Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status

Abstract

Objectives: To examine the effects of the First 1000 Days intervention on the prevalence of infant overweight and maternal postpartum weight retention and care.

Methods: Using a quasi-experimental design, we evaluated the effects of the First 1000 Days program among 995 term, low-income infants and their mothers receiving care in 2 intervention community health centers and 650 dyads in 2 comparison health centers. The program includes staff training, growth tracking, health and behavioral screening, patient navigation, text messaging, educational materials, and health coaching. Comparison centers implemented usual care. Infant outcomes were assessed at 6 and 12 months, including weight-for-length z score and overweight (weight for length ≥97.7th percentile). We also examined maternal weight retention and receipt of care 6 weeks' post partum.

Results: The mean birth weight was 3.34 kg (SD 0.45); 57% of infants were Hispanic; 66% were publicly insured. At 6 months, infants had lower weight-for-length z scores (β: -.27; 95% confidence interval [CI]: -.39 to -.15) and lower odds of overweight (adjusted odds ratio [OR]: 0.46; 95% CI: 0.28 to 0.76) than infants in comparison sites; differences persisted at 12 months (z score β: -.18; 95% CI: -.30 to -.07; adjusted OR for overweight: 0.60; 95% CI: 0.39 to 0.92). Mothers in the intervention sites had modestly lower, but nonsignificant, weight retention at 6 weeks' post partum (β: -.51 kg; 95% CI: -1.15 to .13) and had higher odds (adjusted OR: 1.50; 95% CI: 1.16 to 1.94) of completing their postpartum visit compared with mothers in the comparison sites.

Conclusions: An early-life systems-change intervention combined with coaching was associated with improved infant weight status and maternal postpartum care.

Trial registration: ClinicalTrials.gov NCT03191591.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2021 by the American Academy of Pediatrics.

Figures

FIGURE 1

Intervention and comparison sample size flow for First 1000 Days pediatric program. a The sample size for intervention sites reflects infants who had mothers also receiving prenatal care within the Mass General Brigham health system. b One of the intervention sites embedded a health coach in person at well-child care visits. In-person coaching is not included.

FIGURE 2

Conditional weight gain from birth to 6 and 12 months, by First 1000 Days program intervention assignment. a The unadjusted mean (SD) conditional weight gain scores were −0.08 (0.96) for the intervention sites and 0.12 (1.04) for the comparison sites, with an unadjusted difference of −0.20 (95% CI: −0.31 to −0.10) and an adjusted difference of −0.25 (95% CI: −0.36 to −0.15), indicating that children in the intervention sites gained weight more slowly than those in the comparison sites. b The unadjusted mean (SD) conditional weight gain scores were −0.07 (0.97) for the intervention sites and 0.11 (1.04) for the comparison sites, with an unadjusted difference of −0.18 (95% CI: −0.28 to −0.08) and an adjusted difference of −0.22 (95% CI: −0.33 to −0.11), indicating that children in the intervention sites gained weight more slowly than those in the comparison sites.