https://orcid.org/0009-0009-9857-3934
Figures
Abstract
Women in low- and middle-income countries (LMICs) may engage in a range of cultural food practices during pregnancy, including restricting or avoiding foods high in protein and iron, and foods rich in vitamins and minerals. While research has explored the cultural food practices of pregnant women in LMICs, there is less understanding of the continued cultural food practices of women who migrate to high-income countries and then become pregnant. This systematic review explores the existing research on cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs, residing in high-income countries. A systematic search was conducted in April 2024 across Global Health, CINAHL, and MEDLINE, published in English, with no date restrictions. Eligible studies included those focused on pregnant and postpartum women who had migrated from LMICs to high-income countries. Studies were excluded if they comprised of non-immigrant women or did not involve LMIC participants. Screened were studies for eligibility, data were extracted, and study quality was assessed. In total, 17 studies comprising qualitative (n = 10) and quantitative (n = 7) approaches were included. In 14 studies participants adhered to cultural food practices, wherein certain nutritious foods were restricted during pregnancy or the postpartum period; three studies noted limited adherence due to support, acculturation, and access to traditional foods. Most studies (n = 10) reported traditional “hot” and “cold” food beliefs during pregnancy and postpartum, aiming to maintain humoral balance for maternal and child health and to prevent miscarriage. Nutrition advice was sought from family members, friends, relatives, healthcare providers, and media sources, with a preference for advice from family members in their home countries. There is a need for culturally appropriate nutrition education resources to guide pregnant migrants through healthy and harmful cultural food practices and overall nutrition during this crucial period. (PROSPERO Registration: CRD42023409990).
Citation: Olajide BR, van der Pligt P, McKay FH (2024) Cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from low- and middle-income countries residing in high income countries: A systematic review. PLoS ONE 19(5): e0303185. https://doi.org/10.1371/journal.pone.0303185
Editor: Sharada P. Wasti, University of Greenwich, UNITED KINGDOM
Received: October 16, 2023; Accepted: April 19, 2024; Published: May 9, 2024
Copyright: © 2024 Olajide et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Women play a vital role in preserving cultural heritage by upholding traditional food practices, especially during pregnancy, where cultural food traditions influence food choices [1]. Studies conducted in low- and middle-income countries (LMICs) [2–4] have revealed the scope of cultural food practices women engage in specific to their cultures or groups. These food practices include avoiding foods such as eggs (believed to cause jaundice or hair loss in babies), milk (believed to cause vomiting and heartburn in babies after birth), restricting protein-rich foods (believed to generate heat and potentially cause miscarriage), and reducing the quantity of food consumed (to prevent complications that might arise from delivering a larger baby). These practices highlight the role of cultural traditions in shaping the dietary choices of pregnant women.
Culture plays an important role, not only in influencing the dietary choices of pregnant women, but also in shaping their transition to motherhood. The wide reaching impact of cultural beliefs and practices surrounding food choices during pregnancy highlight the significance of this transition. A review of maternal nutrition during pregnancy in LMICs revealed that cultural beliefs can act as a barrier to adequate nutrition during pregnancy [5]. Findings from studies conducted in a range of LMICs, including Pakistan [2], South Africa [4], and India [6], show that the cultural food practices that pregnant women engage in can lead to restrictions of essential nutrients crucial for the health of both the mother and fetus. A recent review [7] of women in Kenya and Indonesia found they restricted food including meat, eggs, and fruit, during pregnancy as a way to avoid difficult deliveries and reduce the risk of caesarean sections [7]. However, it is worth noting that in some cultural contexts, there exists a belief that the avoidance or consumption of specific foods contributes to the health of both mothers and fetus [8, 9]. A review by de Diego-Cordero and colleagues [7] emphasized that women who adhere to such cultural food practices firmly believe that disregarding them could be detrimental to the health of the fetus or the mother’s overall health. However, it is vital to understand practices from different regions and countries to continue supporting healthy practices, and knowing harmful practices and understanding trusted resources are essential to change harmful practices.
Apart from the influence of culture on the food choices of pregnant women, their sources of nutrition information can have a large influence on food choices during pregnancy. Like women from high income countries, women from LMICs often rely on advice from various sources such as family, friends, antenatal care, and their community for nutritional guidance [10, 11]. However, family members, particularly grandmothers and mothers, play a significant role in the dietary choices of pregnant women in LMIC. A review of the traditional pregnancy diets of migrant women from LMICs in their destination countries show that even after migration, women continue to rely on advice from family and female relatives, both in the destination country and home country [1].
Inadequate nutrient intake during pregnancy is a contributing factor to complications in pregnancy [10, 12]. Inadequate intake of nutrients during pregnancy can result from restrictions or the avoidance of certain foods [12]. A review exploring associations between maternal nutritional status and birth outcomes among African women revealed that insufficient nutrient intake by mothers is associated with poor maternal outcomes, including risk of gestational diabetes mellitus, pre-eclampsia, antepartum hemorrhage, postpartum hemorrhage, prolonged labor, and birth trauma, which can have both short- and long-term consequences [13]. Inadequate nutrient intake during pregnancy negatively affects fetal health and can lead to neural tube and congenital heart defects as well as poor fetal growth [14, 15]. In addition, studies indicate that poor maternal nutrient intake during pregnancy significantly raises the risk of offspring developing chronic health conditions later in life, such as diabetes, obesity, heart disease, and non-communicable diseases [16, 17].
