Healthy Weight Gain Research Articles

Toward Understanding How Social Factors Shaped a Behavioral Intervention on Healthier Infant Formula-Feeding.

As part of a process evaluation, we explored in semi-structured interviews the experiences of 19 mothers who had taken part in a trial to reduce infant formula-milk intake and promote healthy weight gain, and reflections of three facilitators who delivered the intervention and control group protocols. Mothers appreciated the nonjudgmental support provided during the trial, after experiencing stigma and receiving limited advice on how, how much, and how often formula-milk should be given. The information mothers had previously found, printed on formula-milk tins, or provided by family, friends, and health professionals was often perceived as contradictory; the trial guidance also conflicted with social norms relating infant health positively with weight gain. For those recruited into the trial with older infants, who had already exceeded the recommendations, reducing formula-milk amounts was difficult. The findings highlight the difficulties of addressing a highly stigmatized, complex social practice with an individual, behavioral intervention approach.

Integrating an effective obesity prevention program into existing home visiting services: The Healthy Beginnings Program

Background/Aim : The establishment of effective and sustainable programs to promote healthy weight gain in the first years of life is a public health priority given the elevated rates of childhood overweight and obesity worldwide. Healthy Beginnings (HB) was a world-first randomised control trial to demonstrate the effectiveness of an intensive (eight sessions), home-based early obesity prevention intervention delivered by nurses from the third trimester until two years of age. The HB intervention targeting first-time mothers was effective in improving infant feeding practices, reducing TV viewing time and child body mass index (BMI) at two years. However, the program was not cost effective or sustainable without integrating with existing services. The aim of this study is to explore how the HB program has been integrated into existing on-going home-visiting services within New South Wales. Method/Results : In 2016, a steering committee was established by the Chief Executive of the Sydney Local Health District (SLHD) to instigate the integration of the HB program in existing home-visiting services in SLHD. The Healthy Families Healthy Children program, a sustained health home-visiting program targeting vulnerable families in SLHD and the HB team contributed to the development of an addendum. The addendum provided an overview of the service including eligibility criteria to engage families, the modules covered in the program (including behaviours targeted in the HB program), the program schedule (including the integration of the eight HB sessions over two years) and data collection (including expected HB outcomes). The nurses delivering the home visits were provided with a visit checklist containing standard minimum information as well as resources to support key messages developed from the HB Trial. For the purpose of this study a mixed methods approach will be used to explore the barriers, facilitators and effectiveness of integrating the HB program into the sustained health home-visiting program targeting vulnerable families in SLHD. Qualitative interviews will be conducted with higher, middle and program managers aimed at exploring their thoughts and experiences with integrating HB. Focus groups will be conducted with nurses delivering the HB sessions in order to explore their experiences with implementation. The researcher will observe the HB sessions delivered during home-visits and explore clients’ experiences and satisfaction with the sessions. Further, to measure the effectiveness of the integration, the data collected from the electronic medical record on infant feeding behaviours of the clients involved in the home-visits will be analysed. Conclusions/implications : The findings of this study will inform the integration of HB across other Local Health Districts in NSW. More broadly, this study will provide insight into the translation of an evidence-based health promotion program into a real-world setting.

Postpartum Depressive Symptoms: Gestational Weight Gain as a Risk Factor for Adolescents Who Are Overweight or Obese.

