Introduction

This quality standard covers improving nutrition before, during and after pregnancy (up to a year after birth) for women who may become pregnant, and for babies and pre‑school children. It particularly focuses on low‑income and other disadvantaged households.

It does not cover population‑based screening programmes or national maternal and child nutrition policies. It does not cover the nutrition and care of women and children with clinical conditions that require specialist advice, secondary dietary management or clinical therapeutic advice, for whom normal care would be inappropriate. For example, it does not cover women and children with diabetes, epilepsy or HIV, or the care of low birthweight babies.

For more information see the maternal and child nutrition: improving nutritional status topic overview.

Why this quality standard is needed

Nutrition level describes a person's nutritional wellbeing. It is a more comprehensive measure than dietary intake alone because it takes account of body shape and size together with measures of body function.

The importance of ensuring that mothers and their babies are well‑nourished is widely recognised. A pregnant woman's nutrition influences the growth and development of her fetus and forms the foundations for the child's health. The mother's health, both in the short and long term, also depends on how well‑nourished she is before, during and after pregnancy.

A child's diet during the early years has an impact on their growth and development. It is linked to the incidence of many common childhood conditions such as iron‑deficiency anaemia, tooth decay and vitamin D deficiency. It can also affect the risk of developing conditions such as coronary heart disease, diabetes and obesity in adult life.

Up to 50% of pregnancies are likely to be unplanned, so all women who may become pregnant should be aware of the importance of a healthy diet. Many nutritional interventions are likely to have the greatest benefit if delivered before conception and during the first 12 weeks of pregnancy.

The quality standard is expected to contribute to improvements in the following outcomes:

  • premature deaths of mothers

  • postnatal depression

  • hospital admissions

  • childhood illnesses

  • childhood infections

  • children's growth and weight status

  • obesity

  • iron‑deficiency anaemia

  • vitamin D deficiency

  • tooth decay

  • positive experience of primary and secondary care.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcome frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.1 Low birth weight of term babies

2.2 Breastfeeding

2.5 Child development at 2–2½ years (under development)

2.6 Excess weight in 4–5 and 10–11 year olds

2.11 Diet

2.12 Excess weight in adults

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.2 Tooth decay in children aged 5

Table 2 The Adult social care outcomes framework 2015–16

Domain

Overarching and outcome measures

3 Ensuring that people have a positive experience of care and support

Overarching measure

People who use social care and their carers are satisfied with their experience of care and support services

Outcome measure

Placeholder 3E: The effectiveness of integrated care

Table 3 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

1c Neonatal mortality and stillbirths

Improvement areas

Reducing mortality in children

1.6 i Infant mortality (PHOF 4.1*)

3 Helping people to recover from episodes of ill health or following injury

Improvement areas

Improving dental health

3.7 i Decaying teeth (PHOF 4.02**)

ii Tooth extractions in secondary care for children under 10

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

4d Patient experience characterised as poor or worse

i Primary care

Improvement areas

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

Improving people's experience of integrated care

4.9 People's experience of integrated care (ASCOF 3E**)

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF).

** Indicator is complementary with Public Health Outcomes Framework (PHOF) and Adult Social Care Outcomes Framework (ASCOF).

Coordinated services

The quality standard for nutrition: improving maternal and child nutrition specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole maternal and child nutrition care pathway. A person‑centred, integrated approach to providing services is fundamental to improving nutrition in women before, during and after pregnancy, and in babies and pre‑school children.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality maternal and child nutrition service are listed in related quality standards.

The Health and Social Care Act 2012 introduced legal duties for clinical commissioning groups to have regard to the need to reduce health inequalities and to exercise functions with a view to ensuring that health services are provided in an integrated way when they consider that this would reduce inequalities in access to services and outcomes achieved. Given the strong relationship that exists between poor maternal and child nutrition and deprivation, reducing inequalities is of particular importance for improving the nutritional status of mothers and pre‑school children. Therefore it is important to consider focusing interventions in deprived areas when using the quality standard.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, social care and public health professionals involved in improving the nutritional status of women before, during and after pregnancy, and babies and pre‑school children should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting women before, during and after pregnancy, and babies and pre‑school children to improve nutrition. If appropriate, health, social care and public health professionals should ensure that family members and carers are involved in the decision‑making process on ways to improve nutrition in women before, during and after pregnancy, and in babies and pre‑school children.