37.8
Third trimester	209	52.2
Planned pregnancy
Yes	325	81.2
No	75	18.8
Age
<20 years	12	3
20–29 years	195	48.8
30–39 years	178	44.5
≥40 years	15	3.7
Marital status
Single	23	5.8
Married/de facto	372	93
Separated/divorced/widowed	5	1.2
Education
Some high school or less	26	6.5
High school completed	57	14.2
TAFE	104	26
Tertiary education	213	53.3
Household income
<AU$25,000/yr	51	12.8
AU$25,000–AU$50,000/yr	97	24.2
>AU$50,000/yr	252	63
First language
English	332	83
Other	68	17
Having health and nutrition-related qualification
Yes	67	16.8
No	333	83.2
Seen by dietitian and/or nutritionist
Yes	122	30.5
No	278	69.5
Prepregnancy BMI	% (n=326)a	Total =81.5a
Underweight	15	3.8
Normal	152	38
Overweight	82	20.5
Obese	77	19.3

Note:

a Prepregnancy BMI was calculated for only 319 respondents as 69 out of 388 respondents did not provide either prepregnancy self-reported height or weight.

Abbreviations: TAFE, Technical and Further Education; yr, year; BMI, body mass index.

Table 4 Descriptive statistics of women’s nutrition knowledge domains

Nutrition knowledge domain	% mean (correct answers)	Mean	Total score	SD
Food safety practice in pregnancy	84.22	7.58	9	1.72
Diet–health relationship	71.16	8.54	12	2.18
Food sources of nutrients	66.81	14.70	22	3.23
Choosing everyday food	58.00	1.74	3	0.66
Recommended intakes of five foods groupsa and extras or “discretionary choices”b	50.20	2.51	5	1.01
Healthy meal proportion/serving size	49.50	6.93	14	2.22
Multivitamin and supplements during pregnancy	48.40	2.42	5	1.11
Importance of key nutrients in pregnancy	46.50	0.93	2	0.71

Notes:

a Fruit, vegetables, dairy foods, meat and its alternatives, and bread and cereals.

b Including energy dense but nutrient-low foods such as confectionery, jam, cakes, meat pies, and pastries.

Abbreviation: SD, standard deviation.

Table 5 Women’s awareness of food sources of certain macro-and micronutrients and energy density of fat

Food source is high/low of following nutrients	Correct answers	Correct, n (%)	Incorret, n (%)
Sugar
Bananas	Low	333 (83.2)	67 (16.8)
Strawberry yoghurt	High	279 (69.8)	121 (30.2)
Orange 35% juice	High	357 (89.2)	43 (10.8)
Muesli bar	High	317 (79.2)	83 (20.8)
Salt
Sausages	High	349 (87.2)	51 (12.8)
Pasta	Low	221 (55.2)	179 (44.8)
Spinach	Low	363 (90.8)	37 (9.2)
Wholegrain bread	High	51 (12.8)	349 (87.2)
Dietary fiber
Cornflakes	Low	226 (56.5)	174 (43.5)
Bananas	High	300 (75)	100 (25)
Wholegrain bread	High	368 (92)	32 (8)
Fish	High	258 (64.5)	142 (35.5)
Saturated fat
Lean red meat	Low	323 (80.8)	77 (19.2)
Whole milk	High	258 (64.5)	142 (35.5)
Avocado	Low	240 (60)	160 (40)
Vegetarian pastry	High	246 (61.5)	154 (38.5)
Select the most energy dense macronutrient	Fat	86 (21.5)	314 (78.5)
Food source rich in following micronutrients
Vitamin A	Liver	152 (38)	248 (62)
Iron	Red meat	255 (63.7)	145 (36.3)
Iodine	Sea food	261 (65.2)	139 (34.8)
Omega-3 fatty acids	Oily fish	360 (90)	40 (10)

Table 6 Multiple regression analysis of selected demographic factors

Predictors	Nutrition knowledge
	Unstandardized β	Standardized β	P-value
Household income	2.389	0.214	0.000
Education	1.574	0.225	0.000
Language	−4.453	−0.216	0.000
Age	1.926	0.154	0.001
Stage of pregnancy	−1.127	−0.101	0.016
Having health/nutrition-related qualification	−2.046	−0.099	0.020
Prior pregnancy	−0.973	−0.096	0.028
	Multiple R=0.584	Adjusted R^2=0.326	F=22.477, P<0.000

Note: β, beta coefficient.

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