While numerous studies have explored the food practices of pregnant women in LMICs [2–4, 11, 18, 19], the cultural food practices and sources of nutrition information of migrants from LMICs residing in high-income countries, both during pregnancy and the postpartum period, are less clear. This systematic review aims to synthesize the evidence exploring the cultural food practices and sources of nutrition information among pregnant and postpartum migrant women from LMICs residing in high-income countries. This review will also examine the sociodemographic factors that influence cultural food practices during pregnancy and postpartum. This review will significantly contribute to the literature by shedding light on an overlooked aspect of maternal nutrition, while also supporting the future development of culturally appropriate interventions aimed at improving maternal and fetal health outcomes among migrant populations.
Method
A systematic search of three electronic databases, Global Health, CINAHL, and MEDLINE, was conducted in April 2024. The literature search was limited to three databases for several reasons. Firstly, these three specific databases are widely recognized as comprehensive sources within the field. Secondly, these databases were selected based on researchers’ preliminary research which indicated that these databases contain extensive coverage of relevant academic journals and scholarly publications pertinent to the research topic. Additionally, limiting the search to three databases allowed researchers to efficiently manage the scope of this review while still ensuring access to a diverse range of scholarly sources. While researchers recognize that other databases exist, we are confident that the chosen databases provided a robust foundation for this review. The key search terms included cultural, food practices, pregnancy, immigrants, and countries (low- and middle-income and high income). The Boolean operators “AND” and “OR” were used in conjunction with truncation operators and phrase searching. The search syntax was customized for each database. Refer to Table 1 for a comprehensive overview of the complete search strategy. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42023409990).
Study selection
All authors independently reviewed articles to identify relevant studies by following the inclusion and exclusion criteria described in Table 2. All articles were imported into Covidence, an online tool designed for managing systematic reviews [20]. Duplicates were identified and removed. The articles underwent a three-step selection process (see Fig 1). Following the removal of duplicates, articles underwent title and abstract screening. Any article that did not meet the inclusion criteria was removed, while those that met the inclusion criteria were retained, followed by a full-text screening of articles that met the inclusion criteria. The articles were screened at the full-text stage for eligibility, all authors independently read the articles at this stage to determine if the remaining articles met the inclusion criteria. Articles that did not meet the inclusion criteria at this stage were removed. During each step, any disagreements concerning eligibility were resolved through discussion between authors to reach a consensus.
Data extraction
Data were extracted into Microsoft Excel. The corresponding author extracted all data, the second and third authors reviewed and cross-checked the extraction. Data, including key characteristics, participants’ country of origin, destination country, age, level of education, employment status, years of migration, gestational age, common food practices during pregnancy and postpartum, reasons for such practices, the source of information from which pregnant women draw their nutrition information, data collection, and any other key findings, were extracted from all articles.
Quality assessment
By critically evaluating each study’s methodological quality, including how much it addressed the possibility of bias in its design, conduct, and analysis, the quality of all extracted studies was determined. This assessment was conducted using the Joanna Briggs Institute’s (JBI) critical appraisal tools, which were found effective as used in other systematic reviews [21–23]. JBI has a separate appraisal tool for each study design. The tools were used according to the types of study designs used in each of the extracted articles [24, 25].
A rating of “yes”, “no”, “unclear”, or “not applicable” was assigned to qualitative studies based on the answers to 10 validity questions. The same rating scale was applied to cross-sectional studies, which had 8 validity questions, and to cohort studies, which had 11 validity questions.
Consistent with Shi and colleagues [23], the quality of each study was rated as “good” (only yes or not applicable ratings), “fair” (1 to 2 no or unclear ratings), or “poor” (3 or more no or unclear ratings), depending on the number of affirmative responses to the validity questions. The quality of the qualitative studies was assessed using the 10-item qualitative critical appraisal checklist [24]. This checklist evaluated 10 factors within the study, including the congruity between the research methodology and the philosophical perspective, research questions or objectives, data collection, data analysis, results interpretation, influence of the researcher, representation of the participants, ethical approval, and the flow of the conclusion. The cross-sectional studies were assessed for eight factors, including the definition of the inclusion criteria for the sample, the description of the subjects and setting, the measurement of exposures, conditions, and outcomes, the identification and strategies to address confounding factors, and the appropriateness of the statistical analysis method [25]. For the cohort studies, assessment criteria included changes over time, the sufficiency of the follow-up period, loss to follow-up, and the appropriateness of strategies to address loss to follow-up [25].
Data synthesis
Data were synthesized following a narrative reporting method [22, 26], with information summarized and presented descriptively. The descriptive analysis involved extracting relevant information from each study. No quantitative synthesis, such as a meta-analysis, was conducted due to the heterogeneity in study outcomes among the included quantitative studies. The quantitative data synthesis involved a comprehensive extraction and analysis of numerical data reported in the included studies. The narrative reporting method was followed, where quantitative findings were extracted from each study and synthesized descriptively. This process included identifying key numerical results, such as means, ranges, percentages, and summarizing them in the narrative synthesis. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) Statement [27].
Results
The database search generated 562 articles, of which 109 were duplicates. The titles and abstracts of 453 articles were screened, and 415 articles were excluded because they did not refer to or explore the cultural food practices and sources of nutrition information of pregnant or postpartum migrants from LMICs. The remaining 38 articles were included in full-text review, with 21 articles excluded as they did not meet the inclusion criteria. This resulted in 17 articles remaining for inclusion in this review (Fig 1).
Description of included studies
17 studies were included in this review: ten qualitative studies [28–37] and seven quantitative studies (four cross-sectional and three cohort studies) [38–44]. Articles were published between 1987 and 2024. The study populations included pregnant migrant women (n = 7) [32, 34–36, 38, 40, 41], postpartum migrant women (n = 7) [28–31, 37, 43, 44], and both pregnant and postpartum migrant women (n = 3) [33, 39, 42]. The total number of participants in all the studies was 2,415 (participant numbers ranged from 10 to 26 in qualitative studies and from 38 to 1,027 in quantitative studies).
Participants originated from Asian (n = 13) and African countries (n = 4). Their destination countries included Canada (n = 6) [30–34, 44], the USA (n = 4) [37, 40–42], Sweden (n = 2) [28, 29], Singapore (n = 2) [39, 43], the UK (n = 2) [35, 36], and Ireland (n = 1) [38]. Ten studies [28, 30, 32–34, 37, 38, 40–42] reported the duration of time the migrant women had lived in high-income countries. The mean years of migration to the destination countries ranged from 2 to 12 years (range 0 to 20 years). Four studies [34, 38, 39, 41] reported participants’ gestational age, which ranged from 14 to 38 weeks. Refer to Table 3 for detailed information.
Sociodemographic factors
Studies reported that sociodemographic factors such as social group [28, 30, 34–36], level of education [29, 32, 33, 40, 42, 43], maternal age [42, 43], parity [32], and socioeconomic status [33] influenced the cultural food practices of pregnant or postpartum migrants in the host countries.
Social groups were identified as one of the influencing factors on the cultural food practices of migrant women during pregnancy in their destination countries. Five studies [28, 30, 34–36] indicate that migrant women were influenced by their friends and senior colleagues who had previously given birth. For instance, in the studies by Yeasmin and colleagues [35] and Hussain and colleagues [36], it was reported that friends and senior colleagues advised migrant women to avoid consuming cucumber during pregnancy because they believed it could cause skin blemishes on the baby after birth. They also advised against consuming large quantities of food during pregnancy, as they believed it could result in difficult delivery.
The level of education among migrant women was another significant factor influencing food practices during pregnancy [29, 32, 33, 40, 42, 43]. Their education level played a crucial role in how these women adhered to their cultural food practices during pregnancy or postpartum. Two studies [42, 43] reported that migrant women who adhered to their cultural food practices during pregnancy or postpartum generally had higher education levels and were older. In contrast, Higginbottom et al. [33] found that the education level of younger women influenced them to choose not to adhere to traditional practices, as they viewed them as no longer relevant or reasonable.
Cultural food practices
Results relating to cultural food practices during pregnancy and the postpartum period are detailed in Table 4. Fourteen studies (82%) reported that participants maintained their cultural food practices during pregnancy and postpartum in their destination countries [28–33, 35, 36, 38–40, 42, 43]. Three studies [37, 38, 41] reported limited adherence to cultural food practices during pregnancy and the postpartum period. Limited adherence was due to a lack of support from family members in the host country, food acculturation which led migrant women to discover new food products, and lack of access to traditional foods in the host country. One study [37] reported that many participants longed for their traditional foods in the postpartum period but could not have them due to a lack of support from family members. It was further reported that migrant women attributed their subsequent poor health to the omission of traditional foods [37].
Cultural food practices adhered to during pregnancy aimed to ensure successful delivery and healthy outcomes for the baby [28–30, 32–36]. The practices of cold and hot foods beliefs were identified in Ten studies [28, 30–33, 36, 39, 42–44] involving participants who had migrated from Asian countries during pregnancy and the postpartum period. These studies suggest that during pregnancy, a pregnant woman is believed to be in a “hot state” so she should consume cold foods, such as apples and grapes while avoiding hot foods such as spicy foods, ice cream, fish, eggs, and meat [33, 36, 42]. Postpartum is considered a “cold state” and seven studies [28, 30, 31, 33, 39, 42, 43] reported that migrant women engaged in the consumption of hot foods during this period to restore balance to the body after delivery, aid in healing, and facilitate recovery from the birthing process [28, 30]. Hot foods consumed include chicken, pork, certain vegetables (e.g., mustard greens), deep-fried foods, bitter juice, green papaya, hot tea with cinnamon, foods cooked with wine, alcohol, and vinegar, dahl (lentil soup), ginger curry, panjiri, chuanan, dabrha, tea, and hot water for one month, and ate only boiled foods for one month [30, 33, 42, 43]. The comprehensive list of foods classified as either cold or hot during pregnancy and the postpartum period can be found in the S1 Table.
A study [35] conducted among Asian migrant women in the UK reported participants engaged in the practices of “good and bad foods” beliefs during pregnancy. “Good foods” were consumed during pregnancy while bad foods were avoided. “Good foods” are those considered beneficial for both the mother and the fetus, typically being nutritionally enriched with vitamins and minerals or are rich in energy (protein or carbohydrates), such as fruits or fruit juice, vegetables (particularly leafy vegetables), milk, and fish. Conversely, “bad foods”’ were believed to be harmful to the fetus and the pregnant mother and may include items such as peanuts, goat meat, pineapple, papaya, liver, cucumber, and lentils (see S1 Table for comprehensive lists of good and bad foods).
Migrant women also engage in increased or decreased food intake [28–30, 32, 33, 36, 39, 42] and the restriction or avoidance of certain foods during this period due to their cultural beliefs about these foods [28, 31–33, 35, 42]. These practices aim to facilitate easy delivery, prevent miscarriage, enhance the baby’s skin appearance, and protect the baby’s health. Four studies [28, 29, 36, 42] identified that food intake during pregnancy should be less than when not pregnant, this is to avoid having a large baby, with the risk of delivery by cesarean section [28, 36].