Obesity is a risk factor for adverse physical health outcomes during pregnancy. Much less is known about the association between obesity and maternal mental health. Evidence suggests that prenatal depression is associated with excessive weight gain during pregnancy and that this relationship may vary according to pregravid body mass index (BMI). Young women may be particularly vulnerable to postpartum depression. The objective of this study is to examine the association between prepregnancy BMI, gestational weight gain, and postpartum depressive symptoms among adolescents. Participants were 505 pregnant adolescents aged 14 to 21 years followed during pregnancy and 6 months postpartum. Data were collected via interviews and medical record abstraction. Multilevel linear mixed models were used to test the association between excessive gestational weight gain as defined by National Academy of Medicine Guidelines and postpartum depressive symptoms measured via the validated Center for Epidemiologic Studies Depression (CES-D) scale. Analyses controlled for sociodemographic factors (maternal age, race, ethnicity, relationship status), health behaviors (nutrition, physical activity), prenatal depressive symptoms, and postpartum weight retention. Prepregnancy BMI was classified as follows: 11% underweight, 53% healthy weight, 19% overweight, and 18% obese. One-half (50%) of participants exceeded recommended guidelines for gestational weight gain. Adolescents with excessive gestational weight gain who entered pregnancy overweight or obese had significantly higher postpartum depressive symptoms (β, 2.41; SE, 1.06 vs β, 2.58; SE, 1.08, respectively; both P < .05) compared with those with healthy prepregnancy BMI and appropriate gestational weight gain. Adolescents who gained gestational weight within clinically recommended guidelines were not at risk for increased depressive symptoms. Adolescents who enter pregnancy overweight or obese and experience excessive weight gain may be at increased risk for postpartum depressive symptoms. Health care providers should offer preventive interventions during pregnancy and the interconceptional period to support healthy weight gain and safeguard women's mental health.

Maternal conception of gestational weight gain among Latinas: A qualitative study.

Interventions to support healthy gestational weight gain are often ineffective. The objective was to develop a model of how pregnant Latinas-who have a higher risk of poor maternal and neonatal weight-related outcomes-conceptualize healthy gestational weight gain, providing guidance for future interventions. Ten focus groups with 50 pregnant Latinas were conducted by a native Spanish-speaking female moderator. On the basis of participant responses, we used grounded theory to inductively develop a personal conceptual framework for gestational weight gain. Commonly identified barriers to being active and healthy eating included negative emotions, body image, physical discomfort, low energy, and lack of motivation. Women identified sociocultural issues such as a sense of isolation from family (among immigrants) and the degree of perceived social support as important contributors to health behaviors. Two personal health schemas emerged from participant responses. The "mother-child health schema" describes the degree to which participants recognized the interrelatedness of health needs for baby and for themselves. The "attention to gestational weight gain schema" describes how a respondent's attention to and perceived importance of gestational weight gain influences health-related behaviors during pregnancy. Women's sociocultural and interpersonal context influence weight-related behaviors through the lens of personal health schemas. Understanding how cognitive aspects relate to traditional behavioral determinants suggests several opportunities for intervention, such as focusing on healthy behaviors instead of numerical targets for healthy weight gain. Although derived from Spanish-speaking Latin-American women, these results may also be potential leverage points for other minority groups. (PsycINFO Database Record

Diet and nutrition interventions prevent gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy, with rising trend over the years. Dietary nutrient intake (protein, fat and fatty acids, carbohydrate, vitamin D, vitamin E, iron, zinc, selenium and inositol et al.), dietary pattern and probiotics may be related to GDM occurrence. Dietary factors are modifiable factors for preventing GDM. The study reviewed the roles of these dietary factors in preventing GDM. Results showed that plant-based dietary pattern may lower the risk of GDM and dietary pattern characterized with high animal protein, high fat and low carbohydrate may increase the risk of GDM. It warrants further studies that nutrient supplementation may prevent pregnant women from GDM. Diverse diet based on plant and cereal food should be promote for healthy and appropriate weight gain during pregnancy.

Supporting women to achieve healthy weight gain in pregnancy

Supporting women to achieve healthy weight gain in pregnancy

Associations of Prepregnancy Morbid Obesity and Prenatal Depression with Gestational Weight Gain.

Pregnancy outcomes and infant growth and development are influenced by various prenatal and postnatal factors. Gestational weight gain (GWG) is an important indicator of pregnancy management and outcomes. Information about the interaction between prenatal obesity and depression on GWG among low-income women is limited. There also is a lack of information about morbid obesity and GWG. The purpose of this study was to examine the associations of prepregnancy weight status, including morbid obesity as a separate group, and prenatal depression with GWG using electronic medical records in an academic prenatal clinic serving a largely low-income population. Retrospective data were obtained from existing electronic medical records for pregnant women receiving care from an academic outpatient obstetrics/gynecology clinic, largely serving the low-income population of eastern North Carolina between January 2012 and May 2013 (N = 410). Approximately 74% of the study sample was low-income women (either Medicaid insured or uninsured). There was a high prevalence of obesity (28.3%), morbid obesity (14.1%), and prenatal depression (17.8%). A majority of women exceeded Institute of Medicine GWG recommendations (45%), whereas 30% fell below recommendations and 25% met the recommendations. Morbidly obese women had a lower than recommended average weight gain and were less likely to exceed recommendations than to meet them (odds ratio 0.32, 95% confidence interval 0.15-0.70, P = 0.004). Consistent with other findings, obese and overweight women had a higher than recommended average weight gain. GWG recommendations should continue to incorporate prepregnancy weight status. Separate recommendations should be considered for morbidly obese women, who tend to fall below current recommendations. Further studies are needed to understand the difference in weight gain or loss among overweight, obese, and morbidly obese women and to help inform prenatal care interventions aimed at promoting healthy weight gain.

