Women, Infants And Children Program Research Articles

Disparities in Breastfeeding Initiation Among African American and Black Immigrant WIC Recipients in the District of Columbia, 2007-2019.

Objectives. To estimate differences in breastfeeding initiation (BFI) rates between African Americans and Black immigrants enrolled in the District of Columbia Special Supplemental Nutrition Program for Women, Infants and Children (WIC) between 2007 and 2019. Methods. We used data collected as part of routine WIC program activities for first-time mothers (n = 38 142). Using multivariable logistic regression models, we identified determinants of BFI for African Americans, Black immigrants, non-Hispanic Whites, and Hispanics. To assess the trend in BFI over time, we calculated the average of the annual percentage changes. Results. Compared with African Americans, Black immigrants had a 2.7-fold higher prevalence and Hispanics had a 5.8-fold higher prevalence of BFI. The average of the annual percentage changes was 0.85 for Hispanics, 3.44 for Black immigrants, 4.40 for Non-Hispanic Whites, and 4.40 for African Americans. African Americans had the only statistically significant change (P < .05). Disparities in BFI persisted over the study period, with African Americans demonstrating the lowest rates each year. Conclusions. Significant differences exist in BFI between Black immigrants and African Americans. Combining African Americans and Black immigrants masks important differences, overestimates rates among African Americans, and may lead to missed opportunities for targeting interventions and policies to improve breastfeeding. (Am J Public Health. 2022;112(4):671-674. https://doi.org/10.2105/AJPH.2021.306652).

The Impact of Online Nutrition Education on WIC Client Retention and Redemption of the Cash Value Benefit of Fruit/Vegetables

Describe the effectiveness that online nutrition education has on WIC participants in maintaining program participation. All participants of the Indiana Special Supplemental Nutrition Program for Women Infant and Children (WIC) receive supplemental foods, nutrition education, and health care referrals. The Indiana WIC program established an online nutrition education program to help eliminate barriers to participants who are unable to be physically present for their second nutrition education appointments. The aim of this study was to compare the participation of WIC participants enrolled in standard in-person appointments with WIC participants enrolled in the Online Nutrition Education (ONE) pilot program by assessing the completion of the ONE lessons and the cash value benefit usage at 3 months after participants’ acceptance into the WIC program. A quasi-experiment was performed using a time series comparison of WIC participant attendance at their in-person nutrition education appointment to participants completion of an online nutrition education lesson. A second comparison of the two groups observed the participants redemption of their cash value benefit on fruits and vegetables (CVB). A total of 68,748 participants attended the traditional second nutrition education contact appointment during February 1 – September 7, 2019 and with the addition of the ONE pilot a total of 78,857 participants attended in 2020. The increase in participation from 2019 to 2020 was statistically significant (P=0.035). Analysis showed that there was a significant difference (P ≤ 0.001) between the 2019 and 2020 CVB mean redemption rates. This study provides evidence that WIC participants are more likely to maintain their participation when offered the addition of an online nutrition education appointment type.

High Level of Food Insecurity among Families with Children Seeking Routine Care at Federally Qualified Health Centers during the Coronavirus Disease 2019 Pandemic

ObjectiveTo assess food insecurity during pediatric visits to federally qualified health centers (FQHCs) during the coronavirus disease-19 pandemic.Study designInterviews using the validated American Academy of Pediatrics 2-question food insecurity screen were performed with 200 consecutive families presenting for pediatric care to 2 FQHC in Central Texas from April 14 to May 20, 2020, during the initial phase of the pandemic in Texas. Brief qualitative interviews were conducted to determine whether families found a worsening of food insecurity during the pandemic.ResultsOverall, 47% of families had a positive food insecurity screen. More than 90% of these were worrying about food running out and about 60% were positive for the question related to food not lasting. Among families with food insecurity, 94% indicated this had begun or worsened during the pandemic. Of the 115 families volunteering information about employment, 46% reported job loss during this time period. Both ethnicity (P < .001) and Special Supplementation Nutrition Program for Women, Infants and Children (WIC) participation (P = .03) were associated with greater levels of food insecurity. Among primarily Spanish-speaking families participating in the WIC program, 64% reported food insecurity.ConclusionsApproximately one-half of families receiving routine pediatric care at a FQHC during the coronavirus disease-19 pandemic reported food insecurity and this was associated with loss of jobs during the pandemic. Participation in the WIC program was not protective against food insecurity. Increased frequency of food insecurity was detected in Hispanic and Spanish-speaking families. Screening of families at an FQHC should be strongly considered as a part of routine pediatric care. Knowledge of community resources is important for providers to share with patients. (J Pediatr: X 2020;4:100044).Trial RegistrationClinicalTrials.gov: NCT04378595

