As a part of an on-going project to develop a dietary risk assessment tool for low income pregnant women, we evaluated the performance of a modified version of an existing semi-quantified food frequency questionnaire (FFQ) in terms of validity and assessed the nutrient intakes of a sample of English speaking, Caucasian pregnant women living in economically deprived and non-deprived electoral wards of Sheffield. Two statistical techniques were also applied to on energy-adjusted data for identification of discriminatory food items among women living in economically deprived wards. A critical assessment of the influence of individual and social factors on food choice, of the dietary intakes of different socioeconomic groups, of the importance of nutrition prior and during pregnancy and of methods of dietary assessment and associated methodological concerns was undertaken. One-hundred and twenty three pregnant women were recruited for the validation study, which were also included in the main study analysis together with another sub sample of 127 pregnant women. In total 250 pregnant women aged 15 to 43 years provided complete dietary information, of which 174 resided in the 40% most deprived electoral wards and 76 in other wards within Sheffield. The validity of the FFQ was tested against two 24-hour recalls. The FFQ overestimated nutrient intakes but an acceptable agreement between the two assessment methods was observed. Macronutrient intakes of the Sheffield women were similar to other UK pregnancy studies. Mean intakes of calcium, iron, folate and vitamin C however, were relatively lower. Subgroup comparisons showed wide variations in nutrient intakes. The results of regression and discriminant analyses identified food items which might be of importance in the evaluation of the habitual diet of the low income group of pregnant women in Sheffield. The study findings confirm that the FFQ is a valid tool for categorising pregnant women according to dietary intake and that the diet of pregnant women in Sheffield is possibly characterised by low intakes of important nutrients for pregnancy. This study makes an important contribution to future planning and development of interventions for pregnant populations in Sheffield and similar conurbations.

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The study examines the perceptions of diet and nutrition and measures the nutritional consumption of primagravid women, during pregnancy and post partum. The aim was to establish the nutritional knowledge and nutritional status of such women, based on self-reported diet diaries. Quantitative and qualitative data were collected from a sample of 39 primagravid women recruited from five general medical practices in Wiltshire, England, United Kingdom. Thirty-nine participants took part in the study during the first trimester of pregnancy and 37 continued in the study to six months post partum, keeping a self-reported diet diary for one week at the end of the first trimester, third trimester and six months post partum. At the same points in time, participants completed a Likert scale questionnaire based on the Theory of Planned Behaviour (Ajzen, 1985) that measured attitudes and intentions towards eating habits during pregnancy. Interviewer administered questionnaires were conducted at each time point to assess the participants socio-economic status and nutritional knowledge. The self-reported diet diaries were analysed using Dietplan software that measures nutritional intake based on Recommended Daily Allowances (RDAs). Results indicate that some women had under-consumption of a number of nutrients pre and post partum while some participants over-consumed a number of nutrients during their pregnancy. There were gaps in the nutritional knowledge of some participants, suggesting that revised nutritional educational policies should be introduced. Time was the major determinant of poor nutrition post partum, suggesting a need for time management and educational interventions for primagravid women. Small hospitals with Baby Friendly Accreditation were rated more positively than large general hospitals. These results suggest a need for larger hospitals to work towards Baby Friendly Accreditation. The study ascertained that there is a scarcity of research into the effects of over-consumption of nutrients during pregnancy and a recommendation is made to address this issue. A further recommendation is that modifications should be made to the Theory of Planned Behaviour (Ajzen, 1985) on the basis of the findings of this study which suggest that the model should be looked at in reverse, as the influence of a number of factors reduced over time. A modified model of the Theory of Planned Behaviour (Ajzen, 1985) is proposed.

Eating disorders occur primarily in young women, many of whom are of child bearing age. Pregnancy has often been viewed as a period of great developmental change for women. Many psychological processes such as body image, autonomy, dependency and relationships to one's own parents, which have been hypothesised to be important in the development of eating disorders, are highlighted during pregnancy. This may mean that pregnancy is a particularly stressful time for women with eating disorders. The limited amount of previous research in this area has suggested the potential for pregnancy to exert a positive or negative influence on eating disorder symptoms. The present study employs a qualitative methodology, with the aim of exploring the experiences of pregnancy for women with eating disorders and elucidating the meaning behind any changes to the course of eating disorder symptoms. Twelve women who had active eating disorders at the time they became pregnant were retrospectively interviewed using a semi-structured interview schedule. The interview transcripts were analysed using a grounded theory approach. Following this analysis a proposed theoretical model of women with eating disorders' experiences of pregnancy was devised. Central to this model are conflicts between a sense of freedom and a lack of personal control and between a woman's identity as a mother and her eating disordered identity. These conflicts are proposed to be mediated by a woman's sense of physical and psychological attachment to her baby and her sense of her baby as a person. The strengths and limitations of the research are discussed and implications of the theory for clinical practice and future research are suggested.

