Effects of the First 1000 Days Program, a systems-change intervention, on obesity risk factors during pregnancy

Meg Simione, Laura Moreno-Galarraga, Meghan Perkins, Sarah N Price, Man Luo, Milton Kotelchuck, Tiffany L Blake-Lamb, Elsie M Taveras, Meg Simione, Laura Moreno-Galarraga, Meghan Perkins, Sarah N Price, Man Luo, Milton Kotelchuck, Tiffany L Blake-Lamb, Elsie M Taveras

Abstract

Background: First 1000 Days is a systems-oriented program starting in early pregnancy lasting through the first 24 months of infancy focused on preventing obesity and related risk factors among low income, mother-infant pairs. The program was developed in partnership with stakeholders to create an infrastructure for system-wide change. It includes screening for adverse health behaviors and socio-contextual factors, patient navigation and educational materials to support behavior change and social needs, and individualized health coaching for women at highest risk of obesity and has been shown to reduce excess gestational weight gain for women who were overweight at the start of their pregnancy. The purpose of this study was to examine changes from the first to third trimester for women participating in the First 1000 Days Program.

Methods: We collected information through self-administered questionnaires during the first and third trimester of gestation and from electronic health records relating to obesity risk factors. Measures collected included behavior (i.e., diet, physical activity and screen time) and psychosocial (i.e., anxiety) outcomes, as well as enrollment in Women, Infant, and Children (WIC) program. We examined the extent to which participation in the program was associated with changes in behaviors and psychosocial outcomes among women during pregnancy.

Results: Women completed surveys at their initial and third trimester prenatal visits (n = 264). Mean age (SD) was 30.2 (5.51) years and 75% had an annual household income of <$50,000. Mean pre-pregnancy body mass index (BMI) was 27.7 kg/m2 and 64% started pregnancy with a BMI ≥ 25 kg/m2. In multivariable adjusted models, we observed decreases in intake of sugary-drinks (- 0.95 servings/day; 95% CI: - 1.86, - 0.03) and in screen time (- 0.21 h/day; 95% CI: - 0.40, - 0.01), and an increase in physical activity (0.88 days/week; 95% CI: 0.52, 1.23) from the first to third trimester. We also observed a decrease in pregnancy-related anxiety score (- 1.06 units; 95% CI: - 1.32, - 0.79) and higher odds of enrollment in Women, Infant, and Children (WIC) program (OR: 2.58; 95% CI: 1.96, 3.41).

Conclusions: Our findings suggest that a systems-oriented prenatal intervention may be associated with improvements in behaviors and psychosocial outcomes during pregnancy among low-income mothers.

Trial registration: ClinicalTrials.gov ( NCT03191591 ; Retrospectively registered on June 19, 2017).

Keywords: Childhood obesity; Health behaviors; Infant; Maternal health; Obesity risk factors; Pregnancy; Prenatal care; Systems-approach.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Participant flow diagram for women participating in The First 1000 Days Program during pregnancy
Fig. 2
Fig. 2
Examples of The First 1000 Days Programpregnancy booklet supporting behavioral changes

