Effects of the First 1000 Days Program, a systems-change intervention, on obesity risk factors during pregnancy
Meg Simione1,2, Laura Moreno-Galarraga3, Meghan Perkins4
1Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA. msimione@mgh.harvard.edu.
Insights
The First 1000 Days program improved health behaviors and reduced anxiety in pregnant women. This systems-oriented intervention supports low-income mothers through pregnancy, promoting healthier lifestyles and well-being.
Area of Science:
- Public Health
- Maternal Health
- Obesity Prevention
Background:
- The First 1000 Days program is a systems-oriented initiative targeting obesity prevention in low-income mother-infant pairs from pregnancy through infancy.
- It involves stakeholder partnerships to drive system-wide change, incorporating screening, patient navigation, education, and individualized health coaching.
- The program has previously demonstrated success in reducing excess gestational weight gain for overweight pregnant women.
Purpose of the Study:
- To evaluate changes in health behaviors and psychosocial outcomes among women participating in the First 1000 Days Program.
- Specifically, to examine these changes from the first to the third trimester of pregnancy.
Main Methods:
- Data collected via self-administered questionnaires and electronic health records during the first and third trimesters.
- Assessed behaviors (diet, physical activity, screen time) and psychosocial outcomes (anxiety).
- Examined association between program participation and changes in these outcomes.
Main Results:
- 264 women completed surveys; mean age 30.2 years, 75% with annual income <$50,000.
- Significant decreases observed in sugary-drink intake and screen time.
- Significant increases in physical activity and higher odds of enrollment in the Women, Infant, and Children (WIC) program were noted.
- A decrease in pregnancy-related anxiety scores was also observed.
Conclusions:
- Findings suggest that a systems-oriented prenatal intervention, like First 1000 Days, is associated with positive changes in behaviors and psychosocial well-being during pregnancy.
- The program shows promise for improving maternal health outcomes among low-income populations.
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).
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