Furthermore, six studies [32–34, 39, 42, 44] have identified that migrant women also engage in certain healthy food practices during pregnancy or postpartum. Some of these practices include avoiding spicy foods, alcohol, coffee, caffeinated beverages (including soda), raw meat, raw fish, and salty foods. Among all these healthy food practices, the avoidance of spicy foods, alcohol, and coffee consumption was most commonly practiced, as evidenced in all the studies.
Five studies [28, 31–33, 37] identified some hindrances to cultural food practices during pregnancy and the postpartum periods among migrant women in host countries. These hinderances include a lack of support, especially from family members [31, 33, 37], low availability of their cultural foods [28, 32], the cost of their cultural foods [28, 32], the geographical locations where traditional food can be purchased [32], changes in their health beliefs and migrant women’s lifestyles [33], and the time available to prepare their cultural foods [33].
Reasons for cultural food practices
Five reasons that migrant women engage in cultural food practices during pregnancy and the postpartum period were identified (see S2 Table). These are maintaining humoral balance, facilitating easy delivery, the benefits to the fetus, healing, recovery, and lactation, and the impact on the baby’s appearance.
Maintaining humoral balance.
Nine studies [28, 30–33, 36, 39, 42, 43] reported that the cultural food practices in which migrant women engage during pregnancy or postpartum aim to help maintain hormonal balance. These studies suggest that the body is in a hot state during pregnancy and a cold state during postpartum. Therefore, cold foods are to be consumed during pregnancy, while hot foods are expected to be consumed during the postpartum period.
Facilitating easy delivery.
Four studies [28, 29, 36, 42] reported that migrant women follow cultural practices of reducing food intake during pregnancy to facilitate easy delivery. These studies suggest that reducing food intake during pregnancy will help prevent a large fetus and reduce the risk of caesarean section. Certain foods are also known to aid in delivery ease, such as adding butter to every meal consumed during pregnancy [32] and the intake of roasted fennel seeds (Soonf) in brown sugar [30].
Benefits for the fetus.
Five studies [28, 32–35] reported that migrant women engage in cultural food practices during pregnancy to protect the fetus’s health. These practices include the use of Maghrebian spices, avoidance of spicy foods, and cinnamon is believed to protect the fetus from health problems [34]. The consumption of fish, nuts, and black sesame, believed to aid in brain development [33].
Healing, recovery, and lactation.
Eight studies [28, 30–33, 37, 42, 44] reported that during the postpartum period, migrant women consume certain foods believed to aid in healing after delivery and promote lactation for breastfeeding the newborn. These foods are chicken, palm fufu, soup with vegetables, fish, meat, black vinegar and ginger, butter or oil, sugar, wheat flour, almonds, Panjeeri, Kaara, Yakhni, and nuts.
Impact on baby’s appearance.
Five studies [28, 32, 33, 35, 36] reported that foods are considered to impact the fetus’s appearance positively or negatively after birth. Foods consumed during pregnancy that are believed to have a positive impact on the baby’s appearance include fish, which is believed to result in a lovely face, light complexion, and healthy skin for the newborn [28], eggs are consumed for light-coloured skin [33], and milk is believed to contribute to a white colour for the child due to milk’s whiteness [36]. Conversely, raw meat, fish, tea, coffee, snake meat, and rabbit meat are avoided as they are believed to cause cleft lip and cleft palate [33], goat meat is thought to cause spots on the baby’s skin [35], and cucumber is believed to cause rough skin [35] are avoided during pregnancy due to their perceived negative effects on the baby’s appearance after birth.
Sources of nutrition information
The sources of nutrition information encompass a variety of channels (see Table 4). These include healthcare providers [32–34, 40, 41], female family members (mothers, grandmothers, mothers-in-law) [28, 30, 32, 33, 35, 36, 40, 41], friends [32, 33, 35, 41], the internet [34, 41], other relatives [30, 33, 35], husbands [30, 33, 35], community members [32, 33], media sources [32, 33], social networks [34], and books [34].
Participants relied on nutritional advice from family members in their home countries. Six studies [28, 30, 32, 33, 35, 36] reported that participants strongly adhered to the advice provided by their mothers or mothers-in-law. This adherence was attributed to their experiences [28, 35] and the trust they had in these family members [32]. Conversely, four studies [33, 35, 36, 44] noted that participants felt obligated to follow the advice from their home country to avoid disobeying or disrespecting their elders and to prevent conflicts.
Four studies [30, 32, 33, 36] described migrant women encountering conflicting nutrition advice from healthcare providers and their families. This conflict arose from disparities between the information provided by healthcare professionals and that from their home countries. Additionally, these women found the advice from healthcare providers to be culturally irrelevant [33], and that this advice created an overwhelming atmosphere of ambiguity and fear for migrant women [36].
Quality assessment
The analysis of bias risk and quality assessment of the studies was assessed using JBI checklists (see S3 Table). Nine studies [30, 32, 34, 36, 37, 39, 41, 43, 44] were rated “good” because the authors adequately addressed the majority of the validity questions, while seven studies [28, 29, 31, 33, 35, 38, 40] were rated “fair”. The “fair” rating was due to their inadequate addressing of the validity criteria, specifically regarding the researcher’s cultural or theoretical positioning [28, 29, 31, 33, 35], appropriate ethical approval [28, 31, 33], statement of the researcher’s influence [33], inability to state strategies for dealing with confounding factors [38, 40], and unclear statistical analysis [40]. Only one study [42] was rated as “poor” because it failed to adequately address the validity criteria regarding defining the inclusion criteria, inability to identify and state strategies for confounding factors, unclear validity and reliability of the outcomes, and inappropriate statistical analysis.
