Adherence To Nutrition Goals From A Pregnancy Nutrition And Exercise Lifestyle Intervention Program (NELIP) Trial

Adherence to the nutrition component of a nutrition and exercise intervention during pregnancy can be challenging, and many studies do not report tracking changes to nutrition habits over time. Measuring the adherence to specific nutrition goals is critical for the interpretation of the success of a nutrition and exercise intervention. PURPOSE: To use a goal-specific nutrition rubric to examine nutrition adherence as part of the Nutrition and Exercise Lifestyle Intervention Program (NELIP; ClinicalTrials.gov: NCT02804061) during pregnancy. METHODS: Pregnant individuals completed a baseline (12-18 weeks’ gestation) 3-day food intake record (3dFR) and were randomized to one of three strategies, either receiving both nutrition and exercise simultaneously (NE; n = 27), or receiving one component first and the other introduced sequentially at 25 weeks gestation (N + E; n = 30 or E + N; n = 33), completing both components to delivery. The 3dFR was repeated at 25 (midpoint) and 36 weeks’ (endpoint) gestation and scored (out of 20 points) using an analytic rubric developed for NELIP which tracked nutrition adherence to specific goals. RESULTS: Mean adherence was measured across three time points for each treatment group. The main effect of time on adherence was significant (F(2,74) = 5.71, p = 0.004), indicating adherence changed over time across all groups. The main effect of treatment group was also significant (F(2,74) = 4.16, p = 0.02), suggesting differences in adherence among the NE, N + E, and E + N groups. There was no significant interaction between time and treatment group (p = 0.15), suggesting that adherence changed similarly over time for all groups. CONCLUSIONS: Adherence to specific nutrition goals measured with a rubric becomes more difficult as pregnancy progresses, irrespective of the order of delivery of a nutrition and exercise program. Future research may include identifying individual barriers to nutrition adherence in pregnancy, especially in the second and third trimester, and testing and implementing strategies accordingly.