Amount, Preparation and Type of Formula Consumed and Its Association with Weight Gain in Infants Participating in the WIC Program in Hawaii and Puerto Rico.

The aim of this study was to assess the association between amount (below or above recommendations), preparation (liquid vs. powder), and type (regular vs. hydrolysate) of infant formula consumed and weight in infants participating in the Women, Infant and Children (WIC) Program in Hawaii (HI) and Puerto Rico (PR). This was a secondary analysis of 162 caregivers with healthy term 0–2-month-old infants. Socio-demographics, infant food frequency questionnaires, and weight and length were assessed at baseline and after four months. Infant feeding practices were associated with weight-for-length z-scores using multivariable logistic regression. In total, 37.7% were exclusively breastfed and 27.2% were exclusively formula-fed. Among formula users, regular (63.6%) and powder (87.0%) formula were the most common; 43.2% consumed formula above recommendations. Most infants had rapid weight gain (61.1%). Infants fed regular formula had higher odds of overweight after four months (adjusted OR = 8.77, 95% CI: 1.81–42.6) and higher odds of rapid weight gain (adjusted OR = 3.10, 95% CI: 1.12, 8.61). Those exclusively formula fed had higher odds of slow weight gain (adjusted OR = 4.07, 95% CI: 1.17–14.2). Formula preparation and amount of formula were not associated with weight. These results could inform the WIC program’s nutrition education messages on infant feeding. Studies with longer follow-up are needed to confirm these results.

Empowering Women, Infants and Children (WIC) Recipients

Women, Infants, and Children (WIC) is a federal program available to expectant and post-partum women of low economic status. The WIC program provides education, nutritional supplements, and provides health and social referrals to recipients. The overall purpose of this study was to create a program that would inform, educate, and empower recipients so they could utilize the WIC EBT card to its full potential by obtaining all items covered and available to them. A descriptive, pre-experimental, one group pretest -posttest design was utilized. Additionally, the researcher administered survey questions to determine what challenges recipients experience, comfort level using the voucher, and other information pertinent to successful use of the WIC EBT card. Consequently, two 45 minutes educational sessions were provided to recipients regarding the approved foods with an emphasis regarding brands and sizes. Following the in-service classes, significant changes were noted in staff knowledge (n=8) regarding WIC approved items (95% confidence interval and a significant value of.029). This indicated there was a change in knowledge when comparing the number of correct responses selected on the pre-test to the correct responses selected on the post-test. After a thorough analysis, the investigator discovered that Women, Infant, and Children (WIC) recipients were comfortable utilizing their WIC EBT card; however, there was a need for additional education on the products covered by the WIC EBT card.

Prevalence and knowledge of anemia among pregnant women enrolled in Women, Infants and Children supplemental food program

PurposeAlthough anemia during pregnancy is common in the USA, socio-demographic factors make pregnant women enrolled in Women, Infants and Children (WIC) program more vulnerable than the general population. The purpose of this study was to examine the socio-demographic characteristics, blood hemoglobin concentrations, nutrition knowledge and potential associations among these factors in a sample of pregnant women participating in the WIC program.Design/methodology/approachA cross-sectional study using survey methodology was conducted. In total, 60 pregnant women who were between 12 and 24 weeks of gestation and were carrying a single fetus were recruited from two WIC clinics. Overall nutrition knowledge was assessed with 42 questions arranged into three subscales. Participants’ scores were transformed into tertiles. WIC program records were used to record blood hemoglobin values. Principal component analysis was used to validate the knowledge subscales. Correlational and multivariate regression analyses were conducted to examine the relationship among variables.FindingsPrevalence of anemia among the participants was higher than the national averages. Only 10 per cent of participants scored in the high tertile for nutrition knowledge. Anemia-during-pregnancy knowledge score was positively correlated with blood hemoglobin concentrations (r = 0.23, p < 0.05), and it was also a predictor of blood hemoglobin levels (R2 = 0.364, p = 0.02).Originality/valueThis is the first study to report on the knowledge of anemia, anemia during pregnancy and preventive measures among pregnant women enrolled in the WIC program.

