Abstract
Objective: This scoping review aimed to systematically map and describe the existing evidence regarding the knowledge, attitudes and practices of health professionals with regard to plant-based diets during pregnancy and to highlight areas for further research. Design: Following a pre-registered protocol, online databases were searched using a comprehensive search string, in addition to selected grey literature sources, and reference lists of included studies. The studies were independently screened for eligibility by two authors, SM and JM. Data from all eligible studies were charted by the first author, and a narrative summary was performed. Setting: Maternal health care services. Results: Ten studies were included for review, from New Zealand (n 2), Australia (n 2), Germany, Netherlands, United Kingdom, France, Italy and Peru. Most of these studies were observational, employed various validated and non-validated survey instruments, interviews and one education intervention. Knowledge was the most frequently assessed outcome in the reviewed studies. Health professionals’ knowledge of plant-based nutrition in pregnancy was reported to be limited and frequently attributed to a lack of nutrition training. Participants’ personal dietary patterns and work specialisation appear to be closely associated with their knowledge, attitudes and practices regarding plant-based diets. Conclusion: This review identified a significant research gap regarding health professionals’ practices in relation to plant-based diets during pregnancy. Additionally, this review has demonstrated the need for further research, awareness and practice protocols to promote high-quality care and education or professional development to address the prevalent lack of knowledge among this group.
Generated Summary
This scoping review aimed to systematically map and describe the existing evidence regarding the knowledge, attitudes, and practices of health professionals with regard to plant-based diets during pregnancy. The review followed a pre-registered protocol, searching online databases and grey literature sources. Data from eligible studies were charted, and a narrative summary was performed. The review included ten studies, primarily observational, from various countries. The included studies assessed health professionals’ knowledge, attitudes, and practices concerning plant-based diets in pregnancy, with knowledge being the most frequently assessed outcome. The studies used surveys, interviews, and one education intervention to gather data from health professionals working in maternal healthcare settings. The primary aim of the studies was to identify and map available evidence, identify gaps in the existing literature, and shed light on reoccurring factors or characteristics related to the knowledge, attitudes, and practices of health professionals concerning plant-based diets during pregnancy.
Key Findings & Statistics
- A total of 3057 articles were initially found, with 1698 duplicates excluded.
- Seventy-five articles were eligible for full-text screening, with ten studies ultimately included in the review.
- The studies included participants from New Zealand (n = 2), Australia (n = 2), Germany, Netherlands, United Kingdom, France, Italy, and Peru.
- Most of the studies were observational, employing various instruments such as survey instruments, interviews, and one educational intervention.
- Knowledge was the most frequently assessed outcome in the reviewed studies.
- Health professionals’ knowledge of plant-based nutrition in pregnancy was reported to be limited.
- 55.7% of health professionals identified PBD mothers at greatest risk of vitamin B12 deficiency.
- 14.1% of health professionals correctly identified that n-3 PUFA are low or absent in PBD individuals.
- 7.2% of health professionals identified that Zn has greater bioavailability in an omnivorous diet.
- 16.3% of health professionals identified that plant proteins are less bioavailable than animal protein.
- 69.8% of health professionals were moderately confident/confident advising vegetarian patients.
- Significantly more vegetarians (90.5%) believe a planned vegetarian diet is appropriate for all life stages, compared with 45.2% of semi-vegetarians, 24.1% of omnivores.
- Significantly more vegetarians (76.2%) correctly answered a planned vegetarian diet does not increase negative outcomes compared with 35.6% semi vegetarians and 30.6% of omnivores.
- The studies included a range of health professionals, including midwives, obstetricians, general practitioners, and dietitians, with sample sizes ranging from 7 to 475 participants.
- Midwives reported giving nutritional advice (30.5%), referring to dietitians (24.8%), and checking blood Hb (24%).
- Obstetricians reported checking general blood vitamin status (23.5%), giving supplements (15.1%), and referring to dietitians (14.5%).
- Midwives, dietitians, and obstetricians, reported concerns regarding the level of knowledge when giving advice to vegetarian patients, almost half reporting this caused problems for them.
- 75% of health professionals believe PBD put people at risk of iron deficiency.
- 50% of health professionals believe vegetarians are at risk of B12 and protein deficiency.
