EFFECT OF THE PREGNANCY PERIOD PREPARATION CLASSES ON THE NUTRITIONAL BEHAVIOR OF THE POSTPARTUM PERIOD

EFFECT OF THE PREGNANCY PERIOD PREPARATION CLASSES ON THE NUTRITIONAL BEHAVIOR OF THE POSTPARTUM PERIOD

Habibeh Morteza ^*1, Maryam Rezaeyan ², Seyedeh Tahereh Mirmolaei ³ and Anoshirvan Kazemnejad ⁴

Semnan University of Medical Sciences and Health Services ¹, Semnan, Iran.

Faculty of Nursing and Midwifery ², Islamic Azad University Branch of Borujerd, Lorestan, Iran.

Department of Midwifery ³, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

Department of Biostatistics ⁴, Tarbiat Modares University, Tehran, Iran.

ABSTRACT: Postpartum period is an important step because the mother's body needs to heal and recover, after pregnancy period and childbirth. So taking good care and a balanced diet in the postpartum period, plays an important role in the women's health. Thus, training of nutrition is so necessary at this period. The aim of this study was an evaluation the effect of the pregnancy period preparation classes on the nutritional behavior of the postpartum period. This research is a semi-experimental study. 230 number of the nulliparas admitted to the health centers selected by stratified-cluster sampling method and were placed in the intervention and control groups. Classes for the intervention group were held once every one week in the eight sessions and the duration of each session, was one hour. Collection of data was conducted through questionnaires and in order to its analysis, SPSS software was used. The results for this experiment showed that the groups of intervention and control, were similar in terms of the demographic characteristics but there was a significant difference in nutritional behavior of these groups and the amount of food groups and duration of iron tablet's consumption for the intervention group, were more than the control group (P= 0.000). Therefore, the final results from this investigation showed that, classes of the pregnancy period preparation had positive effects on the nutritional behavior and consumption amounts for the food groups in the postpartum period which indicates the importance of pregnancy period classes and role of midwives in the field of the pregnancy period training.

Pregnancy, Pregnancy period preparation classes, Nutrition, Postpartum

INTRODUCTION: The postpartum period is a very special phase in the life of a woman. Her body needs to heal and recover from the pregnancy and childbirth. A good postpartum care and well-balanced diet during the postpartum period, is very important for the health of a woman ¹. Health education influences one's nutrition and health care knowledge, behavior and attitude toward postpartum practices.

Thus, when promoting contemporary postpartum practices, health education courses should be encouraged ². Anaemia in the postpartum period may be associated with an increased prevalence of breathlessness, tiredness, palpitate ones and maternal infections, particularly of the urinary tract ^{3, 4}. Such symptoms may cause women to experience difficulty caring for their baby and may influence the emotional bond the maternal has with her baby ⁵. Therefore, one of the major causes of the mortality of mother is postpartum anaemia ⁶ and may have a negative effect on physical and mental health status of mothers. Several studies have shown that problem of the postpartum period is high, and these problems may be due to routine and inadequate diet and poor eating habits at this time ⁷. Available Chinese data also suggested that the incidences of constipation and hemorrhoids were associated with lack of exercises and a decreased intake of fruit and vegetables ^{8, 7}. Study of ⁹ demonstrated that there is a strong relation between iron status and depression, stress, and cognitive functioning in poor mothers during the postpartum period. There are likely ramifications of this poorer "functioning" on mother-child interactions and infant development. Anaemia is one of the factors affecting breastfeeding and is associated with the low milk production, mastitis and nipple delay in wound healing ¹⁰.

The use of oral iron supplementation for a few months is a standard treatment for anaemia in the postpartum period ¹¹. Therefore, iron deficiency anaemia during pregnancy and postpartum can lead to serious consequences for both mother and child ¹². It is therefore, essential that iron deficiency is identified early and adequately treated before resulting in iron-deficiency anaemia. For instance, ¹³ discussed that preconception nutrition-specific interventions in particular increased folic acid and multivitamins supplements among pregnant women resulted in positive pregnancy outcomes. Effort to the nutritional awareness increasing and trying to convince it to people in the logical form is the first step in training of nutrition. Because, the nutritional awareness increasing leads to changes in behavior, It's mean that inappropriate or wrong nutritional behaviors replace with the appropriate nutritional behaviors ¹⁴.