The Economics of Food Vendors Specialized to Serving the Women, Infants, and Children Program

AbstractThis paper focuses on the impacts of food vendors that have emerged primarily or exclusively to redeem benefits for the Women, Infants and Children (WIC) Program. Federal regulations impose strict requirements on state WIC agencies which authorize vendors that derive more than 50% of their food sales through WIC. Such vendors are commonly known as above‐50 or A50 vendors, and most state WIC agencies do not authorize them. Using extensive transactions‐level data for the Greater Los Angeles area (GLA), we examine A50 vendors’ performance in the WIC program, including their pricing behavior relative to other WIC vendors in a but‐for world where A50 vendors are not authorized. We also conduct econometric tests designed to gauge A50 vendors’ impacts on WIC program access and participation, and costs charged for WIC foods by other program vendors. Results indicate that A50 vendors operating in GLA (a) modestly reduced WIC program food costs relative to a but‐for world where they were not authorized, (b) had a modest pro‐competitive effect on the pricing behavior of small, non‐A50 vendors, which have tended to charge the highest absolute prices for WIC foods in California, (c) caused a modest reduction in participant travel distance (and, hence, transaction costs), and (d) appear to have facilitated participant access. On balance, our results suggest that A50 vendors can improve the food‐delivery environment for the WIC program and facilitate participant access to WIC benefits without imposing additional food costs on the program.

Integrating Obstetrical Care and WIC Nutritional Services to Address Maternal Obesity and Postpartum Weight Retention.

This pilot study evaluated a cost neutral, integrated Special Supplemental Nutrition Program for Women Infants and Children (WIC) and obstetrical service model designed to prevent postpartum weight retention in obese women. A sample of women who received benefits from the Johns Hopkins (JH) WIC program and prenatal care from the JH Nutrition in Pregnancy Clinic, which provides obstetrical care for women with a BMI ≥ 30kg/m2, participated in the WICNIP randomized clinical trial. Intervention participants received enhanced nutrition services and education at five visits and during one phone call between delivery and 6months postpartum. Control participants received standard WIC services. Weight data was collected for all participants at multiple time points: pre-pregnancy, delivery, and postpartum at 4, 6 weeks, 4, and 6 months. Maternal socio-demographic factors, obesity class and the number of education contacts received were also recorded. Fifty-three African-American women were randomized into the intervention and control groups. Intervention participants retained significantly less gestational weight gain than control participants (3.0 ± 11.8 vs. 12.6 ± 20.4, p < 0.05). In both groups, participants with Class III obesity retained significantly less weight than participants in Classes I and II (p = 0.02). An integrated WIC and obstetrical service model is feasible and can limit postpartum weight retention in obese women. Weight retention at 6 months postpartum between intervention and control participants was statistically significant. Further research should explore targeted interventions by obesity class to address weight retention for low-income, African American women who participate in WIC.

The Role of WIC in Obesity Prevention

This paper seeks to answer the following two questions: (1) Is participation in the Supplemental Nutrition Program for Women, Infants and Children (WIC) associated with changes in obesity and overweight? and (2) What obesity prevention interventions in the WIC setting may be most effective for obesity prevention? The available evidence supports the conceptualization of the role of WIC in obesity prevention across the life course, with suggested impacts/influence on gestational weight gain during pregnancy, rapid infant weight gain during infancy, healthy lifestyle behavior during interconception, and prevalence of obesity during early childhood. Through the provision of nutrition education, breastfeeding support, and healthy foods and beverages, the WIC program has the potential to influence the mother’s nutritional knowledge and her and her child’s dietary intake and behaviors in a positive way. Given the wide reach of the program and the high quality of height/weight measurements taken by the WIC program, WIC has the potential to capitalize upon the early critical periods of development to reduce the incidence of overweight and obesity in a substantial proportion of low-income women and children.

Trends in Breastfeeding Among Infants Enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children - New York, 2002-2015.