Discussion
This systematic review marks the first attempt to investigate the continuation of cultural food practices among migrant population from LMICs residing in high income countries. Despite the importance of pregnancy food practices in clinical practice, few reviews [7, 45] have investigated the continuation of cultural food practices during pregnancy and postpartum. These reviews revealed that women continue with various cultural food practices during these periods. Therefore, this systematic review synthesised the evidence regarding the cultural food practices of pregnant and postpartum migrant women from LMICs residing in high income countries. This review extensively examined the influence of sociodemographic factors on food practices during pregnancy and explored the sources of nutritional information during pregnancy while residing in high income countries.
This review demonstrates that migrant women from LMICs continue to adhere to their cultural and traditional food practices in high income countries during both pregnancy and the postpartum period. Two studies [32, 35] indicated that even after spending more than a decade in their destination countries, women continued to strictly follow their cultural and traditional food practices.
This review identified the categorisation of food as “hot”, “cold”, “good”, and “bad” within the context of cultural food practices, which resonates deeply with the principles of ‘symbolic interactionism theory’. This theoretical framework suggests that individuals’ interactions with objects, including food, are heavily influenced by the meanings they attribute to them, which are shaped by social interactions [46, 47]. These meanings, developed within specific cultural contexts, wield significant influence over individuals’ food decisions, often transcending objective truths [47]. Our findings reveal commonalities in the cultural food practices of migrant women from South Asian countries, particularly concerning beliefs surrounding humoral balance during pregnancy and the postpartum period. Notably, these women adhere to traditional beliefs, consuming “cold foods” during pregnancy and “hot foods” after birth. This finding aligns with a systematic review conducted by de Diego-Cordero and colleagues [7], which highlighted similar food practices among migrant women living in their home countries in LMICs, rooted in the humoral properties of food. The convergence of our findings with existing literature emphasises the profound influence of cultural norms and traditions on food practices during pregnancy within this group of Asian migrant women in high income countries. Moreover, this underscores the importance of cultural sensitivity and awareness when providing healthcare and nutritional guidance to pregnant individuals from diverse cultural backgrounds. Their beliefs and dietary choices may differ significantly from mainstream recommendations.
While some of the cultural food practices can be considered harmless or inconsequential from a health perspective, others may have short or long term implications. Some nutritious foods, such as meat, eggs, and specific fruits (e.g., watermelon, pineapple, apple, papaya, and cucumber), were found to be restricted due to cultural food practices during pregnancy. Such restrictions can have adverse effects, including low birth weight, anaemia, neural tube defects, and premature delivery [48, 49]. These findings are consistent with a recent review by Gebregziabher et al. [22] whereby the authors identified that African migrant women in Africa restrict certain foods during pregnancy, including meat, milk, cheese, certain fruits and vegetables (e.g., banana, cabbage), and legumes. This is problematic because restricting foods like eggs and meat during pregnancy can result in growth retardation and negatively impact the future health of the fetus [22].
Interestingly, this finding reveals that alongside the harmful cultural food practices in which migrant women engage, they also adopt certain healthy practices. For instance, they avoid spicy foods, which can help prevent dyspepsia and heartburn, as well as coffee and alcohol, which can reduce the increased risk of heartburn or other discomfort during pregnancy [50]. These practices align well with the healthy eating guidelines for pregnant women, which recommend limiting or avoiding the intake of spicy foods, coffee, and alcohol during pregnancy [51, 52].
This review identified that sociodemographic factors, such as social group and level of education, significantly influenced the food intake of migrant women from LMICs in their destination countries during pregnancy and in the postpartum period. Women who lived within their cultural groups were more likely to adhere to traditional cultural food practices [30, 35, 36], echoing the findings of D’Souza and colleagues [1], in which migrant women were found to be influenced by the advice from female relatives in their destination country and their community.
Adherence to cultural food practices was more common among older women [42, 43], highlighting a generational difference in food preferences. Conversely, younger women, particularly those with higher levels of education, were less interested in such practices and often consumed less healthy foods, including fast foods and junk food, during pregnancy [33]. This shift raises concerns regarding its potential negative impacts on both maternal and fetal health. To interpret these findings, we turn to the theoretical construct of ‘acculturation’, which elucidates the cultural and psychological transformations that occur when individuals interact with different cultures [53]. In the case of these young women, their shift from traditional food practices aligns with the concept of ‘assimilation’ within the ‘bidimensional acculturation model’. Assimilation, characterised by the rejection of one’s culture of origin in favour of embracing the host culture, emerges as a coping mechanism amidst cultural transitions [54]. This theoretical lens not only contextualises the observed dietary changes but also underscores the significance of cultural adaptation in shaping health behaviours. Consequently, this underscores the need for healthcare providers caring for pregnant migrants in high income countries to educate them on proper dietary intake during pregnancy, considering the dynamics of acculturation and its implications on maternal and fetal well-being.
This review highlights the major sources of nutritional information for migrant women during pregnancy and postpartum in destination countries. The major sources of information were family members [28, 30, 32, 33, 35, 36, 40, 41] and healthcare professionals [32–34, 40, 41]. Notably, nutritional advice from female family members, especially mothers or mothers-in-law from their home countries, was highly valued by migrant women compared to advice from healthcare professionals. However, it was noted that some women received contradictory information from these sources [30, 32, 33, 36], with migrant women often perceiving healthcare professionals’ advice as culturally inappropriate. Similar situations were observed among Kenyan immigrant women in the US, as reported by Chebet [55]. This finding underscores the importance of culturally appropriate nutritional information being made available and accessible to pregnant migrant women in various host countries. Such education should be provided by healthcare professionals to support optimal maternal and child health.
