An open web-based questionnaire was distributed from November 1, 2022, to January 6, 2023. The study targeted a convenience sample of women in the Netherlands who were either pregnant or had given birth in the past year and were able to read and write in Dutch. Women of any age, educational status, or BMI were eligible. Participants were recruited via social media, including Facebook advertisements, Instagram, and LinkedIn, by sharing a flyer with a link to the questionnaire (Multimedia Appendix 1). A total of 1709 women completed the questionnaire, of whom 90 (5.3%) were excluded for incomplete responses below 20% (n=77) or being both pregnant and one year postpartum (n=13), leaving data from 1619 (94.7%) women for analysis. Answers were checked for plausibility with no additional checks on bots or ungenuine respondents.

The study was approved by the Social Sciences Ethical Committee of Wageningen University and Research on August 23, 2022. Women checked the informed consent box at the start of the questionnaire, where information on study participation was provided, such as study activities, time investment, data handling, and purpose of the study. Study data were stored separately from names and email addresses on a secured drive of the university. As an incentive, women could participate in a lottery to win one of three €15 (US $15.90) gift vouchers.

The questionnaire, designed in Qualtrics (Qualtrics, Inc), started with a study explanation and informed consent request, followed by 65 questions distributed among 19 pages in Dutch: 32 (49.2%) multiple-choice questions, 2 (3.1%) ranking questions, 11 (16.9%) rating questions, and 20 (30.8%) open-ended questions, of which 13 (20.0%) were optional (Multimedia Appendix 2). Based on their responses, women were directed to specific questions (adaptive questioning). Completion took about 8 (IQR 6‐12) minutes. Women could navigate back to previous questions, and answers were remembered based on IP address. The questionnaire, inspired by Vasiloglou et al [31] and based on the capability, opportunity, motivation—behavior (COM-B) model [32], was developed to assess demographics, pregnancy or postpartum experience, dietary-related behaviors and their determinants, and information-seeking behaviors focusing on app use. The COM-B model served as a framework for deriving questions by defining its components, identifying relevant subtopics, and formulating specific questions accordingly. The questionnaire was pilot-tested by 5 pregnant or postpartum women on content, flow, and technical aspects, with only suggestions for slight textual adaptations.

Items questioned included age, education, work, living area, living situation (living together, not living together, or no current partner), number of children, prepregnancy BMI, planned breastfeeding, and pregnancy weeks or age of newborn in weeks. Age was calculated based on birth year and questionnaire completion year. Education was subdivided into low (primary school, vocational, or lower general secondary education), middle (higher secondary education or intermediate vocational training), and high (higher vocational education or university) based on self-reported educational levels. Hours of work were reported based on categories (equal hours, fewer hours than before pregnancy, more hours than before pregnancy, or no currently paid job). Living area was reported using categories of city and countryside. Number of children was recorded excluding the current pregnancy if pregnant. Self-reported height (cm) and weight before pregnancy (kg) were used to calculate prepregnancy BMI (kg/m²). Pregnancy trimester was determined based on self-reported number of weeks pregnant. Questions on pregnancy and postpartum experiences focused on overall enjoyment (rating scale) and current physical complaints.

Dietary-related experiences were addressed through subjective diet quality, and determinants of healthy dietary habits, such as considered importance of a healthy diet, nutritional knowledge, time, budget, capability to prepare and eat healthy meals, support, and enjoyment of eating. Participants were also asked about their information-seeking behaviors focusing on app use, both general and diet specific, during pregnancy and the postpartum period. Women could also specify which aspects and topics they considered important to include in a pregnancy or postpartum diet app.

Mean and SD were provided for continuous variables, while frequencies and percentages were presented for categorical variables. Responses to open-ended questions were inductively coded by 2 researchers independently, and codes were combined and rephrased after discussion among researchers. The most prevalent codes were synthesized in text. Pregnancy and postpartum periods were compared using chi-square tests for categorical variables and t tests or ANOVA for continuous variables, with significance set at P<.05. Analyses were conducted using RStudio (version 2023.06.1; Posit PBC).

A total of 1619 women were included in the analysis, with an average age of 32 (SD 4) years and a mean prepregnancy BMI of 25 (SD 5) kg/m². Most were highly educated (1214/1619, 75%) and lived with their partner (1570/1619, 97.0%). About half (848/1618, 52.4%) resided in a city (Table 1). Of the 842 pregnant women, half (418, 49.6%) were in their third trimester. Of the 777 postpartum women, most (517, 66.5%) gave birth less than 20 weeks ago. During pregnancy, most women (620/842, 73.6%) maintained similar work hours as before pregnancy, while postpartum women (295/777, 38.0%) worked fewer hours or the same (341/777, 43.9%) compared with before pregnancy (Table 1).

