Defined, In-home, Prenatal Nutrition Intervention for Low-Income Women

Abstract

Objectives The purpose of this project was to develop a detailed, in-home, prenatal nutrition intervention protocol for low-income women and to assess the effectiveness of the intervention in improving their dietary intake. A secondary objective was to identify predictors of infant birth weight. Design A defined protocol was developed and nutritionists followed it to conduct in-home nutrition sessions that included nutrition assessment, education, counseling, and goal setting for low-income women during their pregnancies. A pre/post design was used to assess the effects of the nutrition program on dietary intake. A control group was used in evaluating the effect of the nutrition intervention on birth weight. Subjects/setting Forty low-income pregnant women selected randomly by the county health department nursing staff completed the nutrition intervention. Twenty-six women were also selected to serve as a control group. Intervention For women in the intervention group, in-home visits were conducted weekly for 4 weeks, followed by 2 monthly visits. The purpose of the in-home visits was to use the defined protocol, which included monitoring weight gain and providing individualized dietary intake assessment and nutrition education and counseling. Main outcome measures The primary outcome measures were change in dietary intake from preintervention to postintervention, mothers' weight at time of delivery, and infant birth weight. Statistical analysis performed Paired t tests were used to compare the women's mean daily energy and nutrient intakes before and after the nutrition intervention. Correlation analysis identified relationships between infant birth weight and independent variables, and multiple stepwise regression analysis was used to identify variables that contributed to the variation in infant birth weight. Mean birth weight was compared in the intervention and control groups by means of a t test. A χ 2 test was used for categoric variables. Results Comparison of dietary intakes before and after the intervention revealed significant increases in total energy (2,269 to 2,431 kcal, P<.05), folate (345 to 412 μg, P<.01), vitamin B-6 (2.1 to 2.5 mg, P<.01), iron (17.5 to 21.2 mg, P<.01), zinc (13.6 to 14.7 mg, P<.01), and calcium (1,175 mg to 1,299 mg, P<.01) and significant ( P<.01) increases in daily servings from the vegetable group (1.5±1.0 to 2.2±1.1 serving per day) and breads/grains group (3.4±1.4 to 4.1±1.5 servings per day). There was no significant difference in mean birth weight between the intervention and control groups. Sixty-five percent of the variation in infant birth weight was accounted for by mother's weight at time of delivery, pre-pregnancy body mass index, number of visits by the nutritionist, and change in energy intake from preintervention to postintervention. Applications This defined, in-home, prenatal nutrition intervention protocol can be used by providers of prenatal nutrition services to document outcomes of prenatal nutrition care in high-risk women. Use of a defined protocol will facilitate collection of meaningful outcomes data by service providers. J Am Diet Assoc. 1999;99:1058–1062.