- More than two-thirds of health professionals believe vegans are at risk of B12 and protein deficiency.
- 81% of health professionals felt ill-informed regarding PBD.
- 51% of respondents believed that a lacto-ovo vegetarian diet was unsuitable for pregnant and breastfeeding individuals.
- 91% believed vegan diets were unsuitable for pregnant individuals.
- 4 studies reported on the practices of health professionals, and less than 3% reported having a practice protocol for managing PBD in pregnancy.
Other Important Findings
- Health professionals’ knowledge of plant-based nutrition in pregnancy was reported to be limited and frequently attributed to a lack of nutrition training.
- Participants’ personal dietary patterns and work specialisation appear to be closely associated with their knowledge, attitudes, and practices regarding plant-based diets.
- Frequently reported sources of knowledge or information used by health professionals included: knowledge gained from education, brochures, pamphlets and information sheets distributed by organisations or government publications, scientific journals, nutrition organisations and general knowledge.
- The studies demonstrated the need for further research, awareness and practice protocols to promote high-quality care and education or professional development to address the prevalent lack of knowledge among this group.
- Participants reported concerns about their lack of knowledge with regard to PBD, including a lack of confidence advising on, or discussing PBD in pregnancy, and a limited ability to effectively advise individuals following PBD in pregnancy.
- The review identified a significant research gap regarding health professionals’ practices in relation to plant-based diets during pregnancy.
- In practice, it is often midwives and other antenatal care providers, not dietitians, who are responsible for giving dietary advice during pregnancy.
- The health professionals surveyed in the reviewed studies frequently attributed their own lack of knowledge to a lack of training and education in plant-based nutrition.
- A study demonstrated the effective use of a nutrition education intervention for midwives, resulting in a significant improvement in pregnancy nutrition knowledge (including aspects related to PBD).
Limitations Noted in the Document
- Restricting results by language may have led to the omission of some non-English, non-Western literature.
- The studies included are from a diverse range of geographic locations, they are all upper-middle- (Peru) and high income, with established health-care systems that require extensive education and training to work as health professionals.
- In some instances, this may limit the relevance of these results to developing nations, whose populations are more at risk of undernutrition and experience limited access to high-quality antenatal care.
- The current review used a systematic approach to perform a scoping review, allowing for inclusion of evidence from a wide range of sources. Despite the rigorous approach, some limitations must be noted.
- While the intervention study demonstrated an overall improvement in health professional knowledge, the study was limited by a small sample size, high attrition rate and a limited range of questions used to assess changes in nutrition knowledge.
Conclusion
This scoping review highlights a significant research gap concerning health professionals’ practices regarding plant-based diets during pregnancy, underscoring the need for further investigation in this area. The evidence suggests that health professionals’ knowledge of plant-based nutrition in pregnancy is often limited and that this is frequently associated with a lack of specific training. In addition, there is a need for awareness, and practice protocols to promote high-quality care and education or professional development among this group. The study emphasizes the importance of education and training for health professionals to improve their knowledge of plant-based diets and to enhance their ability to provide appropriate advice to pregnant women. There is a clear need for specific curriculum regarding PBD during pregnancy, tailored to the health professionals frequently involved in antenatal care, such as midwives, obstetricians, and family doctors. The lack of protocols among health professionals, combined with the self-reported lack of knowledge, indicates a need for comprehensive guidelines to standardize the approach to PBD in pregnancy. The findings suggest that the dietary patterns of health professionals themselves and their professional specializations influence their attitudes and practices towards plant-based diets. The need for updated and detailed guidelines for PBD during pregnancy is crucial to support informed decision-making, highlighting the impact on pregnant individuals. This lack of knowledge and confidence reported by health professionals suggests that pregnant individuals may not be receiving the highest quality of care. The translation of growing evidence into clinical practice and public health initiatives is crucial, coupled with promoting education and resources to address the identified gaps. These actions will enhance the quality of care provided to pregnant women following PBD, ultimately improving both maternal and infant health outcomes. The findings also indicate that health professionals’ attitudes are significantly influenced by their own dietary choices, with those following plant-based diets demonstrating more positive perspectives, which can also influence the quality of care provided to patients.