In a recently released study in Pediatrics(10.1542/peds.2020-046706), a team led by Dr. Elsie Taveras conducted an ambitious intervention study that aimed to reduce infant overweight and improve maternal postpartum visit attendance and weight loss. This is a truly amazing study, and I hope everyone who cares for underserved populations has a chance to read it. The 1,000 day intervention program enrolled expectant women and continues through the 2nd birthday of their child. It includes both systems change approaches and individual level supports for patients. The system changes that were integrated throughout the health system include obesity prevention training for providers, enhanced electronic medical record weight tracking with decision tool support, adverse health behavior screening at 1, 6 and 12 months, and educational materials and text messaging to support healthy lifestyle for families. The individual level changes included patient navigation, and health coaching and care coordination provided virtually, by phone and in person. For health equity and to align with community health centers’ mission to serve, the intervention was implemented at two health centers, and not implemented at two comparison centers, rather than being randomized at a participant level.
In total 995 mother-infant dyads received the intervention, and 650 infants and their mothers were treated with usual care. All health centers serve low-income mainly minority families; the study participants were predominantly Hispanic (57%) and publicly insured (66%). The primary infant outcomes measures were mean weight-for length z-score at 6 and 12 months, and prevalence of infant overweight at these time points. Maternal outcomes included attendance at the 6 week postpartum visit and retention of weight (pre versus postpartum visit weight at that time).
This highly ambitious and comprehensive program worked! The analyses are easy to read and well summarized in Tables.