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Diet Quality and Physical Activity in Low-Income Pregnant Women
Antonia Palazzolo
Advisor: Alicja Stannard*
Sacred Heart University, Fairfield Connecticut
Abstract
Physical activity (PA) and a healthy diet are essential during pregnancy. Low income females are at
greater risk due to diminished options of nutritional foods. Research examining both PA and dietary habits
is limited in low-income pregnant women. Purpose: To examine the relationship among diet quality, PA
recommendations and health behaviors in low-income pregnant women. Hypothesis: It was hypothesized
that most women will not meet PA and F&V recommendations and will not smoke or drink alcohol.
Methods: Pregnant and postpartum women low-income women (N=113) were recruited nationwide and
completed an online survey on demographics, fruits and vegetable (F&V) intake, alcohol consumption,
smoking and physical activity using the International Physical Activity Questionnaire. Variables were
categorized as meeting PA recommendations (≥ 8.25 MET hr/wk) and meeting F&V recommendations (≥
4.5 cups/day). Descriptive statistics were performed for all variables.
Results: Mean age was 29.4 ±5.8. Most women were enrolled in WIC program (55.8%), were college
graduates (50.4%), White (75.6%), and met PA recommendations (56.5%). Only 14.2% met FV
recommendations while 5.3% reported consuming alcohol and 9.7% reported smoking. Only 13.3% of
women met both PA and F&V recommendations while 11.5% additionally refrained from smoking and
drinking.
Conclusion: PA and diet quality are necessary in healthy pregnancies but very low percent of low-income
women meet both recommendations. Further studies should be conducted to understand diet patterns, PA
and other health behaviors in low-income pregnant women.
(Key Words: Physical Activity, Low-Income, Diet, Pregnancy)
Design: cross-sectional study
Participants:
• 113 low-income pregnant and postpartum women (<1 yr)
• Recruited nationwide using the ResearchMatch platform
• The purpose of the study was to examine the relationship between diet quality, PA
recommendations and health behaviors in low-income pregnant women.
• We hypothesized that most of the low-income women will not meet F&V
recommendations or the recommended amounts of PA. These women will not
smoke or drink alcohol.
45
35
Percent (%)
Protocols:
• Online survey including demographics, pregnancy health
behaviors, F&V Screener, International Physical Activity
Questionnaire
• PA was scored based on established protocol. Meeting PA
recommendation was categorized as ≥ 8.25 MET hr/wk
• FV screener was scored based on established protocol.
Meeting FV recommendation was categorized as > 4.5
cups/day.
30
25
20
14.2
15
11.5
10
5
0
PA REC.
*REC. = recommendations
F&V REC.
PA & FV REC.
Type of Health Behavior
PA & FV REC. + NO
DRINK/SMOKE
Results
.
Table 1: Characteristics of the
Participants
Age
WIC Enrolled
Education (≥some college)
Pre-pregnancy BMI
Underweight
Normal
Overweight
Obese
Race (multiracial included)
Caucasian
African American
Hispanic
Other
Smoking
Alcohol Consumption
n=113
29.4 ±5.8 yrs
56.3%
87.4%
3.4%
45.4%
20.2%
28.6%
75.6%
17.6%
8.4%
10%
9.2%
5%
• Our findings indicate that only a small amount of the low-income women reached both the
recommended levels of PA and F&V intake. However, this partly supports our hypothesis since
some women smoked and drank during pregnancy. The data supports our hypothesis; the lack of
nutritious diets combined with regular PA in low-income pregnant women.
• One study determined the amount of PA and diet quality are lower in low-income populations of
pregnant women than in mid to high income populations.7 This was not the case here, as
approximately 30% of mid/high income women meet recommendations. This may be possible due
to the type of jobs the women have or the level of their education.
• Other studies also reveal the lack of proper nutrition in low-income pregnant women. A ‘lowincome’ study of white and Native American women, revealed 9.6% of women ate the
recommended vegetable intake and 16% met the recommended fruit intake.5 Our results were
similar in that only 14.2% of the women met F&V intake.