Mobilizing mHealth for Moms: a Review of Mobile Apps for Tracking Gestational Weight Gain

Almost one-half of all pregnant women in the USA exceed the Institute of Medicine’s (IOM) weight gain guidelines. Mobile apps hold promise as a beneficial tool for facilitating healthy gestational weight gain (GWG). The aim of this study was to review mobile apps that focused on GWG tracking and evaluate their features for meeting the IOM weight gain guidelines and encouraging healthy nutrition and physical activity (PA). Trained research staff conducted a review of apps that focused on tracking GWG. The apps were assessed by two reviewers for eight consecutive days, using a profile of an overweight pregnant woman at 12–13 weeks gestation. The reviewers entered weights daily. The weekly rate of weight gain was set above 0.6 lbs per week, which exceeded IOM guidelines for healthy GWG for an overweight woman. Apps were independently scored based on presence of features and guidelines. Initially, 296 apps were screened for review. Among these apps, 209 did not meet inclusion criteria for the review. The final review included 87 apps. Overall, 73 (84%) apps had a weight tracking feature, 19 (22%) apps provided accurate weight gain guidelines, 8 (9%) apps included calorie (kcal) recommendations, and 7 (8%) apps included exercise guidelines. Overall, there is a paucity of apps for tracking GWG that use IOM guidelines and promote evidence-based healthy weight-related behaviors during pregnancy. Furthermore, this review demonstrates the importance of health care practitioners’ role in providing accurate information and behavioral support for achieving healthy weight in pregnancy.

Patient-Provider Communication and Counseling about Gestational Weight Gain and Physical Activity: A Qualitative Study of the Perceptions and Experiences of Latinas Pregnant with their First Child.

Latina women in the United States (U.S.) are disproportionately affected by obesity and are more likely to begin pregnancy overweight and gain excessive weight during pregnancy. The prenatal care period represents a window of opportunity for women to access the healthcare system and receive preventive services, education, nutritional support, and other social services to improve pregnancy outcomes. Excessive gestational weight gain (GWG) has numerous negative short- and long-term consequences for both the mother and newborn. We explored nulliparous Latina women’s perceptions about their experiences communicating with their primary healthcare provider about GWG and physical activity (PA) to identify possible intervention targets using in-depth, semi-structured interviews. Bilingual, trained research staff conducted 23 interviews with first-time pregnant Latinas between 22 and 36 weeks of gestation. Interviews were transcribed verbatim and analyzed using content analysis. Salient text passages were extracted, shortened, coded, and grouped into categories. Women, including those who self-identified as being overweight or obese prior to pregnancy, reported receiving limited or no advice from their healthcare providers about GWG or PA. Additionally, analysis revealed that although participants value information received from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program counselors, they would like to receive more information from their primary healthcare providers about adequate GWG. Furthermore, study findings indicate that some participants received conflicting information regarding PA during pregnancy. Study findings suggest the need for increased integration of communication and counseling about GWG and PA into prenatal care services to promote healthy weight gain and PA among low-income Latina women.

Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications.

