Case Study: Barriers and Facilitators to Healthy Eating During Pre-Conception and Pregnancy

Overview

This qualitative study explored women’s experiences of healthy eating during pre-conception, pregnancy, and early motherhood. It aimed to understand the real-world factors that influence dietary behaviour and to identify what kinds of support are needed to improve maternal nutrition.

The research involved online focus groups with women in the UK who were trying to conceive, currently pregnant, or had infants under six months old.

The Challenge

Healthy eating during pregnancy is widely encouraged due to its importance for maternal and infant health. However, following dietary guidance in practice is often complex and inconsistent.

Rather than viewing this solely as a matter of individual choice or compliance, the study explores how eating behaviour is shaped by broader life circumstances and systems.

Methodology

• Design: Qualitative focus group study

• Participants: 19 women in the UK

• Stages represented: Pre-conception, pregnancy, and early postpartum

• Analysis: Thematic analysis of participant experiences

Key Findings

1. Influences on Healthy Eating

Women described a range of interconnected factors affecting their ability to eat healthily:

• Physical symptoms such as nausea, fatigue, and appetite changes

• Emotional load, stress, and mental exhaustion

• Limited time and energy for food preparation

• Financial pressures affecting food choices

• Reliance on convenience foods due to daily demands

• Confusing or inconsistent dietary guidance

These influences were not isolated. Instead, they interacted and reinforced one another, shaping everyday food decisions in complex ways.

2. What Supports Healthier Eating

Despite these challenges, participants identified several enabling factors:

• Emotional and practical support from partners and family

• Meal planning, routine building, and organisation strategies

• Clear, practical, and trustworthy nutrition advice

• Motivation linked to the baby’s health and pregnancy outcomes

• Stable routines that reduced daily decision-making pressure

Key Insight

We recognise that current advice on healthy eating during pregnancy is still largely delivered through a medical, individual-focused model, which emphasises personal responsibility and behaviour change.

However, the findings of this study show that this approach is limited. Healthy eating is not shaped by knowledge alone, but by wider social, economic, and environmental systems.

What Needs to Change

We recommend a shift towards a more social and system-based approach to maternal nutrition, embedded within medical and care systems.

This approach should:

• Recognise that eating behaviour is shaped by social determinants of health, not just individual choice

• Move beyond isolated dietary advice towards a holistic model of care

• Integrate support across healthcare, public health, and community services

• Address structural factors such as food access, cost, time, and inequality

• Position healthy eating as a shared responsibility across systems, not an individual burden

We also note that a more integrated social approach within medical and care systems urgently needs to be applied to ensure that guidance reflects real-life conditions and lived experiences.

Conclusion

Healthy eating during pregnancy is best understood through a systems thinking and food intersection perspective, where dietary behaviour is shaped by overlapping physical, emotional, social, and structural factors.

To improve maternal nutrition effectively, there must be a shift from a purely medical model to a holistic system-based approach, where health and care systems work alongside social structures to create conditions that genuinely support healthier choices.