Women rated the postpartum period as more pleasant than pregnancy (mean 8.4, SD 1.5 vs 6.6, SD 2.1 on a 10-point scale; P<.001; Table 2). Common pregnancy complaints were tiredness (673/837, 80.4%), frequent toilet visits (547/837, 65.4%), heartburn (424/837, 50.7%), and back pain or pelvic instability (410/837, 49.0%). Postpartum concerns mentioned by the women in optional open answers included recovery (29/764, 3.8%), adjusting to the new situation (23/764, 3.0%) and challenging baby care (70/764, 9.2%) because of, for example, suboptimal sleep (23/764, 3.0%) or a baby who was uncomfortable and/or crying (33/764, 4.3%). Most pregnant women intended to breastfeed (737/837, 88.1%) and about half of postpartum women exclusively breastfed at the time of the survey (404/764, 52.9%).

Women considered the first pregnancy trimester least pleasant (mean 5.8, SD 2.7 on a 10-point scale) and the first 20 weeks postpartum most pleasant (mean 8.4, SD 1.5 on a 10-point scale). Subjective diet quality was rated lower in the first trimester (mean 6.3, SD 1.9 on a 10-point scale) and highest after 20 weeks postpartum (mean 7.1, SD 1.5 on a 10-point scale; Multimedia Appendix 3). Diet was considered most important in the first trimester (mean 9.0, SD 1.0 on a 10-point scale). Interest in learning about nutrition was highest at the start of pregnancy and early postpartum, 43.0% (49/114) and 44.1% (126/286), respectively. In the first weeks postpartum, 53.1% (152/286) of partners also decided about family meals, dropping to 38.5% (50/130) after 30 weeks. Women felt most physically capable of preparing food after 10 weeks postpartum (mean 7.8, SD 1.7 on a 10-point scale).

Almost all women owned a smartphone (1511/1619, 93.3%; Multimedia Appendix 4), and 37.0% (599/1619) owned a tablet. While 90.8% (713/785) of pregnant women used a pregnancy app, only 58.9% (418/710; P<.001) of postpartum women used a postpartum-specific app. Reasons for not using an app during pregnancy were that it was not considered necessary (24/785, 3.1%), that it was not perceived as useful (4/785, 0.5%), and that this was not the first pregnancy (8/785, 1.0%). While women during the postpartum period did not use an app because it was not considered useful (66/710, 9.3%), there was a perceived lack of a high-quality app (42/710, 5.9%), or there was a lack of time (7/710, 1.0%). Apps were discovered through searches (545/1131, 48.2%), family or friends (367/1131, 32.4%), HCPs (311/1131, 27.5%), and social media (293/1131, 25.9%). Most preferred features were reliable information, ease of use, and being freely available. In optional open answers, pregnant women also valued food safety information (225/785, 28.6%), general pregnancy information (101/785, 12.8%), and trustworthy, evidence-based information (41/785, 5.2%), while postpartum women valued healthy nutrition (191/710, 26.9%), recipes or meal plans (101/710, 14.2%), nutrition tips when breastfeeding (91/710, 12.8%), and general postpartum information (61/710, 8.6%).

This study provides important insights into dietary-related experiences, determinants, and information-seeking behaviors, focusing on app use, among pregnant and postpartum women. Both groups highly valued a healthy diet, though differences emerged between stages indicating a need for personalized mHealth apps. During the first pregnancy trimester, women enjoyed food the least, rated their diet lowest, but valued healthy eating the most. Postpartum women had less phase-specific nutritional knowledge but showed a stronger desire to learn about nutrition. They also reported feeling more capable of food preparation despite having less time for it compared with pregnant women. The focus on the child’s health was a major motivator for healthy eating during pregnancy, while hunger was the main motivator postpartum. Partner support was highest in the first trimester and declined over time. Women primarily obtained nutrition information from websites, HCPs, and apps. Almost all pregnant women (713/785, 90.8%) used a phase-specific app, compared with 58.9% (418/710) of postpartum women. Many women noted the apparent lack of a quality postpartum app, highlighting opportunities for improvement.

Consistent with previous research, our study showed that perspectives and experiences regarding nutrition varied between perinatal phases [13,26,33]. Therefore, when designing dietary interventions for pregnant and postpartum women, it is essential to tailor these interventions to the specific needs of each phase. Motivation, opportunity, and capability to prepare and eat healthy meals vary throughout pregnancy and the postpartum period due to several factors. Motivation to eat healthily was highest in the first trimester, driven by concern for the unborn child’s health, as also indicated by Rockliffe et al [33]. In our study, postpartum women rated their diet slightly higher than pregnant women, despite assigning less importance to healthy eating, which may suggest that they more quickly perceive their diet as sufficiently healthy.

The opportunity to eat healthily was influenced by time and social support. Our study found that pregnant women generally had more time for meal preparation and eating, while postpartum women faced time constraints mainly due to childcare priorities, which may lead them to opt for convenient, potentially unhealthy foods, as indicated by other studies [16,34]. The social environment, particularly partner support, also affects eating behavior [13,16,33,35]. In our study, partner support peaked in the first trimester but declined over time, potentially resulting in more time constraints for eating during the postpartum period. Furthermore, family dinners were common in both groups, which can provide valuable social interaction while positively influencing both maternal and children’s eating habits and weight [36-38].