References

    1. Massetti GM, Dietz WH, Richardson LC. Excessive weight gain, obesity, and cancer: opportunities for clinical intervention. JAMA. 2017;318(20):1975–1976. doi: 10.1001/jama.2017.15519.
    1. Mokdad AH, Ballestros K, Echko M, et al. The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319(14):1444–1472. doi: 10.1001/jama.2018.0158.
    1. Rossen LM, Schoendorf KC. Measuring health disparities: trends in racial-ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the United States, 2001-2010. Ann Epidemiol. 2012;22(10):698–704. doi: 10.1016/j.annepidem.2012.07.005.
    1. Olds T, Maher C, Zumin S, et al. Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Int J Pediatr Obes. 2011;6(5–6):342–360. doi: 10.3109/17477166.2011.605895.
    1. Voerman E, Santos S, Inskip H, et al. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA. 2019;321(17):1702–1715. doi: 10.1001/jama.2019.3820.
    1. Mamun AA, Mannan M, Doi SAR. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2014;15(4):338–347. doi: 10.1111/obr.12132.
    1. Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50(6):761–779. doi: 10.1016/j.amepre.2015.11.012.
    1. Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94(5):1225–1231. doi: 10.3945/ajcn.111.015289.
    1. Siega-Riz AM, Viswanathan M, Moos M-K, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1–339.14. doi: 10.1016/j.ajog.2009.07.002.
    1. World Health Organization. Taking Action on Childhood Obesity Report. Geneva; 2018. .
    1. Blake-Lamb TL, Locks LM, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50(6):780–789. doi: 10.1016/j.amepre.2015.11.010.
    1. Thangaratinam S, Rogozinska E, Jolly K, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: Meta-analysis of randomised evidence. BMJ. 2012;344:e2088. doi: 10.1136/bmj.e2088.
    1. Chan CWH, Au Yeung E, Law BMH. Effectiveness of physical activity interventions on pregnancy-related outcomes among pregnant women: A systematic review. Int J Environ Res Public Health. 2019;16(10). 10.3390/ijerph16101840.
    1. van Dammen L, Wekker V, de Rooij SR, Groen H, Hoek A, Roseboom TJ. A systematic review and meta-analysis of lifestyle interventions in women of reproductive age with overweight or obesity: the effects on symptoms of depression and anxiety. Obes Rev. 2018;19(12):1679–1687. doi: 10.1111/obr.12752.
    1. Blake-Lamb T, Arauz Boudreau A, Matathia S, et al. Strengthening integration of clinical and public health systems to prevent maternal-child obesity in the first 1,000Days: a collective impact approach. Contemp Clin Trials. 2018;65:46–52. doi: 10.1016/j.cct.2017.12.001.
    1. Blake-Lamb T, Boudreau AA, Matathia S, et al. Association of the First 1,000 days systems-change intervention on maternal gestational weight gain. Obstet Gynecol. 2020;135(5):1047–1057. doi: 10.1097/AOG.0000000000003752.
    1. Blum RE, Wei EK, Rockett HR, et al. Validation of a food frequency questionnaire in native American and Caucasian children 1 to 5 years of age. Matern Child Health J. 1999;3(3):167–172. doi: 10.1023/a:1022350023163.
    1. Miller SA, Taveras EM, Rifas-Shiman SL, Gillman MW. Association between television viewing and poor diet quality in young children. Int J Pediatr Obes IJPO an Off J Int Assoc Study Obes. 2008;3(3):168–176. doi: 10.1080/17477160801915935.
    1. Brener ND, Kann L, McManus T, Kinchen SA, Sundberg EC, Ross JG. Reliability of the 1999 youth risk behavior survey questionnaire. J Adolesc Health. 2002;31(4):336–342. doi: 10.1016/s1054-139x(02)00339-7.
    1. Jung SJ, Winning A, Roberts AL, et al. Posttraumatic stress disorder symptoms and television viewing patterns in the nurses’ health study II: a longitudinal analysis. PLoS One. 2019;14(3):e0213441. doi: 10.1371/journal.pone.0213441.
    1. Rini CK, Dunkel-Schetter C, Wadhwa PD, Sandman CA. Psychological adaptation and birth outcomes: the role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol. 1999;18(4):333–345. doi: 10.1037//0278-6133.18.4.333.
    1. Cheng ER, Rifas-Shiman SL, Perkins ME, et al. The influence of antenatal partner support on pregnancy outcomes. J Womens Heal. 2016;25(7):672–679. doi: 10.1089/jwh.2015.5462.
