Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study

Autoři: Ewa Mierzejewska aff001;  Talita Honorato-Rzeszewicz aff001;  Dorota Świątkowska aff002;  Marzena Jurczak-Czaplicka aff003;  Tomasz Maciejewski aff002;  Anna Fijałkowska aff004;  Jagna Szulc-Kamińska aff002;  Anna Czach aff002;  Hanna Nałęcz aff003;  Dorota Szostak-Węgierek aff005;  Katarzyna Szamotulska aff001
Působiště autorů: Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland aff001;  Obstetrics and Gynecology Clinic, Institute of Mother and Child, Warsaw, Poland aff002;  Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland aff003;  Department of Cardiology, Institute of Mother and Child, Warsaw, Poland aff004;  Department of Clinical Dietetics, Warsaw Medical University, Warsaw, Poland aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227682


Pregnancy is a period in life in which women are willing to improve their lifestyle. Providing proper information for these women is crucial for their health and the health of their offspring. Clear information about weak points in their nutritional and weight gain knowledge is the first step for proper health care assistance. There are a few previous studies evaluating the nutritional and weight gain knowledge of pregnant women. In the few studies available, different approaches were taken and there was no wider discussion on the content of the questionnaires attempting to measure level of knowledge. The aim of this study, designed in a pilot fashion, was to test the adequacy of the questionnaire as a research instrument in a group of 139 pregnant Polish women. The developed instrument is a 33-item questionnaire comprising four domains: weight gain, importance of nutrients, quality and quantity of food intake. The results of this study indicate that the questionnaire is stable and internal consistency is acceptable (Cronbach’s alpha > 0.7) for dimensions with more than four items. For dimensions with less than four items, internal consistency was poor (Cronbach’s alpha < 0.7). The cumulative explained variance for domains weight gain, importance of nutrients, quantity and quality of food intake was 54.74%, 42.74%, 54.42% and 48.99% respectively. Results from validity, reliability and factor analysis indicate that the questionnaire is adequate for its purpose.

Klíčová slova:

Factor analysis – Food – Nutrients – Nutrition – Pregnancy – Questionnaires – Research validity – Weight gain


1. UN. Decade pillars for nutrition action. 2016.

2. Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death , 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385: 117–171. doi: 10.1016/S0140-6736(14)61682-2Global 25530442

3. Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R. Effect of women’s nutrition before and during early pregnancy on maternal and infant outcomes: A systematic review. Paediatr Perinat Epidemiol. 2012;26: 285–301. doi: 10.1111/j.1365-3016.2012.01281.x 22742616

4. Johnston EO, Sharma AJ, Abe K. Association Between Maternal Multivitamin Use and Preterm Birth in 24 States, Pregnancy Risk Assessment Monitoring System, 2009–2010. Matern Child Health J. 2016;20: 1825–1834. doi: 10.1007/s10995-016-1985-1 27209294

5. Gernand AD, Schulze KJ, Stewart CP, West KP, Christian P. Micronutrient deficiencies in pregnancy worldwide: Health effects and prevention. Nat Rev Endocrinol. 2016;12: 274–289. doi: 10.1038/nrendo.2016.37 27032981

6. Khaing W, Vallibhakara SA-O, Tantrakul V, Vallibhakara O, Rattanasiri S, McEvoy M, et al. Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis. Nutrients. 2017;9: E1141. doi: 10.3390/nu9101141 29057843

7. Bath SC, Steer CD, Golding J, Emmett P, Rayman MP. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013;382: 331–337. doi: 10.1016/S0140-6736(13)60436-5 23706508

8. Trujillo J, Vieira MC, Lepsch J, Rebelo F, Poston L, Pasupathy D, et al. A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum. J Affect Disord. 2018;232: 185–203. doi: 10.1016/j.jad.2018.02.004 29494902

9. Barker D. The fetal and infant origins of adult disease. BMJ Br Med J. 1990;301: 1111. doi: 10.1136/bmj.301.6761.1111 2252919

10. Zhou Y, Li H, Zhang Y, Zhang L, Liu J, Liu J. Association of Maternal Obesity in Early Pregnancy with Adverse Pregnancy Outcomes: A Chinese Prospective Cohort Analysis. Obesity. 2019;27: 1030–1036. doi: 10.1002/oby.22478 31070002

11. Poobalan AS, Aucott LS, Gurung T, Smith WCS, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women—Systematic review and meta-analysis of cohort studies. Obes Rev. 2009;10: 28–35. doi: 10.1111/j.1467-789X.2008.00537.x 19021871

12. Silvestris E, de Pergola G, Rosania R, Loverro G. Obesity as disruptor of the female fertility. Reprod Biol Endocrinol. 2018;16: 1–13. doi: 10.1186/s12958-017-0318-6

13. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: A study of 287 213 pregnancies in London. Int J Obes. 2001;25: 1175–82. doi: 10.1038/sj.ijo.0801670 11477502