Adequate maternal nutrition during the “first 1,000 days” window is critical from conception through the first 6 months of life to improve nutritional status and reduce the risk of poor birth outcomes, such as low birthweight and preterm birth. Unfortunately, many programmes have targeted implementation and monitoring of nutrition interventions to infants and young children, rather than to women during pregnancy or post‐partum. A literature review was conducted to identify barriers to food choice and consumption during pregnancy and lactation and to examine how low‐ and middle‐income countries have addressed maternal nutrition in programmes. A literature review of peer‐reviewed and grey literature was conducted, and titles and abstracts reviewed by authors. Twenty‐three studies were included in this review. Barriers to adequate nutrition during pregnancy included cultural beliefs related to knowledge of quantity of food to eat during pregnancy, amount of weight to gain during pregnancy, and “eating down” during pregnancy for fear of delivering a large baby. Foods considered inappropriate for consumption during pregnancy or lactation contributed to food restriction. Drivers of food choice were influenced by food aversions, economic constraints, and household food availability. Counselling on maternal diet and weight gain during pregnancy was seldom carried out. Programming to support healthy maternal diet and gestational weight gain during pregnancy is scant. Tailored, culturally resonant nutrition education and counselling on diet during pregnancy and lactation and weight gain during pregnancy, as well as monitoring of progress in maternal nutrition, are areas of needed attention.

Family-based obesity prevention for infants: Design of the “Mothers & Others” randomized trial

ObjectiveOur goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life. Design, participants, and methodsThe design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37weeks gestation and when infants are 1, 3, 6, 9, 12, and 15months of age. ResultsThe primary outcome is infant/toddler growth and likelihood of overweight at 15months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention. ConclusionsIf successful in promoting healthy infant growth and enhancing caregiver behaviors, “Mothers and Others” will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2years, including interventional research and federal, state, and community health programs. Trial RegistrationClinicalTrials.gov, NCT01938118, August 9, 2013.

Qualitative Assessment of Key Messages about Nutrition and Weight Gain in Pregnancy in Printed Educational Materials in Alberta.

Printed educational materials are a common source of health information, although their effectiveness in improving women's knowledge or self-care in pregnancy has been questioned. This study describes the information in printed educational materials that address healthy eating during pregnancy and gestational weight gain (GWG) that are currently used in Alberta, Canada. Content of 6 resources was analyzed using a constant comparison qualitative approach. Resources emphasized healthy eating, prenatal supplements, folate supplementation, and healthy weight gain. More resources discussed the importance of "eating enough" than provided guidance on avoiding excessive GWG. Themes identified were: "everything is important" meaning that all healthy behaviours are important, making prioritization difficult; "more is more" emphasized eating more over moderation; "everyone is individual" suggests women seek individualized care through the care provider; and "contradictions" describes differences in content and recommendations within and between resources. New or revised versions of resources should provide congruent information with up-to-date recommendations that are easily prioritized. Care providers should be aware of contradictory information or information that does not align with current recommendations within printed educational materials and be ready to help women address the areas important for her personal behaviour change.

Influence of the 5A's Counseling Strategy on Weight Gain During Pregnancy: An Observational Study

Healthy weight gain during pregnancy may improve health outcomes for women and infants. The objective of this study was to examine providers' use of the 5A's (Assess, Advise, Agree, Assist, and Arrange) in discussions of weight, nutrition, and physical activity during prenatal visits and evaluate the effect of this approach on gestational weight gain. We studied audio recordings of prenatal visits between 22 obstetrics providers and 120 of their patients, coding visits for providers' use of the 5A's. The relationship between the 5A's and gestational weight gain (total weight gain and excess gestational weight gain) was evaluated using multilevel models to account for patient clustering within provider, and adjusted for prepregnancy body mass index, parent study intervention assignment, gestational age at the study visit, and study visit length. Overall, 55% of prenatal visits included any weight-related behavioral counseling. Of these, 59.1% included one of the 5A's and 40.9% included two or more of the 5A's. Counseling conversations most commonly included Assess or Advise (49% and 85% of counseling conversations, respectively). No recorded visits used all 5A's. In adjusted analyses, patients who received counseling with two or more of the 5A's gained an average of 11.8 fewer pounds than patients who received no counseling (p = 0.001). The odds of excess gestational weight gain were lower among women receiving counseling with at least one of the 5A's (p < 0.05). The 5A's were associated with lower gestational weight gain and may be a promising counseling strategy to promote healthy weight gain during pregnancy.

General practitioners and preconception weight management in New Zealand.