Although much educational intervention has focused on the pregnancy-related nutrition and health problems ¹⁵. Such education programs are often not maintained during the postpartum period. The postpartum period received less attention as compared with pregnancy and childbirth ¹⁶. One investigation reported that training classes during the pregnancy period had a positive effect on the nutritional behaviors of pregnant women ¹⁷. Studied the effect of health and nutrition education intervention on the women's postpartum beliefs and practices. Their results showed that women in the intervention group exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits, vegetables, soybean and soybean products as well as nutrition and health knowledge than those in the control groups. Also they reported that the incidence of constipation, leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention group as compared to the control group. Therefore, their results showed that nutritional training had affected on the awareness and nutritional performance in the postpartum period as well as improved the nutritional behaviors during in this period. In another study in America, results of ¹⁸ revealed that the health and nutritional habits of pregnant women were improved after training in the experimental group. Also results of ¹⁹ showed that consumption of fruits and vegetables, significantly increased in pregnant women, after attending in the classes of pregnancy period preparation, but the effects of these classes were not significant on the dairy products and meat consumption.

In research of ²⁰, about the effects of nutritional education on the comparison of dietary intakes before and after the intervention, revealed significant increases in total energy (2.269 to 2.431 kcal), folate (345 to 412 micrograms), Vitamin B-6 (2.1 to 2.5 mg), iron (17.5 to 21.2 mg), zinc (13.6 to 14.7 mg), and calcium (1.175 mg to 1.299 mg) and significant increases in daily servings from the vegetable group (1.5 ± 1.0 to 2.2 ± 1.1 serving per day) and breads/grains groups (3.4 ± 1.4 to 4.1 ± 1.5 servings per day). Also they reported that pregnancy represents an ideal time for health promotion activities. Many women, including adolescents, are interested and willing to change health behaviors to improve the chance that they will deliver a healthy infant.

Therefore, most adolescents who decide to maintain their pregnancy desire to have a healthy baby. In general, adolescents know that nutrition during pregnancy is important to achieve this goal. However, adolescents often lack adequate knowledge of exactly what is needed nutritionally or precisely how to find out ²¹. According to this fact, a few study has been conducted about the effect of prenatal training on the performance of nutrition after childbirth, Therefore, this study was conducted to determine the effect of the classes of the pregnancy period preparation on the nutritional behavior of the postpartum period.

MATERIALS AND METHODS: This study was a quasi-experimental intervention. Samples were 50 pregnant women who admitted to the health care centers in Semnan for prenatal care receiving and had the criteria for participation in this study. Stratified cluster sampling method was used in this study. Characteristics of this study were: nulliparas, gestational age of 18-24 weeks, the ability to reading and writing, being Iranian and dominate for the speaking in Persian, do not having history or known disease, lacking of a bleeding history and threatened for abortion of placenta previa, multifetal pregnancy, cervical incompetence, ectopic pregnancy and history of infertility in the current pregnancy. Data collection method and data collection instrument were a questionnaire. The questionnaire included two parts: the first part was the demographic information and the second part was questions related to the nutritional behavior. Content validity was used to check the validity of the questionnaire and the reliability of it, was approved using the test-retest and with the coefficient of 0.8. In this study, measurement criterion of the nutritional behavior was score that has been achieved by answering to the multiple-choice questions in the questionnaire.

Pregnant women of training group were participated at the training classes (eight weekly training sessions included topics necessary for oral training of prenatal and intrapartum and postpartum for discussion in the form of small groups, past content navigation and along with question and answer) in addition to receiving of the pregnancy period routine care. While the mothers who were in the control group, received only the routine care. Women's of training group should be participated in all meetings of class, otherwise they were excluded from the study. Training classes were held for the two groups by the researcher and midwife (investigation assistant) and audio-visual equipment (TV, video, training videos and pamphlets) at the same time and location. Methods of training were, lecture, discussion in small groups, question and answer, film screening and educational booklet or pamphlet.

At the end of each session, the booklet or educational pamphlet about the material presented of the same session, were placed in the disposal of the samples for their study and their husband at home. Classes were held in the form of the group at eight sessions at the premarital counseling center. Each session was held in the per week, and time at each session was 1-1.5 hours. Content of the training courses (intervention) in the first session included: anatomy and function of the reproductive organs, physical changes in pregnancy, sexual activity in pregnancy and the most common problems of pregnancy.

The second session included: a regular balanced nutrition, nutrition in pregnancy and postpartum, the nutritional problems during the pregnancy period. Third session included: exercise during the pregnancy period. The fourth meeting included: symptoms at the childbirth beginning, scheduling for childbirth, cesarean and vaginal childbirth. The fifth meeting included: pain relieving methods (film screening about childbirth), infant, characteristics of infant and infant care. Sixth session included: normal infant and infant feeding: breastfeeding, benefits and contents of breastfeeding, duration of breastfeeding, breastfeeding difficulties, milking and storing milk and film screening.

