Prenatal and Pediatric Primary Care-Based Child Obesity Prevention Program: A Randomized Trial.

Abstract

To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families. A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age <i>z</i>-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects. Pregnant women (<i>n</i> = 566) were enrolled in the third trimester; 533 randomized to intervention (<i>n</i> = 266) or control (<i>n</i> = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, <i>P</i> = .04) and 2 years (0.56 vs 0.81, <i>P</i> = .03) but not at 3 years (0.63 vs 0.59, <i>P</i> = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, <i>P</i> = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, <i>P</i> = .02) decreased as attendance increased with low, medium, and high attendance. Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.