Why pregnant women struggle to follow healthy diets despite knowing what to eat

Despite knowing what to eat, many women face exhaustion, symptoms, and cost barriers. This study reveals the supports that can make healthy eating possible during pregnancy.

Study: “You Want to Eat Healthy, Especially When You’re Pregnant. But Sometimes, It’s Just Not Possible”: Perceptions of Facilitators and Barriers to Healthy Food and Diet Practices During Pre-Conception and Pregnancy. Image Credit: Hazal Ak / Shutterstock

In a recent study published in the Journal of Human Nutrition and Dietetics, researchers at the University of Hertfordshire and the University of Cambridge in the United Kingdom employed a qualitative study design to analyze data from five online focus groups (n = 19 women), thematically deriving the challenges and facilitators associated with pregnancy and pre-conception dietary habits.

The study sample comprised a small purposive group of UK women – recent mothers, pregnant women, or conception hopefuls – who revealed that despite “knowing what to eat”, they faced internal challenges like fatigue and nausea, and external pressures such as food costs and generic health advice. One participant captured this tension: “You want to eat healthy, especially when you’re pregnant. But sometimes, it’s just not possible.”

The study thereby identified a glaring lack of personalized nutritional support and insufficient professional dietetic advice, which are required to ensure optimal outcomes for mothers and their children. The sample was predominantly white and middle-affluent, which limited socioeconomic diversity.

Background

Decades of research and public health evidence have established the importance of optimal food choices (a healthy diet) for achieving ideal pregnancy outcomes. Well-balanced diets, particularly during pre-conception and gestation periods, have been found to support fertility, fetal development, and lower risks of childhood obesity, diabetes, cardiovascular and mental health issues, rather than guaranteeing specific outcomes.

Consequently, several global public health agencies provide dietary guidelines to advise women on what to eat and avoid during this critical period. In the United Kingdom (UK), the NHS and UK public health agencies provide dietary guidelines that outline the benefits of balanced diets and emphasize the importance of avoiding certain high-risk foods.

Unfortunately, despite a documented increase in such public health outreach efforts alongside the growing accessibility of online pregnancy-associated information, adherence to these guidelines remains alarmingly low. Previous research suggests that while pregnancy can represent a “teachable moment” (exacerbated motivation towards healthier choices), implementing this knowledge often presents significant hurdles.

Midwives usually lack the time or specialized training to provide in-depth nutritional counseling, leaving prospective mothers to resort to generic, one-size-fits-all advice that often fails to address an individual’s unique circumstances (both financial and dietary). While a few such challenges have been anecdotally recorded, the spectrum of facilitators and hindrances to healthy dietary adherence during pre-conception and pregnancy periods remains under-explored in depth. 

About the study

The present study leverages a qualitative approach to address this knowledge gap. It transcribed and thematically analysed data from five online focus groups with a total of 19 women from across the UK to identify the diet-associated challenges and facilitators that women experience during childbearing.

Study participants (age 18 to 44) were screened to include those who were actively trying to conceive (TTC; 3 women), pregnant (Pt; 3 women), and new mothers (15 women; delivery < 6 months prior). The study (February–March 2022) was comprised of online guided conversations wherein participants were encouraged to discuss perceptions and practices surrounding food.

The study aimed to identify the primary challenges women face when attempting to improve their diets (given pregnancy as a context), what factors help them succeed, and what systemic or policy changes are needed to better support them in meeting their pre-conception or pregnancy-associated dietary goals. The study analysis involved transcribing these meetings via the thematic approach recommended by Braun and Clarke, thereby identifying and interpreting common patterns and themes (facilitators and/or challenges) within the conversations.

Study findings

Thematic analysis identified three overarching themes: 1. Healthy eating challenges, 2. The facilitators that help, and 3. The changes are required for better support. The challenges of eating healthily were revealed to be the most powerful and extensively discussed.

Women frequently described what the study refers to as “Mothers’ load”, the overwhelming exhaustion stemming from working, caring for other children, and managing a household. These women stated that sheer fatigue left little energy for meal planning and cooking. Mothers’ load was found to be further compounded by “Body sabotage”, where pregnancy symptoms (e.g., nausea, food aversions, heartburn) made even the thought of healthy foods like salads obnoxious.

When the second pregnancy I found it a bit harder to eat healthily because I was tired and I was working full time and had the baby, 1-year-old. I had them quite close together. So that was tough. And then the thirdpregnancy, I sort of gave up trying to eat healthily because I was exhausted, I think, a lot of the time with the other two. I was so busy with them…

I thought I’d be all zen and be eating 20 vegetables at every meal, or whatever, and instead I was like, “Oh, no. I don’t want to go in the kitchen.”

External factors, particularly the inaccessibility and high comparative cost of healthy foods (relative to their unhealthy counterparts) and the generic nature of the food advice, were also highlighted as key challenges to healthy dietary adherence. Participants expressed frustration while describing how most advice focused on what to avoid rather than what to eat, and rarely tailored to their personal needs, such as being vegetarian or vegan.

However, study findings underscored that strong planning skills and robust family support, particularly from partners who shared domestic responsibilities (e.g., cooking, shopping), could be powerful facilitators that could substantially mitigate pregnancy-associated dietary challenges.

Conclusions

The present study highlights the significant gap between NHS/UK public health dietary guidelines and the on-the-ground challenges faced by women on their path to motherhood. Study findings suggest that providing access to nutrition professionals, such as dietitians and nutritionists, who can offer both general and tailored guidance, could ensure optimal outcomes for both mother and baby.

The authors also note that the timing of advice is essential, as early pregnancy symptoms can disrupt women’s ability to follow dietary guidance. The authors also emphasize the importance of co-created, culturally relevant, and practical resources (such as easy recipes, meal planning support, or digital tools) developed in collaboration with women themselves, alongside a greater government responsibility to make healthy eating more accessible.

…I just feel like some women really struggle to conceive and if there’s a potential that some really tailored advice on their diet could help then I think that would be very welcome and could potentially save money further down the line.