Seventh session included: health and care of the postpartum period, breast care, bleeding, vaginal discharge and danger signs in the mother and infant nutrition and the postpartum sexual activity and eighth session included: the contraceptive methods, the family planning and exercises of the postpartum period. Samples of the training group and control group completed questionnaire at the end of the fourth month of the postpartum period then; SPSS statistical software was used in order to analysis of the data.

RESULTS: The studied women were similar in the characteristics of age, education, occupation, spouse's education, spouse's occupation and income in the groups of training and control. Mean and standard deviation of age for the subjects within the training group, was 23.41±3.22 and for the subjects within the control group, was 23.39 ± 3.54 years. Furthermore, the mean and standard deviation for the spouse's age of subjects within the training group, was 27.17 ± 3.047 years and for the subjects within the control group, was 27.30 ± 3.36.

The average of income within the training group, was 267.26 ± 74.89 thousand Tomans and for the control group, was 383.84 ± 143.23 thousand Tomans that there was no significant difference between these groups. Some of the important features are shown in the Table 1. According to the results of this study, the mean score of nutritional behavior was 17.226 ± 25.9912, in the training group and was 575/2 ± 77/13 in the control group. Results of t-test showed that there was a significant difference between the training and control groups, from the aspect of the nutritional behavior (P=0/000). The findings also showed that there was a significant difference about traits of the consumption of food groups, the number of meals and duration of iron tablet's consumption in these groups (the intervention and control groups) after the postpartum period, that has been shown in the Table 3.

TABLE 1: ABSOLUTE AND RELATIVE FREQUENCY DISTRIBUTION FOR CHARACTERISTICS OF RESEARCH SUBJECTS FOR THE TRAINING AND CONTROL GROUPS

TABLE 2: ABSOLUTE AND RELATIVE FREQUENCY DISTRIBUTION FOR THE POSTNATAL NUTRITIONAL BEHAVIOR FOR THE TRAINING AND CONTROL GROUPS

TABLE 3: ABSOLUTE AND RELATIVE FREQUENCY DISTRIBUTION FOR THE FOOD GROUP'S CONSUMPTION IN THE POSTNATAL PERIOD

DISCUSSION: Findings of this research showed that mean score of the nutritional behavior at the postpartum period in the training and control groups was very different, after intervention in women referred to the health care centers in Semnan city. Moreover, the consumption of meat, fruit, vegetables, dairy products and cereals, the number of daily servings and use duration of the iron supplementation after childbirth, significantly increased for the intervention group. In support of this conclusion, ¹⁷ in one study, investigated the effect of the nutritional training during the pregnancy period on the nutritional behavior of the pregnant, mother and they reported that, there was a significant difference in the nutritional behavior of the pregnant mother for the intervention and control groups. Moreover, results of ¹ showed that consumption of fruits, vegetables and cereals in women of the intervention group was more than those in the control group, and the nutritional behavior in the intervention groups was more desirable than the control group.

Therefore these findings as well confirmed our results. So that in study of ¹⁹, consumption of fruits and vegetables, significantly increased in the pregnant women, after participating in the classes of pregnancy period preparation but the effects of these classes, were not significant on the dairy products and meat consumption. In research of ²⁰, on the comparison of dietary intakes before and after the intervention, revealed a significant

increase in the total energy, folate, iron, zinc, and calcium and showed a significant increase in the daily servings from the vegetable group and breads/grains groups after. Results of ¹⁸ revealed that the health and nutritional habits of pregnant women, were improved after training in the intervention group.

In the study of ²², nutritional training classes, had not been effected on the nutritional status of the pregnant women. Considering this fact that training and encouraging of women in order to changing of the inappropriate behaviors, is very important especially during the pregnancy period and the postpartum period ²³. Therefore, class of the pregnancy period preparation is a good opportunity to providing the fundamental training to the mother and her family in relation to the health behaviors ²⁴. The results from this research showed that classes of the pregnancy period preparation can have a positive effect on the nutritional behaviors and also improves these behaviors.

So that the effect of this behavior changing is still viable up to the four months after childbirth. It seems that, increasing of the nutritional awareness in the behavior that is done in these classes, will lead to changing of behavior. This means that the nutritional correct behaviors are replaced with the nutritional inappropriate or wrong behaviors ¹⁴. It is suggested that, in order to the quality improvement of the postpartum period care and the promotion of the mothers' health, more research and appropriate planning can be performed for the training of pregnancy and postpartum based on the culture of each region of the country.

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    How to cite this article:

    Morteza H, Rezaeyan M, Mirmolaei ST and Kazemnejad A: Effect of the pregnancy period preparation classes on the nutritional behavior of the postpartum period. Int J Pharm Sci Res 2017; 8(2): 734-39.doi: 10.13040/IJPSR.0975-8232.8(2).734-39.

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