The capability to prepare food and eat healthily was influenced by physical complaints and knowledge. Most mentioned complaints in our study, nausea and tiredness during pregnancy, align with other research [33,39]. Physical discomforts can affect cravings, appetite, and taste, which are important drivers of food choices, as mentioned by Groth et al [40]. Capability to prepare food was also lower in the first weeks after delivery likely because of postdelivery physical and mental complaints [41]. Furthermore, fewer postpartum women indicated having sufficient knowledge about phase-specific nutrition compared with pregnant women. Ryan et al [16] found a similar knowledge gap about healthy postpartum lifestyles among postpartum women and HCPs, likely due to limited resources [39] rather than a lack of interest, as several postpartum women in our study expressed a desire to learn more about nutrition.

To learn about nutrition, most women sought information from websites, HCPs, and mobile apps. Nonetheless, several studies reported a lack of nutritional support from HCPs (eg, due to a lack of time and knowledge) [21,26,42]. A lack of support from HCPs, as well as convenience, were important reasons for many women to use digital nutrition sources [26,43,44]. In particular, Wang et al [45] mentioned that women valued apps promoted by HCPs. In our study, 910.8% (713/785) of participants used a pregnancy app, a higher proportion than the 55% reported in Korea [46]. However, among participants in our study, only 58.9% (418/710) used postpartum-specific apps, often due to a lack of time, interest, or perceived availability. Similarly, a study from Canada found that postpartum women faced fewer nutrition resources than pregnant women [39]. This may be explained by a stronger focus on childcare over healthy maternal eating among parents as well as HCPs. In agreement, an Australian study noted that standard postpartum care prioritizes the baby’s health over the mother’s health [47]. These findings underscore the increasing role of digital tools in maternal health and the need for more focus on postpartum nutrition and improved postpartum resources.

To use a perinatal app, women in our study prioritized credible information, ease of use, and cost-free access. Ease of use was also perceived as important by Canadian pregnant women when using online sources [26]. Furthermore, credibility was crucial in the perinatal period [16,26], though conflicting advice in online resources was a common challenge during the perinatal period [42,43]. Other studies among pregnant women highlighted the importance of user-friendliness, enjoyment, and evidence-based, personalized support tailored to their situation [26,45,48,49], and postpartum women indicated preferring accurate and personalized information (eg, culturally relevant recipes) [50-52]. Comparably, women in our study ranked personalized information as the fourth priority in perinatal apps. Considering women’s preferences and the variations in their experiences across perinatal phases, tailoring dietary support in mHealth apps to their personal situations and the distinct needs of each phase appears essential.

This study used a large-scale analysis of an online questionnaire involving more than 1600 pregnant or postpartum women. However, a limitation of this study is the online distribution, which may have led to selection bias toward social media users comfortable with online surveys. While we did check for plausibility of answers, we cannot be certain that bots or ungenuine participants filled in the questionnaire. Most participants were highly educated, underrepresenting lower-educated women—a common survey bias [53,54]. If more lower-educated women had been included, research suggests potential lower motivation for and knowledge about healthy nutrition, which could have influenced our study results through lower engagement in nutrition information retrieval using mHealth apps [55-58]. Additionally, as not only lifestyle during pregnancy and the postpartum period but also the preconception period is critical for maternal and child health, preconception dietary behavior and app use should also be studied to enable intervention as early as possible within the first 1000 days.

A further limitation of this study is the primarily multiple-choice format of the questionnaire, potentially limiting response options, although we pilot-tested the instrument and included text boxes for further explanation. However, as explanations were optional in the questionnaire we might lack relevant input from a subset of respondents. Additionally, self-rated diet quality was subjective, preventing us from making connections between nutrition-related experiences, app use, and actual diet quality. In our study, we expect an overestimation of diet quality, as a study indicated that while only 29% of Dutch adults consumed at least 200 grams of vegetables daily, 41% believed they did [59]. In addition to self-reported dietary assessment or biomarker data, future studies could benefit from qualitative methods to explore detailed perspectives and experiences related to nutrition and app use during pregnancy and the postpartum period.

This large questionnaire study among around 1600 pregnant or postpartum women highlights the importance of tailoring dietary support to specific perinatal phases. Physical discomfort during pregnancy and time constraints during the postpartum period emerged as key barriers to healthy eating, while maternal attention postpartum appeared to focus primarily on infant care rather than maternal health. Women considered nutritional information from HCPs to be reliable, although the dietary guidance from HCPs may be limited. These findings highlight the potential of digital tools, such as apps, to complement existing care. Participants particularly valued easy-to-use, cost-free apps that provide credible and tailored support. The apparent scarcity of postpartum nutrition resources further emphasizes the need for targeted support during this period. Insights from this study can inform the development of user-centered digital interventions to improve maternal diet (Figure 1). Future research could explore in more detail the dietary-related experiences and their determinants through interviews or focus groups and assess dietary intake more objectively using methods such as food frequency questionnaires or dietary recalls.