Although most of the studies (n = 13) included in this review focused on migrant women from South Asian countries and only four studies were among African migrant women, it is evident that there is a relative paucity of research conducted among migrant women from LMICs in their destination countries. This paucity of research is consistent with findings from other reviews [1, 7], such as the systematic review by de Diego-Cordero and colleagues [7], where only two of 24 studies were conducted in high income countries (Canada), while the rest of the studies (n = 22) were conducted in migrant women’s home countries (Africa and Asia countries). This underscores the need for more research to better understand whether these women continue to adhere to their cultural food practices in their host countries. Importantly, this review identified a gap in the literature regarding the impact of these cultural and traditional food practices on birth outcomes among migrant women from LMICs in their destination countries. Future research should aim to address these gaps through focused quantitative and qualitative studies.
Strengths and limitations
This review presents an up-to-date systematic review of the cultural food practices of pregnant migrant LMIC women in their destination countries. The strength of this review lies in the inclusion of various study types, including qualitative, cross-sectional, and cohort studies, without imposing restrictions on publication dates. However, notable limitations must be acknowledged when interpreting our results: only studies published in the English language were included and the search exclusively targeted pregnant and postpartum women. Consequently, articles that identify the food practices of pregnant migrant women in studies conducted with non-pregnant migrant women in their destination countries may be missed.
Conclusion
The findings in this review demonstrate that pregnant migrant women continue to adhere to their cultural and traditional food practices even after migration. This adherence is strongly influenced by their continued communication with their family members back in their home countries, as well as their relatives, friends, and community members in their destination country. The persistence of these cultural food practices indicates the importance placed on culture by pregnant migrant women. Also, these findings showed that migrant women tend to value nutrition information received from family members and friends back in their home country more than that received from healthcare professionals in the host country because they believe that nutrition information provided by healthcare professionals is not culturally appropriate. Therefore, culturally appropriate nutritional education for pregnant migrant women in various host countries should be available and accessible to women, thereby supporting best maternal and child health. This can be achieved through initiatives such as providing cultural competence training for healthcare professionals, fostering collaboration with community leaders, and organizing community-based events.
The outcomes of this review have the potential to inform the healthcare of pregnant migrant women in various high-income countries. This emphasizes the importance of providing culturally sensitive care and assistance during this critical period. Additionally, these findings can guide policymakers in developing strategies to enhance the food practices of pregnant migrants residing in high-income countries. Future research is needed to explore the research gaps identified in this review, leading to a better understanding of how to support migrant women during pregnancy.
Supporting information
S1 Table. Comprehensive list of food categories during pregnancy and postpartum and their potential impact on maternal and fetal health.
https://doi.org/10.1371/journal.pone.0303185.s002
(PDF)
S2 Table. Reasons for cultural food practices.
https://doi.org/10.1371/journal.pone.0303185.s003
(PDF)
Acknowledgments
The authors of this research would like to express their gratitude to the scholars whose articles have been utilized to produce this review.
References
- 1. D’Souza L, Jayaweera H, Pickett KE. Pregnancy diets, migration, and birth outcomes. Health care for women international. 2016;37(9):964–78. pmid:26491790
- 2. Asim M, Ahmed ZH, Nichols AR, Rickman R, Neiterman E, Mahmood A, et al. What stops us from eating: a qualitative investigation of dietary barriers during pregnancy in Punjab, Pakistan. Public Health Nutr. 2022;25(3):760–9. Epub 2021/04/20. pmid:33866982; PubMed Central PMCID: PMC8523588.
- 3. Abere M, Azene AG. Food Taboo and associated factors among pregnant women attending antenatal clinics at Bahir Dar City, North West Ethiopia, 2021: cross-sectional study. Sci Rep. 2023;13(1):7790. Epub 2023/05/14. pmid:37179370; PubMed Central PMCID: PMC10182971.
- 4. Ramulondi M, de Wet H, Ntuli NR. Traditional food taboos and practices during pregnancy, postpartum recovery, and infant care of Zulu women in northern KwaZulu-Natal. J Ethnobiol Ethnomed. 2021;17(1):15. Epub 2021/03/22. pmid:33743760; PubMed Central PMCID: PMC7981893.
- 5. Kavle JA, Landry M. Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications. Matern Child Nutr. 2018;14(1). Epub 2017/08/25. pmid:28836343; PubMed Central PMCID: PMC5763330.
- 6. Wang Z, Chaudhry M, Mistry R, Needham BL, Baylin A, Mancuso P, et al. A mixed-methods study on the dietary practices of early postpartum women during the summer rainy season in Belgaum, Karnataka, India. Ecol Food Nutr. 2022;61(6):728–52. Epub 2022/10/22. pmid:36268551.
- 7. de Diego-Cordero R, Rivilla-Garcia E, Diaz-Jimenez D, Lucchetti G, Badanta B. The role of cultural beliefs on eating patterns and food practices among pregnant women: a systematic review. Nutrition reviews. 2021;79(9):945–63. pmid:33119079
- 8. Banu KK, Prathipa A, Anandarajan B, Sheriff AMI, Muthukumar S, Selvakumar J. Food taboos during antenatal and postpartum period among the women of rural and urban areas of Tamilnadu. International Journal of Biomedical and Advance Research. 2016;7:393–6.
- 9. Oluleke MO, Ogunwale AO, Arulogun OS, Adelekan AL. Dietary intake knowledge and reasons for food restriction during pregnancy among pregnant women attending primary health care centers in Ile-Ife, Nigeria. International Journal of Population Studies. 2016;2(1):103–16.
