Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices

• Published in: The Journal of pediatrics 2016-07, Vol.174, p.171-177.e2
• Main Authors: Gross, Rachel S., MD, MS, Mendelsohn, Alan L., MD, Gross, Michelle B., MS, RD, Scheinmann, Roberta, MPH, Messito, Mary Jo, MD
• Format: Article
• Language: English
• Subjects: Breast Feeding; Directive Counseling; feeding knowledge; Female; Health Knowledge, Attitudes, Practice - ethnology; Hispanic; Hispanic Americans; Humans; Infant; Infant Care; Infant, Newborn; Male; Pediatric Obesity - ethnology; Pediatric Obesity - prevention & control; Pediatrics; Poverty; Pregnancy; Prenatal Care; Primary Health Care; Primary Prevention - methods
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.03.060

Objective To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families. Study design The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall. Results A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P  = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P  = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P  = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P  = .004). Conclusions Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention. Trial registration ClinicalTrials.gov : NCT01541761.