14. Fontana R, Della Torre S. The deep correlation between energy metabolism and reproduction: A view on the effects of nutrition for women fertility. Nutrients. 2016;8: 87. doi: 10.3390/nu8020087 26875986

15. Godfrey KM, Gluckman PD, Hanson MA. Developmental origins of metabolic disease: Life course and intergenerational perspectives. Trends Endocrinol Metab. 2010;21: 199–205. doi: 10.1016/j.tem.2009.12.008 20080045

16. Barker M, Dombrowski SU, Colbourn T, Fall CHD, Kriznik NM, Lawrence WT, et al. Intervention strategies to improve nutrition and health behaviours before conception. Lancet. 2018;391: 1853–1864. doi: 10.1016/S0140-6736(18)30313-1 29673875

17. Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4: 1025–1036. doi: 10.1016/S2213-8587(16)30217-0 27743975

18. Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-Pregnancy Body Mass Index in Relation to Infant Birth Weight and Offspring Overweight/Obesity: A Systematic Review and Meta-Analysis. PLoS One. 2013;8. doi: 10.1371/journal.pone.0061627 23613888

19. GUS. Health status of population in Poland in 2014. In: https://stat.gov.pl/en/topics/health/health/health-status-of-population-in-poland-in-2014,4,1.html# [Internet]. 2016 [cited 26 Oct 2018]. Available: https://stat.gov.pl/en/topics/health/health/health-status-of-population-in-poland-in-2014,4,1.html#

20. Gissler M, Mohangoo AD, Blondel B, Chalmers J, Macfarlane A, Gaizauskiene A, et al. Perinatal health monitoring in Europe: results from the EURO-PERISTAT project. Inform Health Soc Care. 2010;35: 64–79. doi: 10.3109/17538157.2010.492923 20726736

21. GUS. Zdrowie kobiet w Polsce w latach 2004–2009. Krakow; 2012.

22. Popkin BM. Nutrition Transition and the Global Diabetes Epidemic. Curr Diab Rep. 2015;15: 1–8. doi: 10.1007/s11892-015-0631-4 26209940

23. Kavle JA, Landry M. Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications. Matern Child Nutr. 2018;14: 1–13. doi: 10.1111/mcn.12508 28836343

24. Guggino A, Barbero S, Ponzo V, Viora E, Durazzo M, Bo S. Myths about nutrition in pregnancy. J Obstet Gynaecol (Lahore). 2016;36: 964–965. doi: 10.3109/01443615.2016.1168372 27147241

25. Bookari K, Yeatman H, Williamson M. Exploring Australian women’s level of nutrition knowledge during pregnancy: A cross-sectional study. Int J Womens Health. 2016. doi: 10.2147/IJWH.S110072 27574470

26. Blumfield ML, Hure AJ, MacDonald-Wicks L, Smith R, Collins CE. A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries. Nutr Rev. 2013;71: 118–132. doi: 10.1111/nure.12003 23356639

27. Trumpff C, De Schepper J, Tafforeau J, Van Oyen H, Vanderfaeillie J, Vandevijvere S. Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children: A review. J Trace Elem Med Biol. 2013;27: 174–183. doi: 10.1016/j.jtemb.2013.01.002 23395294

28. Phelan S. Pregnancy: a “teachable moment”; for weight control and obesity prevention. Am J Obstet Gynecol. 2010;202: 135.e1–8. doi: 10.1016/j.ajog.2009.06.008 19683692

29. Swift JA, Langley-Evans SC, Pearce J, Jethwa PH, Taylor MA, Avery A, et al. Antenatal weight management: Diet, physical activity, and gestational weight gain in early pregnancy. Midwifery. 2017;6: 40–46. doi: 10.1016/j.midw.2017.01.016 28238351

30. Doyle IM, Borrmann B, Grosser A, Razum O, Spallek J. Determinants of dietary patterns and diet quality during pregnancy: A systematic review with narrative synthesis. Public Health Nutr. 2017;20: 1009–1028. doi: 10.1017/S1368980016002937 27852338

31. Olmedo-Requena R, Gómez-Fernández J, Mozas-Moreno J, Lewis-Mikhael AM, Bueno-Cavanillas A, Jiménez-Moleón JJ. Factors associated with adherence to nutritional recommendations before and during pregnancy. Women Heal. 2018;58: 1094–1111. doi: 10.1080/03630242.2017.1388332 29120272

32. Variyam JN, Golan E. New Health Information Is Reshaping Food Choices. Food Rev. 2002;25: 13–18.

33. Kennedy RAK, Mullaney L, Reynolds CME, Cawley S, McCartney DMA, Turner MJ. Preferences of women for web-based nutritional information in pregnancy. Public Health. 2017;143: 71–77. doi: 10.1016/j.puhe.2016.10.028 28159029