Childhood obesity is a growing concern internationally and a top priority for the World Health Organization. Preconception overweight, obesity and excess gestational weight gain significantly increase childhood obesity risk. Optimising preconception weight is a key preventative measure toward reducing childhood obesity. In 2014, the New Zealand (NZ) Ministry of Health released guidance for health practitioners on healthy weight gain in pregnancy in an effort to reduce the burden of childhood obesity. To explore the knowledge and practice of NZ general practitioners (GPs) regarding preconception and gestational weight management. A nationwide survey was conducted on a randomly selected sample of NZ GPs using a mixed methods approach. Descriptive statistics were used for survey responses and a general inductive approach was applied to the free text data. A total of 200 GPs (42.5%) responded. The majority of GPs were aware of the risks of obesity in pregnancy. Over 50% of GPs reported practice that was not consistent with recommended standards of care. Ministry of Health guidance was known to only 12% of participants. Themes emerging from the free text data included: lack of opportunity for, and awareness of, preconception care; recognition of the importance of this area; and need for further learning. General practitioners in NZ are not providing optimal preconception care. This research highlights the need for a public health message encouraging preconception counselling and better education of GPs on the topic. This should start with promotion of the Ministry of Health guidance.

Come On! Using intervention mapping to help healthy pregnant women achieve healthy weight gain.

Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design 'Come On!', an intervention to promote adequate GWG among healthy pregnant women. We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development. As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of 'Come On!', a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.

A mobile health intervention promoting healthy gestational weight gain for women entering pregnancy at a high body mass index: the txt4two pilot randomised controlled trial.

To determine the feasibility and effectiveness of an mHealth intervention promoting healthy diet, physical activity and gestational weight gain in pregnant women. Randomised controlled trial (RCT). Australian tertiary obstetric hospital. One hundred pregnant women who were overweight or obese prior to pregnancy. Women recruited at the first antenatal clinic visit were randomised to either an intervention or a control group. The intervention consisted of a tailored suite of strategies delivered (from first antenatal visit until 36 weeks' gestation) via multiple modalities available on mobile devices. The primary outcome was intervention feasibility and secondary outcomes were objectively measured changes in gestational weight gain (GWG) and self-reported dietary intake and physical activity. Ninety-one women completed the study. Delivery to protocol provides evidence of program feasibility. Most women engaged regularly with the program, with the majority (97.6%) reporting that the intervention was helpful. Secondary outcomes demonstrated a significantly lower GWG in the intervention group (7.8 kg ± 4.7 versus 9.7 kg ± 3.9; P =0.041) compared with the control group at intervention completion. Intervention group women reported significantly smaller reductions in total, light- and moderate-intensity physical activity from baseline to completion of the intervention (P = 0.001) compared with the control group, but no differences in consumption frequencies of key food groups. An intervention that aimed to deliver healthy diet, physical activity and GWG guidance utilising innovative technology can be feasibly implemented and produce positive physical activity and GWG outcomes. TWEETABLE ABSTRACT: txt4two mHealth study improved gestational weight gain and physical activity in pregnant women with high BMIs.

Women's dietary changes before and during pregnancy: A systematic review

Backgrounddietary intake before and during pregnancy has significant health outcomes for both mother and child, including a healthy gestational weight gain. To ensure effective interventions are successfully developed to improve dietary intake during pregnancy, it is important to understand what dietary changes pregnant women make without intervention. Aimsto systematically identify and review studies examining women's dietary changes before and during pregnancy and to identify characteristics of the women making these changes. Methodsa systematic search strategy was employed using three databases (Web of Science, CINAHL and PubMed) in May 2016. Search terms included those relating to preconception, pregnancy and diet. All papers were quality assessed using the Scottish Intercollegiate Guidelines Network methodology checklist for cohort studies.The search revealed 898 articles narrowed to full-text review of 23 studies. In total, 11 research articles were included in the review, describing nine different studies. The findings were narratively summarised in line with the aims of the review. Findingsthe included studies showed marked heterogeneity, which impacts on the findings. However, the majority report an increase in energy intake (kcal or kJ) during pregnancy. Of the studies that reported changes through food group comparisons, a majority reported a significant increase in fruit and vegetable consumption, a decrease in egg consumption, a decrease in fried and fast food consumption and a decrease in coffee and tea consumption from before to during pregnancy. The characteristics of the women participating in these studies, suggest that age, education and pregnancy intention are associated with healthier dietary changes; however these factors were only assessed in a small number of studies. Key conclusionsthe 11 included articles show varied results in dietary intake during pregnancy as compared to before. More research is needed regarding who makes these healthy changes, this includes consistency regarding measurement tools, outcomes and time points. Implications for practiceMidwives as well as intervention developers need to be aware of the dietary changes women may spontaneously engage in when becoming pregnant, so that care and interventions can build on these.

Pregnant women's perceptions of gestational weight gain: A systematic review and meta-synthesis of qualitative research.

Excess gestational weight gain has numerous negative health outcomes for women and children, including high blood pressure, diabetes, and cesarean section (maternal) and high birth weight, trauma at birth, and asphyxia (infants). Excess weight gain in pregnancy is associated with a higher risk of long-term obesity in both mothers and children. Despite a concerted public health effort, the proportion of pregnant women gaining weight in excess of national guidelines continues to increase. To understand this phenomenon and offer suggestions for improving interventions, we conducted a systematic review of qualitative research on pregnant women's perceptions and experiences of weight gain in pregnancy. We used the methodology of qualitative meta-synthesis to analyze 42 empirical qualitative research studies conducted in high-income countries and published between 2005 and 2015. With this synthesis, we provide an account of the underlying factors and circumstances (barriers, facilitators, and motivators) that pregnant women identify as important for appropriate weight gain. We also offer a description of the strategies identified by pregnant women as acceptable and appropriate ways to promote healthy weight gain. Through our integrative analysis, we identify women's common perception on the struggle to enact health behaviors and physical, social, and environmental factors outside of their control. Effective and sensitive interventions to encourage healthy weight gain in pregnancy must consider the social environment in which decisions about weight take place.

PIH10 - Measuring The Influence Of Patient Counseling At Tertiary Care Hospital In Antenatal Care, South Karnataka, India

The identification and management of current and potential risks and associated problems in antenatal care is important. The aim of study was to assess the awareness levels for the health measures during Pregnancy among the sample size and to evaluate the effect of counseling on them. The Impact of pre and post counseling was measured through a questionnaire administered to a sample of 205 pregnant women. Various socio-demographic variables like age, education, family income and parity were added to the study which could influence the result outcome. After the base level awareness assessment, pregnant women were counseled on the importance of healthy diet, weight gain and regular exercise in maintaining a healthy pregnancy. They were also counseled on the damaging effects of smoking & drinking, dietary sources of iron, vitamins, importance of HIV testing, family planning methods, some warning signs, avoiding self-medication, anemia symptoms, importance of mothers’ milk to infant etc. Post counseling impact was recorded using same questionnaire administered to them before counseling. All pregnant women were in the age group of 20-35 yrs, with basic education up to secondary level (80%), out of which around 60% were primigravida. All the women were 100% aware about HIV and major associated complications during pregnancy. While, steep rise in the percentage of awareness was recorded after counseling like: feeding of mother’s milk (before 20%, after 80%); vitamin/iron need and their sources (before 30%, after 90%); family planning (before 50%, after 90%); sonography (before 30%, after 90%) and anemia symptoms (before 20%, after 85%) etc. Awareness about various health measures among pregnant women can be increased by providing them counseling and educational material like information leaflet.

Evaluation of an Amino Acid-Based Formula in Infants Not Responding to Extensively Hydrolyzed Protein Formula.

Nearly 2% to 3% of infants and children younger than 3 years have confirmed cow's milk protein allergy with multiple clinical presentations including atopic dermatitis (AD), diarrhea, and vomiting/spitting up. Although most infants with cow's milk protein allergy experience clinical improvement with the use of an extensively hydrolyzed (EH) formula, highly sensitive infants may require an amino acid-based formula. In this observational, prospective study, 30 infants (1-12 months of age) with a history of weight loss and persistent allergic manifestations while on an EH formula were provided an amino acid-based formula for 12 weeks. Mean weight gain (z score change) improved +0.43 ± 0.28 (mean ± standard deviation) after the 12-week feeding period. Improvement was observed for many allergic symptoms including significant decreases in AD severity (P = 0.02). These results indicate the new amino acid-based infant formula supported healthy weight gain and improvement in allergic manifestations in infants not responding to EH formulas.