• Our results show small percentage of drinkers (5%) and smokers (9.2%). A longitudinal study of
‘low income’ pregnant women revealed that 10% of women who have never smoked, initiated
smoking during their pregnancy. This may be a result of stress and low socioeconomic status.8 In a
cross-sectional study of ’low income’ pregnant women in Alabama, 5.1% reported consuming
alcohol.9 Both studies are extremely close to our own results.
Conclusion
PA and reaching the recommended intake of F&V are necessary in healthy pregnancies and are not
common among low-income pregnant women. Further studies should be conducted to understand the
patterns of diet and physical activity in low-income pregnant women and what other factors contribute
to this.
References
1.
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9.
*This is a sub-sample of a larger study conducted by Michigan State University, which involved:
Stannard, AB, Mudd, LM, Pivarnik, JP, Weatherspoon, L, & Kerver, J.
13.3
Discussion
Introduction
Purpose and Hypothesis
50
40
Analysis:
• Descriptive statistics were performed for all variables.
• The potential benefits of starting or continuing PA during pregnancy is evident in
most women and has been shown to have minimal risks although some
modifications may be necessary because of anatomic and physiological changes and
fetal requirements which are normal throughout a pregnancy.1
• The US Department of Health and Human Services in 2008 recommends at least
150 minutes, per week, of moderate-intensity aerobic activity.2
• Following a healthy diet of nutrient dense foods and reaching the recommended
F&V intake has also shown to be beneficial for the mother and baby and is
necessary to maintain good health during pregnancy.3 The recommendations for
F&V intake for women include two cups of fruit and two and a half cups of
vegetables daily.4
• When looking at ‘low income’ women during pregnancy, they may gain enough
weight to have a healthy pregnancy, but still have nutrient deficient diets.5
• Increasing F&V intake is necessary to ensure healthy pregnancies. The benefits of
increasing F&V when combined with PA such as walking more than five thousand
steps per day can increase the likelihood of mothers achieving gestational weight
gain and preventing postpartum weight retention.6
• Research examining both PA and dietary habits is limited in low-income pregnant
women.
Figure 1: Percent of Women Meeting
Pregnancy Health Behavior
Recommendations
43.4
Methods
American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. Clin
Obstet Gynecol. 2003;46(2):496-499.
Office of Disease Prevention and Health Promotion:. https://health.gov/paguidelines/guidelines/chapter7.aspx
Morton SMB, Grant CC, Wall CR, et al. Adherence to nutritional guidelines in pregnancy: evidence from the Growing
Up in New Zealand birth cohort study. Public Health Nutr. 2014;17(9):1919-1929. doi:10.1017/S1368980014000482.
United States Department of Agriculture: https://www.choosemyplate.gov
Watts V, Rockett H, Baer H, Leppert J, Colditz G. Assessing diet quality in a population of low-income pregnant
women: a comparison between Native Americans and whites. Matern Child Health J. 2007;11(2):127-136.
doi:10.1007/s10995-006-0155-2.
Cohen TR, Koski KG. Limiting Excess Weight Gain in Healthy Pregnant Women: Importance of Energy Intakes,
Physical Activity, and Adherence to Gestational Weight Gain Guidelines. Journal of Pregnancy. 2013;2013:e787032.
doi:10.1155/2013/787032.
Bhargava, A. (2004). Socio-economic and behavioural factors are predictors of food use in the national food stamp
program survey. The British Journal of Nutrition, 92(3), 497-506. doi:http://dx.doi.org/10.1079/BJN20041210
Webb DA, Culhane JF, Mathew L, Bloch JR, Goldenberg RL. Incident Smoking During Pregnancy and the Postpartum
Period in a Low-Income Urban Population. Public Health Rep. 2011;126(1):50-59.
Li Q, Hankin J, Wilsnack SC, et al. Detection of alcohol use in the second trimester among low-income pregnant
women in the prenatal care settings in Jefferson County, Alabama. Alcoholism, Clinical And Experimental Research.
2012;36(8):1449-1455. doi:10.1111/j.1530-0277.2012.01745.x.