Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status.
Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status.
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DOI：
10.1542/peds.2020-046706
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发表时间：
2021-08
期刊：
影响因子：
8
通讯作者：
Cheng ER
中科院分区：
文献类型：
--
作者：
Taveras EM;Perkins ME;Boudreau AA;Blake-Lamb T;Matathia S;Kotelchuck M;Luo M;Price SN;Roche B;Cheng ER
目的探讨前1000天干预对婴儿超重患病率和产妇产后体重保持和护理的影响。采用准实验设计，我们评估了在两个干预社区卫生中心接受护理的995名足月低收入婴儿及其母亲，以及在两个比较卫生中心接受护理的650对婴儿的前1000天计划的效果。该项目包括员工培训、成长跟踪、健康和行为筛查、患者导航、短信、教育材料和健康指导。比较中心采用常规护理。在6个月和12个月时评估婴儿结局，包括体重长度z评分和超重（体重长度≥97.7百分位）。我们还检查了产妇的体重保持和产后6周的护理。平均（SD）出生体重为3.34 kg (0.45)；57%的婴儿是西班牙裔；66%的人有公共保险。在6个月时，婴儿的体重长度z分数较低（β: - 0.27; 95% CI: - 0.39, - 0.15），超重的几率较低（AOR: 0.46; 95% CI: 0.28, 0.76）。差异持续12个月（z-score β: - 0.18; 95% CI: - 0.30, - 0.07；超重的AOR: 0.60; 95% CI: 0.39, 0.92）。与对照组的母亲相比，干预组的母亲产后6周体重保持适度降低，但不显著（β: - 0.51 kg; 95% CI: - 1.15, 0.13），完成产后随访的几率更高（AOR: 1.50; 95% CI: 1.16, 1.94）。早期生活，系统改变干预结合指导与改善婴儿体重状况和产妇产后护理有关。在前1000天进行个性化健康指导的系统级干预与减少婴儿超重和增加产妇产后护理的接受有关。
To examine the effects of the First 1,000 Days intervention on the prevalence of infant overweight and maternal postpartum weight retention and care. Using a quasi-experimental design, we evaluated the effects of the First 1,000 Days program among 995 full-term, low-income infants and their mothers receiving care in two intervention community health centers, and 650 dyads in two comparison health centers. The program includes staff training, growth tracking, health and behavioral screening, patient navigation, text messaging, educational materials, and health coaching. Comparison centers implemented usual care. Infant outcomes were assessed at 6 and 12 months, including weight-for-length z-score and overweight (weight-for-length ≥97.7th percentile). We also examined maternal weight retention and receipt of care 6-weeks postpartum. Mean (SD) birthweight was 3.34 kg (0.45); 57% of infants were Hispanic; 66% were publicly insured. At 6 months, infants had lower weight-for-length z-scores (β: −0.27; 95% CI: −0.39, −0.15) and lower odds of overweight (AOR: 0.46; 95% CI: 0.28, 0.76) than infants in comparison sites; differences persisted at 12 months (z-score β: −0.18; 95% CI: −0.30, −0.07; AOR for overweight: 0.60; 95% CI: 0.39, 0.92). Mothers in the intervention sites had modestly lower, but non-significant weight retention at 6-weeks postpartum (β: −0.51 kg; 95% CI: −1.15, 0.13) and had higher odds (AOR: 1.50; 95% CI: 1.16, 1.94) of completing their postpartum visit compared to mothers in the comparison sites. An early life, systems-change intervention combined with coaching was associated with improved infant weight status and maternal postpartum care. A systems-level intervention with individualized health coaching in the first 1,000 days was associated with reduced infant overweight and increased receipt of maternal postpartum care.