M. Tech Food Service Management (Hospitality, Tourism and Public Relations, Faculty of Human Sciences), Vaal University of Technology. / Good maternal nutrition is vital for the health and survival of the developing foetus. Nutritive inadequacy has been associated with pregnant women in developing countries particularly Sub Saharan Africa. Adequate intake of both macro and micronutrients by this vulnerable group must be ensured to avoid maternal and infant morbidity and mortality. In this study, a novel approach was employed to develop a cost effective, culturally acceptable and nutrient-dense food multi-mix (FMM) supplement that would help meet 20-25 percent of the recommended daily allowance (RDA) of pregnant women aged between 20and 30 years in the Vaal region. Twenty FMM supplements were formulated using South African food composition tables to ensure adequate nutritional content. Two out of the twenty, were selected and named FMM C1 and C3 respectively. FMM C I and C3 was selected owing to their better nutrient contents and affordability when compared with the others. Food items used to formulate FMM C 1 included maize meal, pea powder, peanut dry, milk powder and kidney beans. FMM C3 was formulated with sorghum, maize meal, peanut dry and onion powder. Chosen food items were dried, roasted, ground and mixed together proportionately. FMM supplements (C 1 & C3) were analyzed using standard laboratory techniques to determine their nutrient content. Results obtained were from the Agricultural Research Council (ARC). The shelf life of the FMM supplements was microbiologically tested. Shelf life testing proved safety for the time of consumption, as very little microbiological growth was found in 28 days. The FMM supplements were then incorporated in the development of two acceptable recipes (soup and gravy).Simple recipe leaflets were developed for use by the subjects. The process proved that it is possible to formulate a FMM or any other food product according to certain formulation criteria since formulated FMM supplements (C1 and C3) met the criteria of at least 20% RDA of Protein (g). However, the criteria for micronutrients and energy were difficult to meet as folate iron and energy showed lower percentages of 10%, 14% and 18% respectively in the experimental situation. Sensory evaluation was conducted to ascertain the acceptability of the developed recipes (soup and gravy). The sample consisted of pregnant women randomly selected from John Haynes and Sharpeville clinics respectively, it can be concluded it is possible to formulate and develop products that were culturally acceptable to the consumers (pregnant women) as sensory analysis indicated the majority (85%) of the respondents liked the gravy and 65% liked the soup. Further research is needed to address the impact on nutritional status, long-term compliance and development of range of FMM with various ingredients to determine the most nutritional, cost effective and acceptable product for pregnant women.

D. Tech. (Food Service Management, Dept. of Hospitality, Tourism and PR management), Vaal University of Technology / The main objective of this study was to develop a cost-effective, culturally acceptable, nutrient-dense food multimix (FMM) based on local food staples for pregnant women in the Vaal region. The impact of the consumption of the multimix on the nutritional status of the women, dietary diversity and outcomes of pregnancy was assessed in an intervention study by measuring the same variables as for a pilot study where the nutritional status of pregnant women was determined. Compliance was measured through monitoring of the FMM consumption and sensory evaluation tests. Quantitative food frequency questionnaires (QFFQs) and 24-hour recall questionnaires were completed in interviews. Anthropometric and biochemical measurements were recorded. The pilot study indicated that the mean total iron intake was 9,74 mg/day, below the estimated average requirement (EAR) of 22 mg/day for pregnant women. Therefore, 41,7 per cent of the women were found to be iron deficient and 50 per cent suffered from iron deficiency anaemia. Food consumed supplied little iron. Eighty per cent of the women were overweight before falling pregnant. Based on the pilot study, the FMM was developed and subjected to the following processes: chemical analysis, shelf life tests, recipe development and sensory evaluation. The product was then implemented in an intervention programme. A control group of pregnant women received soup powder. The respondents were relatively healthy and did not suffer from any chronic diseases. According to the nutrient intakes measured by the QFFQ, indicating usual dietary intakes, the iron intake of 87,5 per cent of the experimental group and 94 per cent of the control group fell below the EAR before intervention. After the intervention it improved in that the iron intake of 35,2 per cent of the experimental group and 33,3 per cent of the control group fell below the EAR. The top 10 items consumed by the experimental group during pre- and post-intervention were mainly rich in carbohydrates. Food containing iron absorption inhibitors such as tannin in tea and phytates in maize meal and bread were among the top 10 foods listed. The highest number of individual food items consumed by an individual in seven days was 39 before the intervention and 52 after the intervention, among the experimental group. The individual food variety improved after the intervention. The reason for this could be the inclusion of the FMM in their diets. The majority of the respondents consumed eight to nine of the nutritious food groups before and after the intervention. The mean food variety score (FVS) for the control group was 38,9 (±10,5) before the intervention, which decreased to 35,8 (±8,39) after the intervention. No improvement in FVS was observed after the intervention in the control group and the FVS indicated medium dietary diversity (30-60 food items). The post-intervention results show that there was an improvement in most of the iron variables. The experimental group showed statistically significant differences between pre- and post-intervention measurements in transferrin and haematocrit levels and the control group in haematocrit levels. All the babies born to the mothers of both the experimental and control groups were healthy with measurements in the normal range. The reason for this could be that the inclusion of the FMM and soup powder in the diets of the experimental and control group, respectively, made the women more aware of the importance of pregnancy monitoring. Furthermore, the attention given to the women by the clinic sisters and the researchers could have contributed to all the improvements mentioned.

Thesis (Ph.D (Nutrition)) --University of Limpopo, 2009 / AIM: This study aimed to assess the nutritional status of non-pregnant women of childbearing age residing in a rural area of Limpopo Province, South Africa, and the effect of fortification of staple foods on their folate and iron status. The following objectives were carried out:  To assess the socio-demographic status and maternity history of non-pregnant rural women of childbearing age.  To determine the following anthropometric measurements; body weight, height, body mass index, waist and hip circumference, and waist hip ratio of women of childbearing age.  To assess dietary intake of non-pregnant rural women of childbearing age using 24-hour recall and quantitative food frequency questionnaires prior to fortification of foods.  To determine folate status of non-pregnant rural women of childbearing age by levels of serum and red blood cell folate, and assessing vitamin B12 and homocysteine levels before and after fortification of foods.  To determine iron status of non-pregnant rural women of childbearing age by full blood count, serum ferritin, iron, total iron binding capacity, transferrin saturation and C–reactive protein before and after fortification of foods.  To determine albumin and liver enzymes (ALP, ALT, AST and GGT) of women of childbearing age before and after fortification.  To assess mycotoxins (i.e. fumonisins) in morogo samples collected randomly among participants from the study area. / the University of Limpopo Research Department,and the National Research Foundation