Objective: To improve maternal infant feeding and activity practices and reduce child obesity with the Starting Early Program (StEP): a primary care-based obesity prevention intervention beginning in pregnancy for low-income Hispanic mother-infant dyads.
Description: Conduct a randomized control trial of the StEP intervention. Women enrolled in the third trimester of pregnancy at an urban public hospital clinic, randomized to StEP intervention vs. standard primary care. Intervention included: individual nutrition counseling in prenatal/peri-partum periods, nutrition and parenting support groups at every well child visit with 2 individual and 13 group intervention sessions scheduled prior to child age 3 years. Feeding styles, diet and lifestyle patterns, psychosocial stressors, and demographic information collected at baseline in pregnancy and infant age 3, 10, 19, months, 2 and 3 years, with measured length/height and weight. Multilevel modeling used to assess intervention impact on infant weight for length z-scores (WFLz). T tests and chi square used to assess impact on nutrition knowledge and practices. Logistic regression used to assess intervention dose on risk of obesity (BMI ≥ 95th% for age and sex) at age 3.
Evaluation: Baseline prenatal assessments (n = 566) found high rates of maternal stress, obesity and unhealthy dietary practices. Five hundred and thirty three pregnant women randomized to StEP vs. standard care. No group differences in baseline mother/infant characteristics. Mean sessions attended by 3 years: 8.5 (range 1–15). At infant age 3 months: higher nutrition knowledge, higher rates of exclusive breastfeeding, tummy time and less early introduction of complimentary foods for intervention group. At 10 months, more exclusive breastfeeding, more responsive feeding styles and less introduction of juice. At age 2, more family meals and less restaurant food. Complete weight data available for infants through age 18 months (n = 433). Intervention group infants had lower mean WFLz between ages 12–18 months (-.21 (.10), p = .046). At 36 months, infants attending >10 sessions were less likely to have obesity, p = .039.
Conclusions and Implications: Interventions like StEP have the potential to improve maternal infant feeding and activity practices and reduce childhood obesity.