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Kracht CL, Neshteruk CD, Moding KJ, Rolke LJ, Wagner BE, Kielb E, Ferrante MJ, Robinson C, Keinsley J, Colella J, Speirs KE, Luecking CT. Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review. Obes Rev 2024:e13815. [PMID: 39159998 DOI: 10.1111/obr.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/19/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024]
Abstract
Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.
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Affiliation(s)
- Chelsea L Kracht
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Kameron J Moding
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
| | - Laura J Rolke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Brooke E Wagner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth Kielb
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
| | - Mackenzie J Ferrante
- Department of Nutritional Sciences, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Cayla Robinson
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Jason Keinsley
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Jordan Colella
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Katherine E Speirs
- Human Development and Family Science, John and Doris Norton School of Human Ecology, University of Arizona, Tucson, AZ, USA
| | - Courtney T Luecking
- Department of Dietetics and Human Nutrition, Martin-Gatton College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
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LeBrón AMW, Rodriguez VE, Sinco BR, Caldwell CH, Kieffer EC. Racialization processes and depressive symptoms among pregnant Mexican-origin immigrant women. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38713848 DOI: 10.1002/ajcp.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
This study examines how racialization processes (conceptualized as multilevel and dynamic processes) shape prenatal mental health by testing the association of discrimination and the John Henryism hypothesis on depressive symptoms for pregnant Mexican-origin immigrant women. We analyzed baseline data (n = 218) from a healthy lifestyle intervention for pregnant Latinas in Detroit, Michigan. Using separate multiple linear regression models, we examined the independent and joint associations of discrimination and John Henryism with depressive symptoms and effect modification by socioeconomic position. Discrimination was positively associated with depressive symptoms (β = 2.84; p < .001) when adjusting for covariates. This association did not vary by socioeconomic position. Women primarily attributed discrimination to language use, racial background, and nativity. We did not find support for the John Henryism hypothesis, meaning that the hypothesized association between John Henryism and depressive symptoms did not vary by socioeconomic position. Examinations of joint associations of discrimination and John Henryism on depressive symptoms indicate a positive association between discrimination and depressive symptoms (β = 2.81; p < .001) and no association of John Henryism and depressive symptoms (β = -0.83; p > .05). Results suggest complex pathways by which racialization processes affect health and highlight the importance of considering experiences of race, class, and gender within racialization processes.
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Affiliation(s)
- Alana M W LeBrón
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Department of Chicano/Latino Studies, School of Social Sciences, University of California, Irvine, Irvine, California, USA
| | - Victoria E Rodriguez
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Brandy R Sinco
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Edith C Kieffer
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Lugo-Candelas C, Talati A, Glickman C, Hernandez M, Scorza P, Monk C, Kubo A, Wei C, Sourander A, Duarte CS. Maternal Mental Health and Offspring Brain Development: An Umbrella Review of Prenatal Interventions. Biol Psychiatry 2023; 93:934-941. [PMID: 36754341 PMCID: PMC10512172 DOI: 10.1016/j.biopsych.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
The idea that risk for psychiatric disorders may be transmitted intergenerationally via prenatal programming places interest in the prenatal period as a critical moment during which intervention efforts may have a strong impact, yet studies testing whether prenatal interventions also protect offspring are limited. The present umbrella review of systematic reviews and meta-analyses (SRMAs) of randomized controlled trials aimed to synthesize the available evidence and highlight promising avenues for intervention. Overall, the literature provides mixed and limited evidence in support of prenatal interventions. Thirty SRMAs were included. Of the 23 SRMAs that reported on prenatal depression interventions, 16 found a significant effect (average standard mean difference = -0.45, SD = 0.25). Similarly, 13 of the 20 SRMAs that reported on anxiety outcomes documented significant reductions (average standard mean difference = -0.76, SD = 0.95 or -0.53/0.53 excluding one outlier). Only 4 SRMAs reported child outcomes, and only 2 (of 10) analyses showed significant effects of prenatal interventions (massage and telephone support on neonatal resuscitation [relative risk = 0.43] and neonatal intensive care unit admissions [relative risk = 0.91]). Notably missing, perhaps due to our strict inclusion criteria (inclusion of randomized controlled trials only), were interventions focusing on key facets of prenatal health (e.g., whole diet, sleep). Structural interventions (housing, access to health care, economic security) were not included, although initial success has been documented in non-SRMAs. Most notably, none of the SRMAs focused on offspring mental health or neurodevelopmental outcomes. Given the possibility that interventions deployed in this period will positively impact the next generation, randomized trials that focus on offspring outcomes are urgently needed.
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Affiliation(s)
- Claudia Lugo-Candelas
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ardesheer Talati
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Caila Glickman
- New York State Psychiatric Institute, New York, New York
| | - Mariely Hernandez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Catherine Monk
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Ai Kubo
- Division of Research, Kaiser Permanente, Oakland, California
| | - Chiaying Wei
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Turku University, Turku, Finland
| | - Cristiane S Duarte
- New York State Psychiatric Institute, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.
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Melwani S, Cleland V, Patterson K, Nash R. Health literacy status of pregnant women and women with young children in Tasmania. Health Promot J Austr 2023; 34:138-148. [PMID: 36285492 PMCID: PMC10100018 DOI: 10.1002/hpja.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 01/27/2023] Open
Abstract
ISSUE ADDRESSED The literature provides evidence that maternal health is strongly linked with noncommunicable diseases (NCDs) and their associated risk factors. Enabling women with the asset of health literacy may help to reduce the intergenerational impact of NCDs. However, little is known about the health literacy of pregnant women and women with young children in Tasmania and globally. This study aimed to identify the health literacy status of pregnant women and women with young children (0-8 years) living in Tasmania and describe their health literacy status according to their demographic characteristics. METHODS An online cross-sectional survey was undertaken. The survey included demographic questions and a health literacy questionnaire (HLQ). The description of demographic differences across the HLQ scales focused on effect sizes (ES) for standardised differences in mean health literacy scores. The differences found to be statistically significant at P < 0.05 were also included. RESULTS 194 participants completed the survey with a mean age of 35.3 years. 73.2% were married, 16.5% were pregnant, 93% had one or more children and 81.5% were university educated. For the first five HLQ scales (score range 1-4), the lowest overall score was seen for the scale "Actively managing my health" (mean = 2.96; SD = 0.54). For the last four scales (score range 1-5), the lowest overall score was seen for the scale "Navigating the health care system" (mean = 3.75, SD = 0.67). Nonpregnant women, women with children, women with chronic health conditions and nonmarried women experienced more health literacy challenges. CONCLUSION Women in our study showed various strengths and challenges with mean scores varying across the nine HLQ scales. Understanding the health literacy needs of women will enable health services to co-design solutions and interventions capable of responding to the evolving health needs of pregnant women and women with young children. This approach will ensure that codesigned solutions can engage the end-user in healthy lifestyle practices and the solutions are sustainable. SO WHAT?: We must shift away from a "one size fits all" approach to tailor services to respond to the differing health literacy needs of pregnant women and women with young children to support healthy lifestyle practices and reduce the NCD burden.
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Affiliation(s)
- Satish Melwani
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kira Patterson
- School of Education, University of Tasmania, Launceston, Tasmania, Australia
| | - Rosie Nash
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Wilkie G, Leung K, Moore Simas TA, Tucker KL, Chasan-Taber L. The Association Between Acculturation and Diet and Physical Activity Among Pregnant Hispanic Women with Abnormal Glucose Tolerance. J Womens Health (Larchmt) 2022; 31:1791-1799. [PMID: 36040352 PMCID: PMC9805839 DOI: 10.1089/jwh.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Hispanic women are disproportionately affected by gestational diabetes mellitus (GDM), yet few studies have assessed the impact of acculturation on health behaviors that may reduce GDM risk. Materials and Methods: We assessed relationships between acculturation and meeting American Diabetes Association guidelines for macronutrient intake and American College of Obstetricians and Gynecologists guidelines for physical activity (PA) using baseline data from Estudio Project Aiming to Reduce Type twO diabetes, a randomized trial conducted in Massachusetts (2013-2017) among 255 Hispanic pregnant women with hyperglycemia. Acculturation was assessed via the Psychological Acculturation Scale, duration of time and generation in the continental United States, and language preference; diet with 24-hours dietary recalls; and PA with the Pregnancy Physical Activity Questionnaire (PPAQ). Results: The majority of participants who reported low psychological acculturation (74.9%), preferred English (78.4%), were continental U.S. born (58.0%), and lived in the continental United States ≥5 years (91.4%). A total of 44.8%, 81.8%, 22.9%, and 4.6% of women met guidelines for carbohydrate, protein, fat, and fiber intakes, respectively; 31.9% met guidelines for PA. Women with higher acculturation were less likely to meet carbohydrate guidelines (English preference: adjusted risk ratios [aRR] 0.45, 95% confidence intervals [CI] 0.23-0.75; U.S. born: aRR 0.60, 95% CI 0.36-0.91; duration of time in United States: aRR 0.96, 95% CI 0.92-0.99). Women with higher acculturation were more likely to meet PA guidelines (U.S. born: aRR 1.95, 95% CI 1.11-3.44). Conclusions: In summary, higher acculturation was associated with lower likelihood of meeting dietary guidelines but greater likelihood of meeting PA guidelines during pregnancy. Interventions aimed at reducing GDM in Hispanics should be culturally informed and incorporate acculturation. Clinical Trial Registration: clinicaltrials.gov NCT01679210.
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Affiliation(s)
- Gianna Wilkie
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine Leung
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, and University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine L. Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Lisa Chasan-Taber
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
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Lapidos A, Kieffer EC, Guzmán R, Hess K, Flanders T, Heisler M. Barriers and Facilitators to Community Health Worker Outreach and Engagement in Detroit, Michigan: A Qualitative Study. Health Promot Pract 2022; 23:1094-1104. [PMID: 34549635 DOI: 10.1177/15248399211031818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
An effective approach to engaging populations who face health care access barriers is support from community health workers (CHWs). There is little research, however, on specific barriers and facilitators related to two key areas of CHW practice: outreach, defined as the ability to make any initial contact with the priority population, and engagement, defined as the ability to continue to work with the priority population after initial contact is made. The current qualitative study is ancillary to a randomized evaluation of a CHW-led program for Medicaid Health Plan enrollees. Implementation experiences with outreach and engagement led the evaluators to develop the current study in which health plan and nonhealth plan CHWs (n = 12) serving low-income, predominantly Black populations in Detroit participated in qualitative semistructured interviews to elucidate barriers and facilitators to outreach and engagement. All audio recordings were transcribed verbatim. The study team used inductive qualitative data analysis techniques. Barriers to outreach included inaccurate contact information and mistrust. Barriers to engagement included lack of ability to provide needed resources, leading to hopelessness and diminished trust, and discontinuity of services due to eligibility changes and terminated programs. Facilitators included adapting outreach schedules and strategies to community needs, availability of resources, and relational strategies that leveraged CHW social proximity. Further research should systematically investigate the relative success of different CHW-led outreach and engagement strategies for specific populations so as to better design and implement CHW programs.
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Affiliation(s)
| | | | | | | | | | - Michele Heisler
- University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Center for Clinical Management Research, Washington, DC, USA
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Santiago-Torres M, Contento I, Koch P, Tsai WY, Gaffney AO, Marín-Chollom AM, Shi Z, Ulanday KT, Shen H, Hershman D, Greenlee H. Associations Between Acculturation and Weight, Diet Quality, and Physical Activity Among Latina Breast Cancer Survivors: The ¡Mi Vida Saludable! Study. J Acad Nutr Diet 2022; 122:1703-1716. [PMID: 35398558 PMCID: PMC10030055 DOI: 10.1016/j.jand.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Among Latinos, greater acculturation to the United States (US) is associated with risk of obesity and obesity-related comorbidities. Less is known about the associations between acculturation and obesity-related modifiable risk factors, such as diet quality and physical activity (PA) among Latina breast cancer survivors. OBJECTIVE The aim of this study was to explore associations between acculturation and weight status, diet quality, and PA among Latina breast cancer survivors. DESIGN This is a cross-sectional secondary analysis of baseline data on demographic and clinical characteristics, acculturation, anthropometric measures, diet quality, and PA collected from Latina breast cancer survivors enrolled in the ¡Mi Vida Saludable! (My Healthy Life) behavioral diet and PA intervention trial. PARTICIPANTS/SETTING Participants were Latina women (n = 167) residing in New York City, with a medical history of stage 0 to III breast cancer, no evidence of recurrent or metastatic disease, and at least 90 days post cancer treatment who participated in the ¡Mi Vida Saludable! randomized controlled trial between July 2016 and October 2018. MAIN OUTCOME MEASURES Acculturation status was measured by the Short Acculturation Scale for Hispanics score, language preference, place of birth, and duration of US residence. Weight, height, and waist and hip circumferences were measured at an in-person clinic visit. Diet information was collected via 3 telephone-based 24-hour dietary recalls and PA information was collected via staff administered 7-day recalls. STATISTICAL ANALYSES PERFORMED Linear regression models examined associations between acculturation and weight status, diet quality, and PA. RESULTS Based on the Short Acculturation Scale for Hispanics acculturation score, more acculturated compared with less acculturated Latinas were younger in age, more educated, and had higher annual household incomes (all, P < .05). Compared with Spanish-speaking Latinas, English-speaking Latinas had larger waist circumference (103 vs 96.1 cm; P = .01) and poorer-quality diets (Healthy Eating Index 2015 scores, 57.3 vs 71.5; P < .001). Greater levels of acculturation were also associated with higher levels of leisure walking at a moderate-to-vigorous intensity (265.8 vs 179.0 min/wk; P =.04). CONCLUSIONS Greater levels of acculturation were associated with higher central obesity and poorer-quality diets. Future lifestyle modification trials tailored to the unique role of acculturation on adopting behavior change recommendations is a promising next step in this line of research.
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Affiliation(s)
- Margarita Santiago-Torres
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Isobel Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Pamela Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Amanda M Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, New Britain, Connecticut
| | - Zaixing Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Kathleene T Ulanday
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Hanjie Shen
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Dawn Hershman
- College of Physicians and Surgeons, Columbia University Medical Center, New York, New York
| | - Heather Greenlee
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
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Nikniaz L, Tabrizi JS, Farhangi MA, Pourmoradian S, Allameh M, Hoseinifard H, Tahmasebi S, Nikniaz Z. Community-Based Interventions to Reduce Fat Intake in Healthy Populations: A Systematic Review and Meta-Analysis. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401318666220308125105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Reducing fat intake is a major focus of most dietary recommendations aiming to prevent chronic diseases. Thus, this study aimed to summarize community-based interventions for reducing fat consumption among healthy people.
Methods:
According to PRISMA guidelines, in this systematic review and meta-analysis databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar were searched up to January 2021. Randomized clinical trials (RCTs) or quasi-experimental studies reporting the effect of community-based interventions to reduce fat intake in a healthy populations were included. The quality of studies was assessed using the Cochrane Collaboration tool and The Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was performed using CMA2 software.
Results:
Our search strategy resulted in a total of 1,621 articles, 43 of which were included in the study after screening. Of the 43 included studies, 35 studies reported a significant decrease in fat intake using educational and multiple intervention methods. About 82% of studies using the technology were effective (significant decrease in fat intake) in reducing fat intake. Moreover, studies specifically designed to change fat intake were more effective than multicomponent interventions. The meta-analysis of high-quality studies showed that the differences in total fat (-0.262 g/d) and saturated fat (-0.350 g/d) intake between the intervention and control groups were statistically significant (P<0.05).
Conclusion:
Based on the high-quality studies, educational and multiple interventions are suggested in the community settings to decrease fat intake. For a concise conclusions, long-term and high frequency interventions focusing on reducing fat intake are desirable.
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Affiliation(s)
- Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Samira Pourmoradian
- Nutrition research center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Motahareh Allameh
- Adolescent, Youth and Schools Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Hosein Hoseinifard
- MSc in biostatistics, Iranian Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Tahmasebi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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9
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Melwani S, Cleland V, Patterson K, Nash R. A scoping review: global health literacy interventions for pregnant women and mothers with young children. Health Promot Int 2021; 37:6322401. [PMID: 34269394 DOI: 10.1093/heapro/daab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization is focused on enhancing health literacy (HL) throughout the life-course to address the growing burden of non-communicable diseases (NCDs) globally. Pregnancy and early motherhood offer a window of opportunity to address NCDs risk earlier in the life-course. Empowering women through HL may help to reduce the intergenerational impact of NCDs. A scoping review of the international literature was conducted to identify HL interventions that focused on improving NCD-related health outcomes or health behaviors of pregnant women and/or mothers with young children. The search was conducted on 4 databases and identified 5019 articles. After full text screening, 25 studies met the inclusion criteria. No study acknowledged their intervention as an HL intervention, even though they were assessed as targeting various HL dimensions. Only one study measured the HL of mothers. The review suggests that HL interventions are being underutilized and highlight the need to create awareness about the importance of addressing HL of pregnant women and mothers using appropriate tools to understand HL strengths and challenges in achieving healthy lifestyle practices. This can help to co-design locally responsive solutions that may enable women to make informed healthier lifestyle choices for themselves and for their children and thus may accelerate prevention of NCDs globally.
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Affiliation(s)
- Satish Melwani
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Kira Patterson
- School of Education, College of Arts, Law and Education, University of Tasmania, Launceston, TAS 7250, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
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10
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Lin YC, Lin YC, Chen JH, Lin PL, Chen T, Huang HL. Long-term effects of a lay health advisor intervention on immigrant children's dental caries and maternal preventive behaviour: A randomized controlled trial. Community Dent Oral Epidemiol 2021; 50:280-291. [PMID: 34169539 DOI: 10.1111/cdoe.12670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES An oral health disparity exists between native and immigrant children in Taiwan. This study evaluated the long-term effectiveness of a lay health advisor (LHA) intervention on immigrant children's dental caries and maternal preventive behaviours. METHODS Fifty-one immigrant mother-child pairs were randomly assigned to LHA intervention (n = 23) and control (n = 28) groups. Mothers in the LHA group received a four-chapter one-on-one lesson plan, which included dental caries-related knowledge, brushing techniques, caries prevention and free preventive services, from the LHA over 4 weeks. Mothers in the control group received only a health brochure. Baseline and 1-week, 2-month, and 8-month follow-up information was collected using dental examinations and questionnaires. RESULTS The mean ages of the children in the LHA and control groups were 4.0 ± 1.4 and 4.2 ± 1.5, respectively. The decayed, missing due to caries, filled teeth (dmft) index in the LHA and control groups was 4.8 ± 6.0 and 5.4 ± 5.4, respectively, at baseline. At the 8-month postintervention follow-up, the number of filled teeth (ft) in the LHA group was higher than that in the control group (β = 8.3, P = .033). The effect size (ES) demonstrated an upward trend at 1-week, 2-month and 8-month follow-ups in ft (ES = 0.21, 0.50 and 0.59, respectively) and a decrease in the number of decayed teeth (dt) (ES = 0.30, 0.43 and 0.57, respectively). The mothers in the LHA group were observed to be 10.9 times more likely than control mothers to assist their children in toothbrushing for 3 min at the 1-week follow-up (95% CI = 1.98-59.40, P = .006). CONCLUSIONS The LHA intervention strategy had positive effects on the immigrant children's new dt and ft and on maternal preventive behaviour, such as assisting their children in toothbrushing.
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Affiliation(s)
- Yi-Ching Lin
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Chun Lin
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jen-Hao Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dentistry, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Pi-Li Lin
- Department of Nursing, School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Ted Chen
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hsiao-Ling Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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11
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Ricklan SJ, Cuervo I, Rebarber A, Fox NS, Shirazian T. Two decades of interventions in New York State to reduce maternal mortality: a systematic review. J Matern Fetal Neonatal Med 2019; 34:3514-3523. [PMID: 31744355 DOI: 10.1080/14767058.2019.1686472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To perform a systematic review of interventions to reduce maternal mortality in New York.Study design: We conducted a systematic review of literature published between 2000 and January 2019 reporting interventions to reduce maternal mortality in New York using PubMed and search terms: pregnancy-related death or maternal mortality OR maternal death AND New York. Eight hundred and ninety-three articles were reviewed by title, content, and focus on New York interventions or policies. Ten met inclusion criteria. A second review of the Safe Motherhood Initiative (SMI) identified an additional six articles.Results: Nine articles described hospital-based initiatives; one described a community-based initiative. No prospective randomized controlled trials in a nonsimulated setting were identified. Several articles described SMI bundles; one tested simulated checklist implementation. Three presented results of bundle implementation but did not significantly impact measured maternal mortality and/or morbidity. The single community-based initiative provided doulas to low-income women, yielding significantly lower rates of preterm birth and low birthweight, but no difference in cesarean deliveries compared to other women in the community.Conclusion: Current hospital-based interventions have not reduced maternal mortality in New York. The single community-based intervention identified reduced adverse birth outcomes. Continued concern about maternal mortality in New York suggests community-based approaches should be considered to affect change in conjunction with longer term hospital-based interventions.
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Affiliation(s)
| | - Isabel Cuervo
- Weill Cornell Medical College, Cornell University, New York, NY, USA.,Saving Mothers, New York, NY, USA
| | - Andrei Rebarber
- Saving Mothers, New York, NY, USA.,Maternal Fetal Medicine Associates PLLC, New York, NY, USA
| | - Nathan S Fox
- Maternal Fetal Medicine Associates PLLC, New York, NY, USA
| | - Taraneh Shirazian
- NYU Langone Health, New York, NY, USA.,Saving Mothers, New York, NY, USA
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12
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Heisler M, Lapidos A, Henderson J, Guzman RM, Wolfe J, Meyer P, Law D, Kieffer EC, Ernst C, Djelaj V, Khaldun J, Ayanian JZ. Study protocol for a Community Health Worker (CHW)-led comprehensive neighborhood-focused program for medicaid enrollees in detroit. Contemp Clin Trials Commun 2019; 16:100456. [PMID: 31646214 PMCID: PMC6804462 DOI: 10.1016/j.conctc.2019.100456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 01/16/2023] Open
Abstract
Residents of low income neighborhoods disproportionately experience poor health, and many have unmet social needs. Clinical trials have shown the efficacy of Community Health Worker (CHW) programs in improving outcomes for a variety of health conditions. An important next step is developing and evaluating financially sustainable CHW program models in real-life settings. This program evaluation examines health care utilization among participants in a geographically targeted program led by salaried CHWs from three Medicaid health plans. Beneficiaries who reside in the Cody Rouge neighborhood of Detroit and had more than 3 Emergency Department (ED) visits or at least 1 ambulatory care-sensitive hospitalization in the prior 12 months are eligible for the program. Health plan CHWs assigned to the program reach out to eligible beneficiaries to provide an assessment; link them to resources; and provide follow-up. At 12-month follow up, claims data on ED visits, ambulatory care-sensitive hospitalizations, primary care visits, and related costs will be compared between beneficiaries who participated and eligible beneficiaries randomized to receive usual outreach. We hypothesize that patients enrolled in the CHW intervention will experience a reduction in acute care usage resulting in cost savings compared to those receiving usual health plan outreach. This study is among the first to evaluate the impact on health care utilization of augmented services delivered by health plan CHWs for high-utilizing health plan members as part of a health plan-community-academic partnership. This study will provide important information on CHW program sustainability and provide insights into effective implementation of such programs. Trial registration NCT03924713.
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Affiliation(s)
- Michele Heisler
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Adrienne Lapidos
- Department of Psychiatry, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - James Henderson
- Consulting for Statistics Computing & Analytics Research, University of Michigan, 3550 Rackham, 915 E. Washington St, Ann Arbor, MI, 48109, USA
| | - Rebeca M Guzman
- Detroit Health Department, 3245 E. Jefferson, Suite 100, Detroit, MI, 48203, USA
| | - Jason Wolfe
- University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA
| | - Patricia Meyer
- University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA
| | - David Law
- Joy-Southfield Community Development Corp, 18917 Joy Road, Detroit, MI, 48228, USA
| | - Edith C Kieffer
- University of Michigan School of Social Work, 1080 South University, Ann Arbor, MI, 48109, USA
| | - Caleb Ernst
- University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA
| | - Valentina Djelaj
- Detroit Health Department, 3245 E. Jefferson, Suite 100, Detroit, MI, 48203, USA
| | - Joneigh Khaldun
- Detroit Health Department, 3245 E. Jefferson, Suite 100, Detroit, MI, 48203, USA.,State of Michigan Department of Health and Human Services, USA
| | - John Z Ayanian
- Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA.,University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA.,Gerald R. Ford School of Public Policy, University of Michigan, 735 S. State St, Ann Arbor, MI, 48109, USA
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13
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Berube LT, Messito MJ, Woolf K, Deierlein A, Gross R. Correlates of Prenatal Diet Quality in Low-Income Hispanic Women. J Acad Nutr Diet 2019; 119:1284-1295. [PMID: 30956126 PMCID: PMC6663603 DOI: 10.1016/j.jand.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. OBJECTIVE The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. DESIGN This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. PARTICIPANTS The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). MAIN OUTCOME MEASURES Prenatal diet quality was measured by the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. RESULTS Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. CONCLUSIONS Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.
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Affiliation(s)
- Lauren Thomas Berube
- New York University Steinhardt, Department of Nutrition and Food Studies, 411 Lafayette St, 5 Floor, New York, NY 10003, 212-998-5580,
| | - Mary Jo Messito
- New York University School of Medicine, Department of Pediatrics, 462 First Avenue, New York, NY 10016, 212-263-6424,
| | - Kathleen Woolf
- New York University Steinhardt, Department of Nutrition and Food Studies, 411 Lafayette Street, 5 Floor, New York, NY 10003, 212-992-7898,
| | - Andrea Deierlein
- New York University College of Global Public Health, Department of Public Health Nutrition, 715-719 Broadway, 12 Floor, New York, NY 10003,
| | - Rachel Gross
- New York University School of Medicine, Department of Pediatrics, 462 First Avenue, New York, NY 10016, 212-263-8974,
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14
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Al Wattar BH, Mylrea-Lowndes B, Morgan C, Moore AP, Thangaratinam S. Use of dietary assessment tools in randomized trials evaluating diet-based interventions in pregnancy: a systematic review of literature. Curr Opin Obstet Gynecol 2018; 28:455-463. [PMID: 27755129 DOI: 10.1097/gco.0000000000000322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Accurate assessment of dietary intake in interventional trials is the key to evaluate changes in dietary behaviour and compliance. We evaluated the use of dietary assessment tools in randomized trials on diet-based interventions in pregnancy by a systematic review. RECENT FINDINGS We updated our previous search (until January 2012) on trials of diet and lifestyle interventions in pregnancy using Medline and EMBASE up to December 2015. Two independent reviewers undertook study selection and data extraction. We assessed the characteristics of dietary assessment tools, the timing and frequency of use and any validation undertaken.Two-thirds (39/58, 67%) of the included studies used some form of tools to assess dietary intake. Multiple days' food diaries were the most commonly used (23/39, 59%). Three studies (3/39, 8%) validated the used tools in a pregnant population. Three studies (3/39, 8%) prespecified the criteria for adherence to the intervention. The use of dietary assessment tools was not associated with study quality, year of publication, journal impact factor, type of journal and the study sample size. SUMMARY Although self-reporting dietary assessment tools are widely used in interventional dietary trials in pregnancy, the quality and applicability of existing tools are low.
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Affiliation(s)
- Bassel H Al Wattar
- aWomen's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University London bNorth West London Hospitals NHS Trust cMultidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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15
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Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2017; 11:CD010443. [PMID: 29129039 PMCID: PMC6485974 DOI: 10.1002/14651858.cd010443.pub3] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their infants in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. This is an update of a Cochrane review that was first published in 2015. OBJECTIVES To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM, and associated adverse health consequences for the mother and her infant/child. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 November 2016) and reference lists of retrieved studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs, comparing combined diet and exercise interventions with no intervention (i.e. standard care), that reported on GDM diagnosis as an outcome. Quasi-RCTs were excluded. Cross-over trials were not eligible for inclusion. We planned to include RCTs comparing two or more different diet/exercise interventions, however none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, assessed the risk of bias of the included trials and assessed quality of evidence for selected maternal and infant/child outcomes using the GRADE approach. We checked data for accuracy. MAIN RESULTS In this update, we included 23 RCTs (involving 8918 women and 8709 infants) that compared combined diet and exercise interventions with no intervention (standard care). The studies varied in the diet and exercise programs evaluated and health outcomes reported. None reported receiving funding from a drug manufacturer or agency with interests in the results. Overall risk of bias was judged to be unclear due to the lack of methodological detail reported. Most studies were undertaken in high-income countries.For our primary review outcomes, there was a possible reduced risk of GDM in the diet and exercise intervention group compared with the standard care group (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.71 to 1.01; 6633 women; 19 RCTs; Tau² = 0.05; I² = 42%; P = 0.07; moderate-quality evidence). There was also a possible reduced risk of caesarean section (RR 0.95, 95% CI 0.88 to 1.02; 6089 women; 14 RCTs; moderate-quality evidence). No clear differences were seen between groups for pre-eclampsia (RR 0.98, 95% CI 0.79 to 1.22; 5366 participants; 8 RCTs; low-quality evidence), pregnancy-induced hypertension and/or hypertension (average RR 0.78, 95% CI 0.47 to 1.27; 3073 participants; 6 RCTs; Tau² = 0.19; I² = 62%; very low-quality evidence), perinatal mortality (RR 0.82, 95% CI 0.42 to 1.63; 3757 participants; 2 RCTs; low-quality evidence) or large-for-gestational age (RR 0.93, 95% CI 0.81 to 1.07; 5353 participants; 11 RCTs; low-quality evidence). No data were reported for infant mortality or morbidity composite.Subgroup analyses (based on trial design, maternal body mass index (BMI) and ethnicity) revealed no clear differential treatment effects. We were unable to assess the impact of maternal age, parity and specific features of the diet and exercise interventions. Findings from sensitivity analyses (based on RCT quality) generally supported those observed in the main analyses. We were not able to perform subgroup analyses based on maternal age, parity or nature of the exercise/dietary interventions due to the paucity of information/data on these characteristics and the inability to meaningfully group intervention characteristics.For most of the secondary review outcomes assessed using GRADE, there were no clear differences between groups, including for perineal trauma (RR 1.27, 95% CI 0.78 to 2.05; 2733 participants; 2 RCTs; moderate-quality evidence), neonatal hypoglycaemia (average RR 1.42, 95% CI 0.67 to 2.98; 3653 participants; 2 RCTs; Tau² = 0.23; I² = 77%; low quality evidence); and childhood adiposity (BMI z score) (MD 0.05, 95% CI -0.29 to 0.40; 794 participants; 2 RCTs; Tau² = 0.04; I² = 59%; low-quality evidence). However, there was evidence of less gestational weight gain in the diet and exercise intervention group compared with the control group (mean difference (MD) -0.89 kg, 95% CI -1.39 to -0.40; 5052 women; 16 RCTs; Tau² = 0.37; I² = 43%;moderate-quality evidence). No data were reported for maternal postnatal depression or type 2 diabetes; childhood/adulthood type 2 diabetes, or neurosensory disability. AUTHORS' CONCLUSIONS Moderate-quality evidence suggests reduced risks of GDM and caesarean section with combined diet and exercise interventions during pregnancy as well as reductions in gestational weight gain, compared with standard care. There were no clear differences in hypertensive disorders of pregnancy, perinatal mortality, large-for-gestational age, perineal trauma, neonatal hypoglycaemia, and childhood adiposity (moderate- tovery low-quality evidence).Using GRADE methodology, the evidence was assessed as moderate to very low quality. Downgrading decisions were predominantly due to design limitations (risk of bias), and imprecision (uncertain effect estimates, and at times, small sample sizes and low event rates), however two outcomes (pregnancy-induced hypertension/hypertension and neonatal hypoglycaemia), were also downgraded for unexplained inconsistency (statistical heterogeneity).Due to the variability of the diet and exercise components tested in the included studies, the evidence in this review has limited ability to inform practice. Future studies could describe the interventions used in more detail, if and how these influenced behaviour change and ideally be standardised between studies. Studies could also consider using existing core outcome sets to facilitate more standardised reporting.
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Affiliation(s)
- Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Judith C Gomersall
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Joanna Tieu
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Shanshan Han
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen’s and Children’s Hospital7th Floor, 72 King William RoadAdelaideSouth AustraliaAustralia5006
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16
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Blumberg J, Ballares V, Durbin JL. Ethnic variations on gestational diabetes mellitus and evidence-based first-line interventions. J Matern Fetal Neonatal Med 2017; 31:2641-2647. [PMID: 28689444 DOI: 10.1080/14767058.2017.1344967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE/OBJECTIVES To analyze the cultural and ethnic impact of gestational diabetes mellitus (GDM), report the associated complications, and investigate how lifestyle interventions are effective in preventing these associated complications. METHODS A literature review was conducted using online databases like CINAHL and Cochrane review. Findings were limited to journal articles published between 2012 and 2017. Irrelevant and relevant articles were determined by research topic, specific population, and type of interventions. RESULTS Due to the growing rate of Hispanics, this ethnic group will have the most impact of GDM. There is a link between the prevalence of GDM and being classified as obese or overweight among women of childbearing age. Differences in perinatal outcomes were noted in different ethnicities especially between Hispanic and Caucasian women. Higher prevalence of GDM did not equal higher impact. In fact, the ethnicity with the highest rate tends to have the lowest impact. Lifestyle interventions reduced the rate and impact of complications of GDM. CONCLUSIONS There is ethnic variation on the impact of GDM, with the Hispanic women having the most prevalence. Lifestyle interventions such as diet and exercise should be the first-line therapy for all women with GDM.
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Affiliation(s)
- Joy Blumberg
- a Department of Advanced Practice Nursing , Indiana State University , Terre Haute , Indiana , USA
| | - Victoria Ballares
- a Department of Advanced Practice Nursing , Indiana State University , Terre Haute , Indiana , USA
| | - Jessica L Durbin
- a Department of Advanced Practice Nursing , Indiana State University , Terre Haute , Indiana , USA
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17
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Carolan-Olah M, Duarte-Gardea M, Lechuga J. A systematic review of interventions for Hispanic women with or at risk of Gestational diabetes mellitus (GDM). SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:14-22. [PMID: 28844353 DOI: 10.1016/j.srhc.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 12/15/2016] [Accepted: 02/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Gestational Diabetes Mellitus (GDM) is a serious health concern for pregnant women, with Hispanic women at particular risk for developing the condition. The aim of this review was to critically examine GDM intervention programs for Hispanic women, in the United States of America (US). METHODS English and Spanish electronic databases were searched for relevant studies published between 1995 and 2015. Eligible study designs included randomized controlled trial, pre/post-test and quasi experimental methods. RESULTS Findings indicated that there was a dearth of literature reporting on GDM interventions for Hispanic women and just seven papers met inclusion criteria. These seven studies were included in the review and they reported on interventions for: (1) pregnant women at high risk of developing GDM; (2) pregnant women with GDM. Results suggest that a combination of intensive counselling over a prolonged period of time, together with a low calorie, possibly low glycemic index diet, produces best results. CONCLUSION The review found that intensive nutritional counselling approaches which promote low calorie/low GI diets appear to be most effective in BGL management in this population. Interventions that are delivered in Spanish and culturally tailored may be more acceptable to participants. More research is needed to develop suitable interventions to improve GDM management among Hispanic women.
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Affiliation(s)
- Mary Carolan-Olah
- Victoria University, College of Health and Biomedicine, St Alban's Campus, PO Box 14228, Melbourne 8001, Australia.
| | - Maria Duarte-Gardea
- The University of Texas at El Paso, College of Health Sciences, Department of Public Health Sciences, 500 W University Ave, El Paso, TX 79902, United States.
| | - Julia Lechuga
- The University of Texas at El Paso, College of Health Sciences, Department of Psychology, 500 W University Ave, El Paso, TX 79902, United States.
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18
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Hromi-Fiedler A, Chapman D, Segura-Pérez S, Damio G, Clark P, Martinez J, Pérez-Escamilla R. Barriers and Facilitators to Improve Fruit and Vegetable Intake Among WIC-Eligible Pregnant Latinas: An Application of the Health Action Process Approach Framework. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:468-477.e1. [PMID: 27373861 PMCID: PMC4934128 DOI: 10.1016/j.jneb.2016.04.398] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 04/04/2016] [Accepted: 04/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Identify barriers and facilitators to improve prenatal fruit and vegetable (F&V) intake among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible Latinas using the Health Action Process Approach framework. DESIGN Qualitative data were collected via audiotaped in-depth interviews as part of a larger study to design an intervention to increase prenatal F&V intake. SETTING Hartford, Connecticut. PARTICIPANTS Forty-five WIC-eligible Latinas completed the study. Included women were: ≥ 18 years old; in 2nd or 3rd trimester; having a singleton pregnancy; overweight or obese (ie, pregravid body mass index ≥ 25); not on a restricted diet; nonsmokers. PHENOMENON OF INTEREST Prenatal factors that promote and hinder F&V intake. ANALYSIS Transcripts were independently read and coded, and a consensus was reached about emerging themes. RESULTS Ten factors influenced prenatal F&V intake: social support, family structure, F&V access, F&V preferences, F&V knowledge, F&V health outcome expectations, self-efficacy, intentions, F&V action/coping planning strategies, and maternal health status. CONCLUSIONS AND IMPLICATIONS Social support from family/friends emerged as the primary distal factor driving prenatal F&V intake. Interventions designed to empower pregnant Latinas to gain the access, confidence, knowledge, and strategies necessary to consume more F&Vs must consider strengthening support to achieve the desired outcome.
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Affiliation(s)
- Amber Hromi-Fiedler
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT.
| | - Donna Chapman
- Exercise Science and Sports Studies Department, Springfield College, Springfield, MA
| | | | | | - Pamela Clark
- Women's Ambulatory Health Services, Hartford Hospital, Hartford, CT
| | - Josefa Martinez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
| | - Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
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19
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Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev 2015; 2015:CD007145. [PMID: 26068707 PMCID: PMC9428894 DOI: 10.1002/14651858.cd007145.pub3] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2012, Issue 4. Excessive weight gain during pregnancy is associated with poor maternal and neonatal outcomes including gestational diabetes, hypertension, caesarean section, macrosomia, and stillbirth. Diet or exercise interventions, or both, may reduce excessive gestational weight gain (GWG) and associated poor outcomes; however, evidence from the original review was inconclusive. OBJECTIVES To evaluate the effectiveness of diet or exercise, or both, interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (5 November 2014), contacted investigators of the previously identified ongoing studies and scanned reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or exercise, or both, interventions for preventing excessive weight gain in pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We organised RCTs according to the type of interventions and pooled data using the random-effects model in the Review Manager software. We also performed subgroup analyses according to the initial risk of adverse effects related to poor weight control. We performed sensitivity analysis to assess the robustness of the findings. MAIN RESULTS We included 65 RCTs, out of which 49 RCTs involving 11,444 women contributed data to quantitative meta-analysis. Twenty studies were at moderate-to-high risk of bias. Study interventions involved mainly diet only, exercise only, and combined diet and exercise interventions, usually compared with standard care. Study methods varied widely; therefore, we estimated the average effect across studies and performed sensitivity analysis, where appropriate, by excluding outliers and studies at high risk of bias.Diet or exercise, or both, interventions reduced the risk of excessive GWG on average by 20% overall (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.73 to 0.87; participants = 7096; studies = 24; I² = 52%). This estimate was robust to sensitivity analysis, which reduced heterogeneity, therefore we graded this evidence as high-quality. Interventions involving low glycaemic load diets, supervised or unsupervised exercise only, or diet and exercise combined all led to similar reductions in the number of women gaining excessive weight in pregnancy.Women receiving diet or exercise, or both interventions were more likely to experience low GWG than those in control groups (average RR 1.14, 95% CI 1.02 to 1.27; participants = 4422; studies = 11; I² = 3%; moderate-quality evidence). We found no difference between intervention and control groups with regard to pre-eclampsia (RR 0.95, 95% CI 0.77 to 1.16; participants = 5330; studies = 15; I² = 0%; high-quality evidence); however, maternal hypertension (not a pre-specified outcome) was reduced in the intervention group compared with the control group overall (average RR 0.70, 95% CI 0.51 to 0.96; participants = 5162; studies = 11; I² = 43%; low-quality evidence).There was no clear difference between groups with regard to caesarean delivery overall (RR 0.95, 95% CI 0.88 to 1.03; participants = 7534; studies = 28; I² = 9%; high-quality evidence); although the effect estimate suggested a small difference (5%) in favour of the interventions. In addition, for combined diet and exercise counselling interventions there was a 13% (-1% to 25%) reduction in this outcome (borderline statistical significance).We found no difference between groups with regard to preterm birth overall (average RR 0.91, 95% CI 0.68 to 1.22; participants = 5923; studies = 16; I² = 16%; moderate-quality evidence); however limited evidence suggested that these effect estimates may differ according to the types of interventions, with a trend towards an increased risk for exercise-only interventions.We found no clear difference between intervention and control groups with regard to infant macrosomia (average RR 0.93, 95% CI 0.86 to 1.02; participants = 8598; studies = 27; I² = 0%; high-quality evidence), although the effect estimate suggested a small difference (7% reduction) in favour of the intervention group. The largest effect size occurred in the supervised exercise-only intervention group (RR 0.81, 95% CI 0.64 to 1.02; participants = 2445; studies = 7; I² = 0%), which approached statistical significance (P = 0.07). Furthermore, in subgroup analysis by risk, high-risk women (overweight or obese women, or women with or at risk of gestational diabetes) receiving combined diet and exercise counselling interventions experienced a 15% reduced risk of infant macrosomia (average RR 0.85, 95% CI 0.73 to 1.00; participants = 3252; studies = nine; I² = 0; P = 0.05; moderate-quality evidence)There were no differences in the risk of poor neonatal outcomes including shoulder dystocia, neonatal hypoglycaemia, hyperbilirubinaemia, or birth trauma (all moderate-quality evidence) between intervention and control groups; however, infants of high-risk women had a reduced risk of respiratory distress syndrome if their mothers were in the intervention group (RR 0.47, 95% CI 0.26 to 0.85; participants = 2256; studies = two; I² = 0%; moderate-quality evidence). AUTHORS' CONCLUSIONS High-quality evidence indicates that diet or exercise, or both, during pregnancy can reduce the risk of excessive GWG. Other benefits may include a lower risk of caesarean delivery, macrosomia, and neonatal respiratory morbidity, particularly for high-risk women receiving combined diet and exercise interventions. Maternal hypertension may also be reduced. Exercise appears to be an important part of controlling weight gain in pregnancy and more research is needed to establish safe guidelines. Most included studies were carried out in developed countries and it is not clear whether these results are widely applicable to lower income settings.
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Affiliation(s)
- Benja Muktabhant
- Faculty of Public Health, Khon Kaen UniversityDepartment of Nutrition123 Friendship HighwayKhon KaenKhon KaenThailand40002
| | - Theresa A Lawrie
- World Health OrganizationDepartment of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerland1201
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Bain E, Crane M, Tieu J, Han S, Crowther CA, Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 2015:CD010443. [PMID: 25864059 DOI: 10.1002/14651858.cd010443.pub2] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their babies in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. OBJECTIVES To assess the effects of combined diet and exercise interventions for preventing GDM and associated adverse health consequences for women and their babies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 February 2014) and reference lists of retrieved studies. We updated the search in February 2015 but these results have not yet been incorporated and are awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs assessing the effects of interventions that included diet and exercise components. We included studies where combined diet and exercise interventions were compared with no intervention (i.e. standard care).We planned to also compare diet and exercise interventions with alternative diet and/or exercise interventions but no trials were identified for this comparison. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. Data were checked for accuracy. MAIN RESULTS We included 13 randomised controlled trials (involving 4983 women and their babies). We assessed the included trials as being of moderate risk of bias overall.When comparing women receiving a diet and exercise intervention with those receiving no intervention, there was no clear difference in the risk of developing GDM (average risk ratio (RR) 0.92, 95% confidence interval (CI) 0.68 to 1.23; 11 trials, 3744 women), caesarean section (RR 0.92, 95% CI 0.83 to 1.01; seven trials, 3246 women), or large-for-gestational age (RR 0.90, 95% CI 0.77 to 1.05; 2950 infants). Only one trial reported on perinatal mortality, and found no clear difference in the risk of stillbirth (RR 0.99, 95% CI 0.29 to 3.42; 2202 fetuses) or neonatal death (RR 0.99, 95% CI 0.06 to 15.85; 2202 neonates).Very few differences were shown between groups for the review's secondary outcomes, including for induction of labour, perineal trauma, pre-eclampsia, postpartum haemorrhage and infection, macrosomia, birthweight, small-for-gestational age, ponderal index, neonatal hypoglycaemia requiring treatment, hyperbilirubinaemia requiring treatment, shoulder dystocia, bone fracture or nerve palsy. Women receiving a combined diet and exercise intervention were, however, found to have a reduced risk of preterm birth compared with women receiving no intervention (RR 0.71, 95% CI 0.55 to 0.93; five trials, 2713 women).A trend towards reduced weight gain during pregnancy was shown for women receiving the combined diet and exercise intervention (mean difference (MD) -0.76 kg, 95% CI -1.55 to 0.03; eight trials, 2707 women; P = 0.06, random-effects); but no clear difference in postnatal weight retention was observed overall.In relation to adherence to the interventions, a number of trials that reported on behaviour modifications showed benefits in diet- (5/8 trials) and physical activity- (4/8 trials) related behaviours for women receiving the combined diet and exercise intervention, compared with women receiving no intervention; however there was notable variation across trials in outcomes measured and results observed. Only two trials reported on well-being and quality of life of women, and did not observe differences between groups for these outcomes.Very few trials reported on outcomes relating to the use of health services, although one trial suggested a reduced length of antenatal hospital stay for women receiving a combined diet and exercise intervention (MD -0.27 days, 95% CI -0.49 to -0.05; 2153 women).No information was available on outcomes for the infant as a child or adult, or for most longer-term outcomes for the mother. AUTHORS' CONCLUSIONS There are limitations associated with the available RCT evidence on the effects of combined diet and exercise interventions during pregnancy for preventing GDM. Results from 13 RCTs (of moderate quality) suggest no clear difference in the risk of developing GDM for women receiving a combined diet and exercise intervention compared with women receiving no intervention. However, the ability to draw firm conclusions was limited by variations in the quality of trials, characteristics of the interventions and populations assessed, and outcome definitions between trials.Based on the data currently available, conclusive evidence is not available to guide practice. Further large, well-designed RCTs, addressing the limitations of previous studies, are needed to assess the effects of combined interventions on preventing GDM and other relevant pregnancy outcomes including caesarean birth, large-for-gestational age and perinatal mortality. Health service utilisation and costs, and longer-term outcomes for mothers and their babies should be included. We identified another 16 trials which are ongoing and we will consider these for inclusion in the next update of this review.
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Affiliation(s)
- Emily Bain
- ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia, 5006
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Shah MK, Kieffer EC, Choi H, Schumann C, Heisler M. Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women. HEALTH EDUCATION & BEHAVIOR 2015; 42:593-603. [PMID: 25636316 DOI: 10.1177/1090198114568307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers. A community-partnered randomized controlled trial (RCT) with pregnant Latino women resulted in significantly improved vegetable, fiber, added sugar, and total fat consumption compared to a minimal intervention group. However, studying RCT intervention effects alone does not explain the mechanisms by which the intervention was successful or help identify which participants may have benefitted most. PURPOSE To improve the development and targeting of future community health worker interventions for high-risk pregnant women, we examined baseline characteristics (moderators) and potential mechanisms (mediators) associated with these dietary changes. METHOD Secondary analysis of data for 220 Latina RCT participants was conducted. A linear regression with effects for intervention group, moderator, and interaction between intervention group and moderator was used to test each hypothesized moderator of dietary changes. Sobel-Goodman mediation test was used to assess mediating effects on dietary outcomes. RESULTS Results varied by dietary outcome. Improvements in vegetable consumption were greatest for women who reported high spousal support at baseline. Women younger than age 30 were more likely to reduce added sugar consumption than older women. Participants who reported higher baseline perceived control were more likely to reduce fat consumption. No examined mediators were significantly associated with intervention effects. CONCLUSION Future interventions with pregnant Latinas may benefit from tailoring dietary goals to consider age, level of spousal support, and perceived control to eat healthy.
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Affiliation(s)
| | | | | | - Christina Schumann
- Community Health and Social Services Center (CHASS), Inc., Detroit, MI, USA
| | - Michele Heisler
- University of Michigan, Ann Arbor, MI, USA Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, USA
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