34. Niedzwiedzka E, Wadolowska L, Kowalkowska J. Reproducibility of a non-quantitative food frequency questionnaire (62-item FFQ-6) and PCA-driven dietary pattern identification in 13-21-year-old females. Nutrients. 2019;11: 1–19. doi: 10.3390/nu11092171

35. Suliga E, Sobaś K, Król G. Validation of the Pregnancy Physical Activity Questionnaire (PPAQ) Walidacja kwestionariusza Pregnancy Physical Activity Questionnaire (PPAQ). Med Stud. 2017;33: 40–45. doi: 10.5114/ms.2017.66955

36. Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a pregnancy physical activity questionnaire. Med Sci Sports Exerc. 2004. doi: 10.1249/01.MSS.0000142303.49306.0D 15595297

37. Wendołowicz A, Stefańska E, Ostrowska L. Żywienie Kobiet W Okresie Ciąży. Med Ogólna i Nauk o Zdrowiu. 2014;20: 341–345. doi: 10.5604/20834543.1124669

38. Ministerstwo Zdrowia. Żywienie w ciąży. 2011. Available: https://www.gov.pl/documents/292343/0/Żywienie+w+ciąży+ulotka.pdf/e4538144-b04c-4f81-802d-91c93ebf5a92

39. Rasmussen KM, Yaktine AL, Guidelines I of M (US) and NRC (US) C to RIPW. Weight Gain During Pregnancy. Weight Gain During Pregnancy: Reexamining the Guidelines. 2009. doi: 10.17226/12584

40. Peterson RA. Constructing effective questionnaires. Sage publications; 2000.

41. Cappelleri JC, Jason Lundy J, Hays RD. Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clin Ther. 2014;36: 648–662. doi: 10.1016/j.clinthera.2014.04.006 24811753

42. Trakman GL, Forsyth A, Hoye R, Belski R. Developing and validating a nutrition knowledge questionnaire: Key methods and considerations. Public Health Nutr. 2017;20: 2670–2679. doi: 10.1017/S1368980017001471 28735598

43. Bookari K, Yeatman H, Williamson M. Falling short of dietary guidelines–What do Australian pregnant women really know? A cross sectional study. Women and Birth. 2017;30: 9–17. doi: 10.1016/j.wombi.2016.05.010 27317129

44. Bookari K, Yeatman H, Williamson M. Australian Pregnant Women’s Awareness of Gestational Weight Gain and Dietary Guidelines: Opportunity for Action. J Pregnancy. 2016;8162645: 1–9. doi: 10.1155/2016/8162645 26881080

45. Popa AD, Niţă O, Graur LI, Popescu RM, Botnariu GE, Mihalache L, et al. Nutritional knowledge as a determinant of vitamin and mineral supplementation during pregnancy. BMC Public Health. 2013;13: 1105. doi: 10.1186/1471-2458-13-1105 24289203

46. Bryant J, Waller A, Cameron E, Hure A, Sanson-Fisher R. Diet during pregnancy: Women’s knowledge of and adherence to food safety guidelines. Aust N Z J Obs Gynaecol. 2017;57: 315–322. doi: 10.1111/ajo.12523 27624518

47. Freitas-Vilela AA, Smith ADAC, Kac G, Pearson RM, Heron J, Emond A, et al. Dietary patterns by cluster analysis in pregnant women: relationship with nutrient intakes and dietary patterns in 7-year-old offspring. Matern Child Nutr. 2017;13: 1–14. doi: 10.1111/mcn.12353 27723265

48. Shub A, Huning Y-S YS, Campbell J, McCarthy A. Pregnant women’s knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Res Notes. 2013;6: 278. doi: 10.1186/1756-0500-6-278 23866845

49. Downs DS, Savage JS, Rauff EL. Falling Short of Guidelines? Nutrition and Weight Gain Knowledge in Pregnancy. J Women’s Heal Care. 2014;3: 1000184. doi: 10.4172/2167-0420.1000184 25599012

50. Popkin B, Monteiro C, Swinburn B. Overview: Bellagio Conference on Program and Policy Options for Preventing Obesity in the Low- and Middle-Income Countries. Obes Rev. 2013;14: 1–8. doi: 10.1111/obr.12108 24102826

51. Perez-Escamilla R, Bermudez O, Buccini GS, Kumanyika S, Lutter CK, Monsivais P, et al. Nutrition disparities and the global burden of malnutrition. BMJ. 2018;361: 1–8. doi: 10.1136/bmj.k2252 29899012

52. WHO. The double burden of malnutrition. Policy brief. World Heal Organ. 2017. doi: 10.1111/j.1745-6584.1983.tb00740.x

53. Flores CA V. Produção, industrialização e comercialização de verdura de palma forrageira. SEBRAE/PB. 2001;13: 94–102.

Článek vyšel v časopise


2020 Číslo 1