This cross-sectional study of young mothers and their health care providers gives an insight into the pattern of dietary changes, supplement intake, current sources of information and preferred information sources in addition to the reasons behind their preferences for information support. Addressing eating behaviour and nutritional requirements of adolescent pregnant women in order to enhance their pregnancy and birth experiences is important as an association between poor nutritional status and adverse pregnancy outcomes is well documented [2–4, 15, 16]. This survey allowed a wider verification of the identified issues in a series of in-depth explorative interviews of young women and health care professionals from Doncaster, Manchester and London, details of which are reported elsewhere .
These surveys which included responses from all regions in England as well as Scotland, Wales and Northern Ireland showed that young mothers are motivated and keen in adopting healthy dietary changes as indicated in their responses for making positive changes during pregnancy. However it was important that a considerable proportion of responding women were not consuming red meat, eggs, oily fish and soft cheese (such as cream cheese or spreadable cheese). It was encouraging to see a high level of interest and enthusiasm for making positive changes however such a high proportion of adolescents indicating avoiding foods which are potentially valuable sources of vitamins and minerals, such as B vitamins and iron (red meat and eggs) or vitamin D and calcium (oily fish and soft cheese)  are of concern. Attention to adequate nutrition in supplying sufficient amount of nutrients are increasingly realised due to its impact on healthy pregnancy and birth outcomes .
The poor dietary habit identified in this study is in line with other investigators’ findings showing a poor nutritional intake in young mothers [1, 8]. The low intake of foods such as soft cheese and eggs may suggest inadequate communication with young women and a state of confusion regarding prohibiting raw/runny eggs or unpasteurised mould ripened soft cheeses rather than avoiding all types of eggs or pasteurised soft cheeses. It is likely that food avoidance be due to personal taste or cultural restrictions in which case health professionals’ role in guiding for alternative sources becomes essential for all particularly this group of women.
It is therefore of prime importance to provide sufficient support and appropriate education for health professionals who have direct contact with young pregnant mothers to enhance their knowledge and dietary behaviour with the overall aim of optimising pregnancy and birth outcomes. This is particularly noteworthy, considering the level of awareness and appreciation of the role, and the trust these young women place in their health professionals, especially in midwives, to obtain nutritional information. This ultimately affirms the need for equipping health professionals with appropriate support, skills and knowledge for effective communication of nutritional messages during pregnancy and postpartum.
The majority of midwives and family nurse practitioners felt that they were providing nutritional support to young women during pregnancy as part of their role but acknowledged there were some areas where they lacked confidence and would like further training. The role of midwives in promoting dietary changes has been explored in previous studies and it has been shown to be central in supporting women to make positive changes [19, 20]. The qualitative interviews with young women and health professionals undertaken as part of the earlier stages of this study however found that while most health care professionals provided some nutritional support and information, the extent to which this was tailored to young women's individual needs varied considerably . There are significant barriers to providing individualised nutritional support particularly in terms of time pressures and a lack of appropriate resources . It is therefore important that the need for post-registration training, both relating to the specific nutritional issues identified in this study and wider skills regarding how behaviour change techniques can be applied in this context .
There were differences in the resources provided by midwives and FNPs to young women and also in the resources used for their own information. These differences however largely reflect the different models of support and care offered by the different professions. This is further supported by open answer comments from young women, although indicating a high satisfaction and trust in midwifery care, expressing a sense of time limitation or insufficient resources to provide adequate and appropriate support during pregnancy. Young women were aware of risks and biases associated with accessing information via websites or commercial sources due to a lack of consistency and trustworthiness. The findings however were indicative of their desire to receive specific, robust, trustworthy and standardised information from authoritative sources; the potential for alternative digital formats is also indicated via mobile technology (e.g. apps) or interactive websites (e.g. easy to follow recipes, healthy eating guidance). Although they acknowledged mobile technology and digital sources should not replace face to face contacts, they appreciated additional support to allow continuous access, facilitate healthy dietary change and maximise benefits in between appointments. A lack of using online technologies either as tools to facilitate discussion or for helping young women to access further support was evident in the data collected from health care professionals. Young women have been found to routinely access online information  and support  during pregnancy; however research has suggested that health care professionals lack confidence in using these technologies effectively . This suggests that further investigation to develop and evaluate dietary and lifestyle interventions delivered through mobile technology and interactive websites as an adjunct to care provided by health care professionals may be advantageous.
Limitations and strengths
The majority of young women respondents were aged over 20 years at the time of the survey; however young women were invited to participate if they aged between 16 and 20 during their pregnancies.
Young women were asked their current age and number of pregnancies, but were not asked to specify their age when they had their first child, so those ‘20 or over’ at the time of the survey, may have had their first child as an adolescent.
Although we asked participants to respond if they were pregnant or recently have been pregnant, the time since the pregnancy may also have varied between participants meaning that some young women may be less likely to remember details about their diet or supplement use accurately. However, the overall dietary habit rather than details of dietary intake was explored which may have less of an impact on the availability of the information. Any pregnancy complications experienced may also have affected the young women's ability to recall information accurately however pregnancy complications were not recorded. With the exception that none of our participants were from Chinese origin, the participants’ ethnic backgrounds were mainly in line with the national data as a great majority have identified themselves as white and a much smaller proportions were from black, mixed and Asian ethnic minorities (national data includes 2.0, 84.4, 2.7, 2.0, 2.1% respectively) .
Our study included a self-selected group of young pregnant mothers or those who recently gave birth and this limits the representativeness of our findings; this may have been a more motivated and interested group of young women to respond to such a survey. However, the variation in the included ethnicities in line with the national data regarding ethnicities and postcode data indicating inclusivity of all geographical regions within the UK is encouraging. This as well as the nature of provided information in identifying the poor quality of nutritional behaviour of a considerable proportion of young mothers and their desire for making healthy changes confirms the need for developing appropriate supportive interventions delivered through health care professionals.
Similarly with respect to the health care professionals’ survey it was not possible to calculate a response rate or record the number or characteristics of non-responders to determine if they differed in any way from respondents. This may also have had an impact in that those professionals least comfortable with using online resources may have been less likely to complete the questionnaire. However using online networks allows a remote access with a possibility of open and honest answers without interference or the pressures sometimes felt in the face to face or research situations with close contacts .