- 10. Maykondo BK, Horwood C, Haskins L, Mapumulo S, Mapatano MA, Kilola BM, et al. A qualitative study to explore dietary knowledge, beliefs, and practices among pregnant women in a rural health zone in the Democratic Republic of Congo. Journal of Health, Population and Nutrition. 2022;41(51).
- 11. Riang’a RM, Broerse J, Nangulu AK. Food beliefs and practices among the Kalenjin pregnant women in rural Uasin Gishu County, Kenya. Journal of ethnobiology and ethnomedicine. 2017;13(1):1–16.
- 12. Iradukunda F. Food taboos during pregnancy. Health Care Women Int. 2020;41(2):159–68. Epub 2019/04/19. pmid:30998436.
- 13. Wrottesley SV, Lamper C, Pisa PT. Review of the importance of nutrition during the first 1000 days: maternal nutritional status and its associations with fetal growth and birth, neonatal and infant outcomes among African women. J Dev Orig Health Dis. 2016;7(2):144–62. Epub 2015/08/19. pmid:26279311.
- 14. Brown B, Wright C. Safety and efficacy of supplements in pregnancy. Nutr Rev. 2020;78(10):813–26. Epub 2020/01/12. pmid:31925443; PubMed Central PMCID: PMC7558284.
- 15. Yang J, Kang Y, Cheng Y, Zeng L, Yan H, Dang S. Maternal Dietary Patterns during Pregnancy and Congenital Heart Defects: A Case-Control Study. Int J Environ Res Public Health. 2019;16(16). Epub 2019/08/21. pmid:31426394; PubMed Central PMCID: PMC6721011.
- 16. Osendarp SJM, Brown KH, Neufeld LM, Udomkesmalee E, Moore SE. The double burden of malnutrition-further perspective. Lancet. 2020;396(10254):813. Epub 2020/09/21. pmid:32950083.
- 17. Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, et al. The double burden of malnutrition: aetiological pathways and consequences for health. Lancet. 2020;395(10217):75–88. Epub 2019/12/20. pmid:31852605; PubMed Central PMCID: PMC7613491.
- 18. Dereje T, Dessalegn T, Tefera B. Food-related taboos and misconceptions during pregnancy among rural communities of Illu Aba Bor Zone, southwest Ethiopia. a community based qualitative cross-sectional study. BMC Pregnancy and Childbirth. 2021;21(309). https://link.springer.com/article/10.1186/s12884-021-03778-6 pmid:33865339
- 19. Getnet W, Aycheh W, Tessema T. Determinants of Food Taboos in the Pregnant Women of the Awabel District, East Gojjam Zone, Amhara Regional State in Ethiopia. Advances in Public Health. 2018;2018:9198076.
- 20.
Covidence. Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. 2023. Available from: www.covidence.org.
- 21. Chen J, Cross WM, Plummer V, Lam L, Tang S. A systematic review of prevalence and risk factors of postpartum depression in Chinese immigrant women. Women Birth. 2019;32(6):487–92. Epub 2018/12/19. pmid:30559006.
- 22. Gebregziabher H, Kahsay A, Gebrearegay F, Berhe K, Gebremariam A, Gebretsadik GG. Food taboos and their perceived reasons among pregnant women in Ethiopia: a systematic review, 2022. BMC Pregnancy Childbirth. 2023;23(1):116. Epub 2023/02/17. pmid:36797675; PubMed Central PMCID: PMC9933406.
- 23. Shi Y, Davies A, Allman-Farinelli M. The Association Between Food Insecurity and Dietary Outcomes in University Students: A Systematic Review. Journal of the Academy of Nutrition and Dietetics. 2021;121(12):2475–500.e1. pmid:34352437
- 24. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015;13(3):179–87. pmid:26262565
- 25.
Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis 2020.
- 26. Popay J, Roberts HM, Sowden AJ, Petticrew M, Arai L, Rodgers M, et al, editors. Guidance on the conduct of narrative synthesis in systematic Reviews. A Product from the ESRC Methods Programme. Version 12006.
- 27. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. pmid:33782057
- 28. Ahlqvist M, Wirfält E. Beliefs concerning dietary practices during pregnancy and lactation. A qualitative study among Iranian women residing in Sweden. Scandinavian journal of caring sciences. 2000;14(2):105–11. pmid:12035273.
- 29. Essén B, Johnsdotter S, Hovelius B, Gudmundsson S, Sjöberg NO, Friedman J, et al. Qualitative study of pregnancy and childbirth experiences in Somalian women resident in Sweden. BJOG: an international journal of obstetrics and gynaecology. 2000;107(12):1507–12. pmid:11192108.
- 30. Grewal SK, Bhagat R, Balneaves LG. Perinatal beliefs and practices of immigrant Punjabi women living in Canada. Journal of obstetric, gynecologic, and neonatal nursing: JOGNN. 2008;37(3):290–300. pmid:18507600.
- 31. Groleau D, Soulière M, Kirmayer LJ. Breastfeeding and the cultural configuration of social space among Vietnamese immigrant woman. Health & place. 2006;12(4):516–26. pmid:16157504.
- 32. Higginbottom GMA, Vallianatos H, Forgeron J, Gibbons D, Mamede F, Barolia R. Food choices and practices during pregnancy of immigrant women with high-risk pregnancies in Canada: a pilot study. BMC pregnancy and childbirth. 2014;14:370. pmid:25467067.
- 33. Higginbottom GMA, Vallianatos H, Shankar J, Safipour J, Davey C. Immigrant women’s food choices in pregnancy: perspectives from women of Chinese origin in Canada. Ethnicity & health. 2018;23(5):521–41. pmid:28158953.
