A new study of an intervention that used care management techniques to help women improve prenatal health revealed women made some positive changes, including reduced consumption of sugary drinks, increases in physical activity, and a decrease in pregnancy-related anxiety.1
Called the First 1,000 Days, the systems-oriented program, which starts in early pregnancy and lasts through the first 24 months of infancy, is for low-income mother/infant pairs. It is designed to help women and their children eliminate obesity risk factors. Patient navigators called women, and health coaches worked with high-risk women.
“We implemented the program in several health centers in the greater Boston area with the goal of really improving obesity and related risk factors for low-income mothers,” says Meg Simione, PhD, lead study author and research scientist in the division of general academic pediatrics at Massachusetts General Hospital and instructor of pediatrics at Harvard Medical School. “Our major findings were looking at obesity risk factors, and we saw [positive] changes in diet, screen time, anxiety, physical activity, and enrollment in WIC among the pregnant women. The study focused on women who lived in low-income communities.”
One of the reasons for targeting a low-income population was weight-related disparities for women and children who live in low-income communities. “We didn’t specifically target any other characteristics,” Simione says. “The vast majority of our women were identified as Latinx.”
Another study of the First 1,000 Days program revealed the intervention, combined with coaching, was associated with improved infant weight and maternal postpartum care.2 A third study involving the program showed the systems-change intervention was associated with modest reduction in excess gestational weight gain among women who were overweight before pregnancy.3
The authors focused on a systems-level approach, which differentiates it from similar research. “There are other studies that have shown to improve behaviors and gestational weight gain, but they were targeted at an individual level,” Simione explains. “We brought together a group of stakeholders and tried to change the system.”
The intervention focused on these five behavior targets:
- Eating a balanced, nutritional diet;
- Drinking predominantly water and avoiding sugary drinks;
- Becoming physically active;
- Getting recommended amounts of sleep;
- Reducing stress through social supports.
Women received booklets, available in four languages, with information about how to meet the goals. They contained sections on gestational weight gain recommendations and behavior-changed goal-setting.
“The booklets provided to patients had information about what their behavior target should be, and steps to achieve that,” Simione says.
For example, one booklet item advises physical activity most days, meaning at least 30 minutes per day of moderate-intensity exercise like fast walking. The colorful bullet point information, which also includes photos of a pregnant woman jogging and another pregnant woman swimming, includes these points:
• Activity and exercise during pregnancy is good for most women.
• Exercise can:
- Give you more energy;
- Help relieve stress;
- Help you not gain too much weight;
- Make you feel better and happier;
- Make you stronger for labor and delivery.
The section on exercise also includes tips, such as staying active with a friend and to walk to the store, children’s school, or daycare center.
Health information also was delivered through posters hanging in health centers and public health offices.
A third tactic involved a text messaging program in which women would receive two to three messages during their pregnancy.
“The text messages provided behavior change support and education,” Simione says. “We also had videos available to them.”
Patient navigators and health coaches also helped reinforce behavior change through phone calls and ensuring women were connected to resources. They answered any questions about the educational materials.
In addition to the goal of helping women change their behaviors, Simione and colleagues studied anxiety as an obesity risk factor. “We need to think about things beyond nutrition and physical activity,” she explains.
Women were assessed with a pregnancy anxiety score that focused on five topics:
- The extent of worry about their health during pregnancy;
- Worry about their baby’s health and normal growth and development;
- Worry about losing the baby;
- Concern about a hard labor or difficult delivery;
- Concern about taking care of a new baby.
Based on the pregnancy anxiety scores, researchers found the pregnancy-related anxiety score decreased from baseline to after the intervention.
“Women’s well-being is critically important, so ensuring that they have the skills to reduce their anxiety and stress can lead to better maternal outcomes and also lead to better child health outcomes.”
REFERENCES
- Simione M, Moreno-Galarraga L, Perkins M, et al. Effects of the First 1,000 days program, a systems-change intervention, on obesity risk factors during pregnancy. BMC Pregnancy Childbirth 2021;21:729.
- Taveras EM, Perkins ME, Boudreau AA, et al. Twelve-month outcomes of the First 1,000 Days program on infant weight status. Pediatrics 2021 Aug;148(2):e2020046706. doi: 10.1542/peds.2020-046706.
- Blake-Lamb T, Boudreau AA, Matathia S, et al. Association of the First 1,000 Days systems-change intervention on maternal gestational weight gain. Obstet Gynecol 2021;135:1047-1057.
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