A Preliminary Study of Clinical Practice and Prenatal Nutrition in Rural Kansas

Abstract

Introduction. The primary purpose of this study was to learn if new recommendations for prenatal supplements of docosahexaenoic acid (DHA) and choline have been implemented into care by physicians who care for pregnant women in rural Kansas communities. Both nutrients are inadequate in the diet of most pregnant women in the United States and not all prenatal supplements provide DHA and choline.

Methods. A cross sectional web-based survey was developed and provided by University of Kansas Medical Center (KUMC) students to 44 rural Kansas clinics believed to have physicians who provide obstetrical care. Questions about DHA and choline were embedded in a larger survey focused on prenatal care. A total of 29 surveys were returned, however, only 21 were completed by physicians who provided obstetrical care.

Results. DHA (3/21) and choline (0/21) were rarely singled out for recommendation in contrast to folic acid (16/21) and iron (14/21). Participants stated that most women sought prenatal care during the first trimester of their pregnancy and indicated that they recommended prenatal vitamins at the first visit. Eleven gave patients a prescription for prenatal vitamins.  The remaining patients either chose traditional over the counter prenatal vitamin capsules or less traditional chewable (gummy) vitamins, which provide lower concentrations of nutrients.  Common barriers to nutritional counseling were limited resources and time constraints. Clinicians assessed their confidence and ability to provide nutritional counseling as moderate and competent, respectively.

Conclusions. New nutritional recommendations for DHA and choline have not been implemented into standard of care in rural Kansas.