    1. Deputy NP, Sharma AJ, Kim SY, Hinkle SN. Prevalence and characteristics associated with gestational weight gain adequacy. Obstet Gynecol. 2015;125(4):773–781. doi: 10.1097/AOG.0000000000000739.
    1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–497. doi: 10.1001/jama.2012.39.
    1. Dodd JM, Deussen AR, Louise J. A randomised trial to optimise gestational weight gain and improve maternal and infant health outcomes through antenatal dietary, lifestyle and exercise advice: The OPTIMISE randomised trial. Nutrients. 2019;11(12). 10.3390/nu11122911.
    1. Ainscough KM, O’Brien EC, Lindsay KL, et al. Nutrition, behavior change and physical activity outcomes from the PEARS RCT: An mHealth-supported, lifestyle intervention among pregnant women with overweight and obesity. Front Endocrinol (Lausanne) 2019;10:938. doi: 10.3389/fendo.2019.00938.
    1. Dodd JM, Louise J, Cramp C, Grivell RM, Moran LJ, Deussen AR. Evaluation of a smartphone nutrition and physical activity application to provide lifestyle advice to pregnant women: The SNAPP randomised trial. Matern Child Nutr. 2018;14(1). 10.1111/mcn.12502.
    1. Flynn AC, Seed PT, Patel N, et al. Dietary patterns in obese pregnant women; influence of a behavioral intervention of diet and physical activity in the UPBEAT randomized controlled trial. Int J Behav Nutr Phys Act. 2016;13(1):124. doi: 10.1186/s12966-016-0450-2.
    1. Dodd JM, Cramp C, Sui Z, et al. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial. BMC Med. 2014;12:161. doi: 10.1186/s12916-014-0161-y.
    1. Mahabamunuge J, Simione M, Hong B, et al. Association of sugar-sweetened beverage intake with maternal postpartum weight retention. Public Health Nutr. 2020:1–8. 10.1017/S1368980020005169.
    1. Cummins S, Macintyre S. Food environments and obesity-neighbourhood or nation? Int J Epidemiol. 2006;35(1):100–104. doi: 10.1093/ije/dyi276.
    1. Forbes LE, Graham JE, Berglund C, Bell RC. Dietary change during pregnancy and women’s reasons for change. Nutrients. 2018;10(8). 10.3390/nu10081032.
    1. Skreden M, Bere E, Sagedal LR, Vistad I, Øverby NC. Changes in beverage consumption from pre-pregnancy to early pregnancy in the Norwegian fit for delivery study. Public Health Nutr. 2015;18(7):1187–1196. doi: 10.1017/S136898001400189X.
    1. Crozier SR, Robinson SM, Borland SE, Godfrey KM, Cooper C, Inskip HM. Do women change their health behaviours in pregnancy? Findings from the Southampton Women’s survey. Paediatr Perinat Epidemiol. 2009;23(5):446–453. doi: 10.1111/j.1365-3016.2009.01036.x.
    1. Hillier SE, Olander EK. Women’s dietary changes before and during pregnancy: a systematic review. Midwifery. 2017;49:19–31. doi: 10.1016/j.midw.2017.01.014.
    1. Hayes L, Mcparlin C, Kinnunen TI, Poston L, Robson SC, Bell R. Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial. BMC Pregnancy Childbirth. 2015;15:52. doi: 10.1186/s12884-015-0479-2.
    1. Flannery C, Fredrix M, Olander EK, McAuliffe FM, Byrne M, Kearney PM. Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions. Int J Behav Nutr Phys Act. 2019;16(1):97. doi: 10.1186/s12966-019-0859-5.
    1. Bogaerts AFL, Devlieger R, Nuyts E, Witters I, Gyselaers W, Van den Bergh BRH. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. Int J Obes. 2013;37(6):814–821. doi: 10.1038/ijo.2012.162.
    1. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;6:CD007145. doi: 10.1002/14651858.CD007145.pub3.
    1. Peaceman AM, Clifton RG, Phelan S, et al. Lifestyle interventions limit gestational weight gain in women with overweight or obesity: LIFE-moms prospective meta-analysis. Obesity. 2018;26(9):1396–1404. doi: 10.1002/oby.22250.
    1. The International Weight Management in Pregnancy Collaborative Group Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;358:j3119. doi: 10.1136/bmj.j3119.
    1. Paul KH, Graham ML, Olson CM. The web of risk factors for excessive gestational weight gain in low income women. Matern Child Health J. 2013;17(2):344–351. doi: 10.1007/s10995-012-0979-x.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi