文章基本信息

标题：Association of Prenatal Participation in a Public Health Nutrition Program With Healthy Infant Weight Gain
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作者：Lynn S. Edmunds ; Jackson P. Sekhobo ; Barbara A. Dennison 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：Suppl 1
页码：S35-S42
DOI：10.2105/AJPH.2013.301793
语种：English
出版社：American Public Health Association
摘要：Objectives. We tested the hypothesis that early enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is associated with a reduced risk of rapid infant weight gain (RIWG). Methods. We used a longitudinal cohort of mother–infant pairs (n = 157 590) enrolled in WIC in New York State from 2008 to 2009 and estimated the odds of RIWG, defined as a 12-month change in weight-for-age z score of more than .67, comparing infants of mothers enrolled during the first, second, or third trimester of pregnancy with those who delayed enrollment until the postpartum period. Results. After adjusting for potential confounders, the odds of RIWG (odds ratio [OR] = 0.76; 95% confidence interval [CI] = 0.74, 0.79) were significantly lower for infants of women enrolling during the first trimester versus postpartum. Birth weight-for-gestational-age z score (OR = 0.33; 95% CI = 0.32, 0.33) attenuated the estimate of prenatal versus postpartum enrollment (OR = 0.92; 95% CI = 0.88, 0.95; first-trimester enrollees). Conclusions. The results demonstrate that prenatal WIC participation is associated with reduced risk of RIWG between birth and age 1 year. Improved birth weight for gestational age may be the mechanism through which early prenatal WIC enrollment protects against RIWG. Childhood obesity is a well-documented public health concern. The prevalence of obesity, after increasing for several decades, appears to be decreasing among preschool-aged children from low-income families who participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). 1–4 Well-established risk factors for child obesity include dietary patterns, physical inactivity, and television viewing behaviors, but research has increasingly focused on early life factors, including prenatal and perinatal factors. 5–8 Researchers have suggested that gestation and early infancy are critical periods in the development of obesity, 6 during which the foundation is laid for a lifelong predisposition for body composition. 6,9 Additionally, rapid infant weight gain (RIWG) is a risk factor for obesity. 10,11 WIC is a public health nutrition program designed to help prevent adverse health outcomes during periods of critical growth and development 12 by providing nutritious supplemental foods, breastfeeding support, nutrition education, and medical and social referrals. More than 50% of all US infants are enrolled in WIC, highlighting the broad reach and public health significance of the program. 13 Because federal support for public programs has been challenged, research documenting benefits of WIC participation on infant outcomes is necessary to ensure informed decision making. Prenatal WIC participation has been associated with increased gestational age and birth weight. 14 Early prenatal and continued participation in the WIC program exposes the mother to the maximum program benefits, including the support of breastfeeding peer counselors and certified lactation consultants beginning in the prenatal period, a critical time when infant feeding decisions are being made. Despite the potential benefits of prenatal enrollment in WIC for infant health outcomes, no published studies have examined whether prenatal WIC enrollment and infant growth during the first year of life are associated. We designed this study to test (1) the association between maternal WIC enrollment and RIWG and (2) infant birth weight and breastfeeding duration as potential mediators of the association between maternal WIC participation and RIWG. We hypothesized that early prenatal participation in WIC would protect against RIWG and that breastfeeding and birth weight for gestational age would mediate this association.