- 34. Legault A, Marquis M. Nutrition information-seeking behaviour of low-income pregnant Maghrebian women. Canadian journal of dietetic practice and research: a publication of Dietitians of Canada = Revue canadienne de la pratique et de la recherche en dietetique: une publication des Dietetistes du Canada. 2014;75(1):22–8. pmid:24606956.
- 35. Yeasmin SF, Regmi K. A qualitative study on the food habits and related beliefs of pregnant British Bangladeshis. Health care for women international. 2013;34(5):395–415. pmid:23550950.
- 36. Hussain B, Bardi JN, Fatima T. Pregnancy related cultural food practices among Pakistani women in the UK: a qualitative study. British Journal of Midwifery. 2021;29(7):402–9. 151268444.
- 37. Qureshi R, Pacquiao DF. Ethnographic Study of Experiences of Pakistani Women Immigrants With Pregnancy, Birthing, and Postpartum Care in the United States and Pakistan. Journal of Transcultural Nursing. 2013;24(4):355–62.
- 38. Lindsay KL, Gibney ER, McNulty BA, McAuliffe FM. Pregnant immigrant Nigerian women: an exploration of dietary intakes. Public health. 2014;128(7):647–53. pmid:25065518.
- 39. Chen L, Low Y, Fok D, Han W, Chong Y, Gluckman P, et al. Dietary changes during pregnancy and the postpartum period in Singaporean Chinese, Malay and Indian women: the GUSTO birth cohort study. Public Health Nutrition. 2014;17(9):1930–8. https://journals.cambridge.org/action/displayJournal?jid=PHN. pmid:23806144
- 40. Karki R, Perry C, Wilkinson J, Cole G. Prenatal nutrition among Bhutanese refugees in Utah: a pilot study. Journal of Hunger & Environmental Nutrition. 2022;17(4):494–500. https://www.tandfonline.com/doi/full/10.1080/19320248.2022.2032898.
- 41. Lindsay AC, Le Q, Nogueira DL, Machado MMT, Greaney ML. Sources of information about gestational weight gain, diet and exercise among Brazilian immigrant women living in the USA: a cross-sectional study. Public Health Nutrition. 2021;24(17):5720–9. https://www.cambridge.org/core/journals/public-health-nutrition/article/abs/sources-of-information-about-gestational-weight-gain-diet-and-exercise-among-brazilian-immigrant-women-living-in-the-usa-a-crosssectional-study/1B4EA6E81E0EC4B70E922A79A71D313D. pmid:33904387
- 42. Stewart MM, Whiteford MB. Dietary habits and obstetrical service utilization during pregnancy and lactation among Tai Dam women of central Iowa. Ecology of Food and Nutrition. 1987;20(2):121–42.
- 43. Teo C, Chia A, Colega MT, Chen L, Fok D, Pang W, et al. Prospective associations of maternal dietary patterns and postpartum mental health in a multi-ethnic Asian cohort: the Growing up in Singapore towards Healthy Outcomes (GUSTO) Study. Nutrients. 2018;10(3):299. https://www.mdpi.com/2072-6643/10/3/299/htm. pmid:29498695
- 44. Dennis C-L, Brennenstuhl S, Brown HK, Grigoriadis S, Vigod SN, Marini FC, et al. Traditional postpartum rituals among immigrant and non-immigrant Chinese women. Transcultural psychiatry. 2024;61(1):85–94. pmid:37993996.
- 45. Withers M, Kharazmi N, Lim E. Traditional beliefs and practices in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery. 2018;56:158–70. Epub 20171111. pmid:29132060.
- 46.
Blumer H. Symbolic interactionism: Perspective and method. Calfornia: University of California Press1969. 219 p.
- 47.
Pelto GH, Pelto PP, Messer E. Research Methods in Nutritional Anthropology. Hong Kong: United Nations University Press.1989. 217 p.
- 48. Marangoni F, Cetin I, Verduci E, Canzone G, Giovannini M, Scollo P, et al. Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document. Nutrients. 2016;8(10). Epub 2016/10/19. pmid:27754423; PubMed Central PMCID: PMC5084016.
- 49. Vinaykumar N, Kumar A, Quadros LS, Prasanna LC. Determining the effect of folate diets during pregnancy and lactation on neurobehavioural changes in the adult life of offspring. J Taibah Univ Med Sci. 2019;14(6):523–30. Epub 2020/01/08. pmid:31908640; PubMed Central PMCID: PMC6940624.
- 50.
NSW Medications in Pregnancy and Breastfeeding Service. Heartburn in pregnancy and breastfeeding. 2013.
- 51.
Dietitians Australia. Diet and Nutrition Health Advice: Pregnancy and breastfeeding 2023 [updated 20 April 2023; cited 2024 5 April]. Available from: https://dietitiansaustralia.org.au/health-advice/pregnancy-and-breastfeeding#anchor-body.
- 52.
National Health and Medical Research Council. Australian Dietary Guidelines Canberra: National Health and Medical Research Council: National Health and Medical Research Council; 2013 [cited 2024 5 April]. Available from: www.nhmrc.gov.au/guidelines-publications/n55.
- 53. Berry JW. Immigration, Acculturation, and Adaptation. International Association of Applied Psychology. 1997;46(1):5–68.
- 54. Renzaho AM, Swinburn B, Burns C. Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to Australia. Int J Obes (Lond). 2008;32(4):594–600. Epub 20080205. pmid:18253161.
- 55.
Chebet SJ. Pregnancy-Related Nutritional Beliefs, Knowledge, and Cultural Practices Among Kenyan Immigrant Women Living In Tennessee.: Middle Tennessee State University; 2021.