The Effects Of An Individual Instructional Program On Calcium Nutrition For Pregnant Women

Background Recently, pregnant women who suffering from malnutrition simply because of economic reasons reduces significantly. But the lack of calcium nutrition for pregnant women is remarkable. Pregnant women may suffer from bone loss or even osteoporosis during pregnancy if they take calcium inadequately.It may affect bone mass accumulation of pre-menopausal women and indirectly leads to the occurrence of postmenopausal osteoporosis.On the other hand, bone status of neonatal at birth is highly dependent on the nutritional status of his mother's nutrition environment provided. Inadequate calcium intake of pregnant women can also affect the growth and development of the fetus and newborn. Individualized nutrition instruction could increase the pregnant women's knowledge of calcium nutrition, improve their dietary calcium intake and promote the bone health status of pregnant women.At present,the majority of domestic studies only described the bone health status of pregnant women during pregnancy, while few intervention study using calcium supplement to promote bone health. There is few study that through a unmixed dietary intervention to promote bone health status of pregnant women. Overseas studies also showed a downward trend of bone mineral density in pregnant women with gestation aging. However,in foreign countries, whether in ordinary people or pregnant women,the phenomenon of taking nutrient supplements are relatively common,so there was little nutrition intervention literature. Therefore, this study aims to explore the effects of an individual instructional program on calcium nutrition based on the theory of planned behaviour and evaluate its clinic effects on calcium nutrition for pregnant women, with a view to provide methodological and empirical evidence for establishing the model of nutrition guidance during pregnancy.Objectives To develop an individual instructional program on calcium nutrition;To evaluate the effects of individual instructional program on calcium nutrition;To test the effects of theory of planned behavior applying in the study.Methods A quasi-experimental study was designed.168 pregnant women who taking pregnantal check up at obstetric outpatient were recruited and assigned to intervention group or control group according to the date of the first time attendance.There were 85 cases in intervention group and 83 cases in control group. There were no statistically significant differences in age,BMI,gestational weeks,education, occupation, husband's education and occupation, income per capita monthly between two groups (P> 0.05).Pregnant women in the control group received routine care in pregnantal program, which relates to check-flow introduction, the relevant knowledge about prenatal care,childbirth preparation, childbirth and postpartum health care.Pregnant women in the intervention group attened a 6-month individual calcium nutritional instruction in addition to the routine education care in pregnantal program,including seminars,panel discussions,individual guidance.Evaluation indicators included dietary calcium intake, bone health status of pregnant women, development condition of fetal,etc.These indicators were measured before and after the intervention and each month and after delivery. The change of dietary calcium intake,fetal biparietal diameter and some other indicators were compared by repeated-measure analysis of variance(ANOVA) and multi-factor variance analysis(MANOVA),the change of other indicators were compared by t test and x2 test.The factors affecting the scientific calcium supplementation were analyze by path analysis.Results②There was trend of increasing more quantity of dietary calcium intake in intervention group than in control group (P<0.05).It is evident that there were statistical significance differences in dietary calcium intake between the two groups after intervention(P <0.001).②The BUA, SOS, STI in intervention group were higher than in control group after the intervention (P<0.001)and in intervention group before the intervention(P<0.001).The BUA, SOS, STI in the control group after the intervention were lower than before(P<0.05);There was statistically significant difference in bone mass between intervention group and control group after the intervention (P<0.001);The incidences of calcium deficiency symptoms were significant lower in intervention group than in control group after the intervention (P<0.001);③After the intervention, the uterus heights were increased with gestation aging both in intervention group and control groups (P<0.001),and there were significant differences in 20 weeks pregnancy and 36 weeks pregnancy between the two groups(P<0.05),but the differences did not have clinical significance;④The fetal biparietal diameters were increased with the gestation aging both in intervention group and control groups after the intervention(P<0.001),but there was no statistical difference between the two groups(P>0.05);There were no statistical significant differences in placental grade at the baseline,23-week pregnancy and 32-week pregnancy between intervention group and control group(P>0.05);There were no statistical significant differences in intervention in neonatal weight,length and head circumference between the two groups(P>0.05);⑤The scores of knowledge and behavior in intervention groups were significant higher than that in control group(P<0.001).⑥Path analysis results showed that,attitude toward behavior, subjective norms and perceived behavioral control affected the behavioral intention of scientific calcium(P<0.05).Among them, the effect of the subjective norms(standardizedβ=0.758) was stronger than that of attitude toward behavior(standardizedβ=0.216) and perceived behavioral control (standardizedβ=0.145).In the subjective norms, the affects in descending order are doctors(standardizedβ=0.304, P<0.01),family (standardizedβ=0.293,P<0.05),friends(standardizedβ=0.281,P<0.05), colleagues(standardizedβ=0.121,P<0.05).Conclusion Individual calcium nutrition guidance could improve the dietary calcium intake and promote bone health of pregnant women during pregnancy as well as increase their knowledge of scientific calcium supplementation. Through the application of theory of planned behavior, we could analyze factors that affecting pregnant women's scientific calcium intentions,and the results could instruct the interventions personally.Individual instructional program on calcium nutrition could be regard as an effective model for intervention.