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Title: No improvements in postnatal dietary outcomes were observed in a two-arm, randomized, controlled, comparative impact trial among rural, Southern, African-American women

Author
item Thomson, Jessica
item TUSSING-HUMPHREYS, LISA - University Of Illinois
item LANDRY, ALICIA - University Of Central Arkansas
item Goodman, Melissa

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/20/2017
Publication Date: 6/21/2018
Citation: Thomson, J.L., Tussing-Humphreys, L.M., Landry, A.S., Goodman, M.H. 2018. No improvements in postnatal dietary outcomes were observed in a two-arm, randomized, controlled, comparative impact trial targeting rural, Southern, African-American women. Journal of the Academy of Nutrition and Dietetics. 118(7):1196-1207.

Interpretive Summary: To recover from the birth of their child as well as keep up with the demands of motherhood, proper nutrition is very important for new mothers. However, suboptimal diet quality is prevalent among women in the postnatal period. This is troubling not only for the mothers but also for their children because positive relationships exist between maternal and child diet quality. The primary objective of this study was to determine if postnatal diet quality scores of Delta Healthy Sprouts participants in the two treatment groups differed from one another or changed over time. From September 2013 to May 2016, 54 postpartum women residing in the three rural counties in Mississippi were followed for 12 months. The experimental treatment of the intervention built upon the Parents as Teachers curriculum (control treatment) by adding culturally tailored, maternal weight management and early childhood obesity prevention components. Participants’ dietary intake data were collected five times in the 12-month postnatal period. Postnatal retention rates were 83% (25/30) and 88% (21/24) for control and experimental groups, respectively. Diet quality scores, on average, were very low throughout the postnatal period for both groups and did not change over time. Diet quality scores averaged across time were 38 and 42 points (out of a possible 100), respectively, for the control and experimental participants. Neither treatment was successful at improving the poor diet quality of this cohort of women in the 12 months following the birth of their infant. Improving the eating habits of this population of women remains a considerable challenge.

Technical Abstract: Objective: The primary objective was to determine if postnatal diet quality scores of participants in the two treatment arms differed or changed over time. The secondary objectives were to determine if postnatal psychosocial constructs related to diet differed in the two treatment arms, changed over time, or were associated with postnatal diet quality. Design: Delta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial. Participants/setting: Pregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in three Mississippi counties were recruited for this study between March 2013 and December 2014. Postnatal data was collected from participants between September 2013 and May 2016. The postnatal attrition rates were 17% and 13% for the control and experimental arms. Intervention: The control arm received the Parents as Teachers curriculum while the experimental arm received a nutrition and physical activity enhanced Parents as Teachers curriculum. Main outcome measures: Multiple pass 24-hour dietary recalls were collected from participants at the postnatal month 1, 4, 6, 8, and 12 visits. Healthy Eating Index-2010 was used to calculate diet quality. Statistical analysis performed: Linear mixed models, using maximum likelihood estimation, were used to test for significant treatment, time, and treatment by time effects on postnatal dietary outcomes. Results: Control arm mean total HEI-2010 scores were 37, 37, 40, 39 and 36 points at postnatal month 1, 4, 6, 8 and 12 visits. Corresponding experimental arm scores were 42, 42, 40, 46, and 38 points. Experimental arm scores were significantly higher than control arm scores across time. Time and interaction effects were not significant. Conclusions: Neither the standard PAT curriculum nor the enhanced PATE curriculum were effective at improving the poor diet quality of this cohort of rural, Southern, African American women during the 12 months following the birth of their infant.