Delta healthy sprouts: a randomized comparative effectiveness trail to promote maternal weight control and reduce childhood obesity in the Mississippi Delta

Authors: Thomson, Jessica; TUSSING-HUMPHREYS, LISA - University Of Illinois; Goodman, Melissa

Submitted to: Contemporary Clinical Trials
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/20/2014
Publication Date: 1/14/2014
Publication URL: http://handle.nal.usda.gov/10113/61920
Citation: Thomson, J.L., Tussing-Humphreys, L.M., Goodman, M.H. 2014. Delta healthy sprouts: a randomized comparative effectiveness trail to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Contemporary Clinical Trials. 38:82-91.

Interpretive Summary: Gaining too much or too little weight during pregnancy can cause health problems for both the mother and her infant. Health concerns include gestational diabetes, hypertension, and preeclampsia in the mother. For the infant, health risks include preterm birth, and both large and small birth size and weight, all of which may affect the child’s risk for obesity later in life. Additionally, infant feeding practices, such as breastfeeding and proper introduction of solid foods also may affect a child’s risk for obesity. Hence, educating pregnant women about recommended weight gain during pregnancy and weight management for both her and her infant after birth may improve the health of mothers and their children. In particular, educating women during their pregnancy may be a particularly effect method of preventing childhood obesity. Therefore, we are testing an 18-month, culturally tailored, maternal weight management and early childhood obesity prevention intervention for African American mothers-to-be in the Mississippi Delta. The Delta Healthy Sprouts Project will test the effectiveness of two home visitation programs on weight control, diet improvement, and increased exercise in mothers and appropriate growth, feeding practices, and reduced confinement time in infants. Women are recruited in their second trimester of pregnancy and assigned to one of two groups – Parents as Teachers (control) or Parents as Teachers Enhanced (experimental). Parents as Teachers is a proven approach to increase parents’ knowledge of child development and improve parenting practices. Parents as Teachers Enhanced builds upon the Parents as Teachers educational lessons by including diet and exercise components specifically designed for pregnancy and the first year after the infant’s birth. Both educational programs are taught to the study participants in their homes by trained educators. We believe that while both groups of participants will have improvements in their health, the experimental group will have better control of their weight gain during pregnancy, lose more weight after pregnancy, and have less rapid infant growth during the first year of life. We also will look at breastfeeding, and mother and child eating patterns and exercise habits. The Delta Healthy Sprouts Project aims to improve the health and well-being of African American mothers and their infants in the Mississippi Delta region, and potentially break the intergenerational cycle of obesity in this disadvantaged population.

Technical Abstract: Excessive and inadequate gestational weight gain can complicate a woman’s pregnancy and put her and her child at risk for poor delivery and birth outcomes. Further, feeding and activity habits established early in life can significantly impact the development of childhood obesity. Methods: The on-going Delta Healthy Sprouts Project is a randomized, controlled, comparative trial testing the efficacy of two Maternal, Infant, and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States. Women are enrolled in their second trimester of pregnancy and randomized to one of two treatment arms. The control arm curriculum is based on Parents as Teachers, an evidence based approach to increase parental knowledge of child development and improve parenting practices. The experimental arm, labeled Parents as Teachers Enhanced, builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically designed for the gestational and postnatal periods. We hypothesize that, as compared to the control arm, the experimental arm will be more effective in preventing inappropriate gestational weight gain, reducing postnatal weight retention, and decreasing infant obesity rates. We also will evaluate mother and child dietary and physical activity outcomes, breastfeeding initiation and continuation, and child feeding practices. Conclusion: The Delta Healthy Sprouts Project tests a novel, combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease.