Background Antenatal care (ANC) provides an ideal opportunity to encourage behaviour change, which can have a positive influence on maternal and child health. Despite a high burden of deleterious health behaviours during pregnancy, little is known about the nature and content of preventive health counselling provided during ANC. The Pregnancy Risk Assessment Monitoring System (PRAMS) in Ireland is a modified version of CDC methodology that monitors maternal behaviours and experiences that occur before, during and after pregnancy.

Aim To assess the prevalence and content of preventive health counselling during antenatal care in pregnancy in Ireland.

Methods Cross-sectional analysis of the PRAMS study was conducted. PRAMS was established at Cork University Maternity Hospital, a large urban, obstetric hospital (˜9,000 live births annually). A sampling frame of 2,400 mother-infant pairs was used to alternately sample 1,200 women. Outcome measures included self-report of receipt of preventive health counselling on effects of smoking, alcohol, breastfeeding, appropriate weight gain and folic acid supplementation during ANC. Women were defined as in high need of counselling if they reported ≥1 of the following: cigarette/alcohol use in the last 3 months of pregnancy, pre-pregnancy BMI >25 kg/m², non-adherence to daily folic acid supplements and stated intent to bottle-feed. Bivariate analyses were conducted to examine if those with a high need of counselling received counselling for their specific health concern.

Results The response rate was 61% (n = 718); mean age was 32 years, 82.3% (n = 587) were 3^rd-level educated and 31% (n = 219) were primiparous. Highest reported counselling rates were on the topics of breast-feeding (84.8%, n = 592) and folic acid supplementation (67.7%, n = 483). Reported counselling was lower regarding the effects of smoking (47.6%, n = 333), alcohol (48.5%, n = 338) and appropriate weight gain (31.5%, n = 219). Women identified with a high need for counselling on breast-feeding (30.7%, n = 219), alcohol consumption (31.8%, n = 225) and appropriate weight gain (29.2%, n = 202) were not significantly more likely to receive counselling on these topics; those continuing to smoke during pregnancy were more likely to have received counselling on its effects (OR 7.4 95% CI 3.3–16.7, p < 0.05). Women who took folic acid during the first trimester were almost twice as likely to have received advice on this topic (OR = 1.9, 95% CI 1.3–2.8, p < 0.05).

Conclusion The prevalence of preventive health counselling is lower than expected. Pregnant women with a high need for counselling were not more likely to receive it for many health promotion topics. Improved delivery methods of preventive health counselling during pregnancy may be required.