Channeling the voice of underserved communities on nutritional insufficiency and unaddressed needs on maternal infant health.

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Addressing the obesity pandemic has been a looming challenge before COVID 19 changed our daily lives. Evidence to date suggest that to achieve full prevention, we should intervene during the first 1000 days of life. This goal requires optimal health and access to essential services as early in pregnancy as possible. Alternatives to mitigate the sequelae of intrauterine exposures are critical as most pregnancies are unplanned. The baby act trial was designed to evaluate the effects of a community based multimodal lifestyle intervention to improve early growth outcomes among participants of the Puerto Rico Women, Infant and Children Special Nutrition Program (PRWIC). Reports on the rate of overweight/obesity in early childhood and women post-partum during 2017-18 fiscal year showed a significant increase with an extremely low percent of women reporting fruit and vegetable consumption. Poor health habits following the first of a series of catastrophic events to take place in our study location remain a major concern. Preliminary data from BAT showed a rate of overweight/obesity prior to pregnancy of 63.7% and reported levels of fruit and vegetable consumption during pregnancy that do not reach the minimal amount needed to achieve health benefits. As subsequent events ensued, the PRWIC standard of care (control condition), was adapted. BAT participants continued to receive the intervention as designed, but our assessment team provided additional support as needed to achieve access to essential services. Navigation for PRWIC registration and information on health and government services was made available. As study implementation have remained responsive to our partner's real-life conditions, it is the goal of this study to assess the impact of the living conditions during the COVID 19 pandemic on women who participated in the PRWIC program and delivered during this global emergency. We will implement intervention mapping strategies to explore differences in the lived experience of transition from pregnancy to motherhood as reported by women who participated in BAT in both conditions, and PRWIC participants who delivered at the San Juan City Hospital that where not enrolled in BAT. Data collected via surveys on healthcare, nutrition, social determinants of health, and clinical measures, will be integrated with qualitative analysis achieved through in-depth interviews with a random group of participants from each group. Our overarching goal is to explore the root cause for minimal compliance with healthy eating behaviors during pregnancy and beyond, the effects of BAT participation on the rate of at-risk weight in both mother and infant. Acceptability of strategies to address women's health screening and coordination of care will be explored. We will address the following aims: 1) Compare the effects of BAT participation on maternal/infant weight and nutritional status, 2) Define the influence of baseline and lockdown living conditions on pregnancy and postpartum/early care outcomes among PRWIC participants, 3) Explore the acceptability of implementing the Implicit Interception Care model to address the needs of women who participated in the PRWIC program.