Breastfeeding is widely accepted as the optimal method of infant feeding (1,2). New York Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has prioritized the promotion of breastfeeding. To assess breastfeeding trends among New York WIC infants, indicators for measuring breastfeeding practices reported by the New York Pediatric Nutrition Surveillance System (PedNSS) during 2002-2015 were examined. The prevalence of breastfeeding initiation increased from 62.0% (2002) to 83.4% (2015), exceeding the Healthy People 2020 (HP2020)* objective of 81.9% in 2014, with improvements among all racial/ethnic groups. The percentage of New York WIC infants who breastfed for ≥6 and ≥12 months increased from 30.2% and 15.0% (2002) to 39.5% and 22.8% (2015), respectively. The prevalence of exclusive breastfeeding for ≥3 and ≥6 months increased from 8.9% and 2.9% (2006) to 14.3% and 8.0% (2015), respectively. Despite improvements in breastfeeding initiation, increasing the duration of breastfeeding and of exclusive breastfeeding among infants enrolled in the New York WIC program remains challenging. Identifying targeted strategies to support continued and exclusive breastfeeding should remain priorities for the New York WIC program.

Women, Infants and Children (WIC) Program redemptions at California farmers’ markets: making the program work for farmers and participants

AbstractMany states including California allow fruit and vegetable checks (FVCs) issued by the Women, Infants and Children (WIC) Program to be redeemed at farmers’ markets. Despite the potential of the FVC program to increase the revenue of participating farmers and to provide fresh, locally grown fruits and vegetables to WIC participants, analysis of data for California shows that redemptions of FVCs at farmers’ markets have to date been miniscule. We study the barriers to use of FVCs at farmers’ markets and consider strategies for expanding both farmer and WIC client participation in the farmers’ market program. Our methodology involved design, implementation and analysis of surveys of both farmers’ market managers and farmer vendors who participate in the program and analysis of the behavior of WIC participants through California WIC program redemption data. One major factor limiting redemptions in California is that relatively few farmers’ markets currently accept FVCs and both market managers and farmers report that the authorization process is onerous. WIC participants who shopped at authorized markets more fully utilized the fixed-dollar value of their voucher, compared with participants who shopped at other authorized WIC vendors. Nevertheless, participants who visited a farmers’ market are unlikely to return. The study concludes with suggested pathways to increase WIC participant utilization of farmers’ markets.

Use of a mixed-method approach to evaluate the implementation of retention promotion strategies in the New York State WIC program

This research assessed the implementation of strategies piloted at 10 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics aimed at increasing retention in the program, by enhancing participants’ shopping experiences. Under WIC Retention Promotion Study: Keep, Reconnect, Thrive (WIC RPS), clinics were recruited and assigned to implement one or a combination of strategies: a standardized Shopping Orientation (SO) curriculum, a Guided Shopping Tour (GST), and a Pictorial Foods Card (PFC) from November 2012 through August 2013. This paper presents results from the process evaluation of the retention strategies, using a mixed-methods comparative case study design employing WIC administrative data, interviews, and focus groups. Qualitative data were inductively coded, analyzed and mapped to the following implementation constructs: organizational capacity, fidelity, allowable adaptations, implementation challenges, and participant responsiveness, while quantitative data were analyzed using SAS to assess reach and dose.Several sites implemented the SO and PFC interventions with the necessary fidelity and dose needed to assess impact on participants’ shopping experiences. Sites that were assigned the GST strategy struggled to implement this strategy. However, use of the standardized SO enabled staff to use a “consistent list of shopping tips” to educate participants about the proper use of checks, while use of the PFC increased participants’ awareness of the variety of WIC-allowable foods. During follow-up telephone calls, 91 percent of participants reported the shopping tips as helpful. Future analyses will assess the impact of enhanced shopping experience on retention at intervention sites.Keywords: Special Supplemental Nutrition Program for Women, Infants and Children (WIC); Mixed-methods; Process evaluation; Shopping with WIC checks; Retention

Screen Time Associated to Unhealthy Diets in Low-Income Children

The aim of this study was to examine the relationship between screen time (TV viewing and video game playing), dietary intake and overweight/obesity prevalence in low-income, primarily Hispanic young children. Data were obtained via a 2011 phone survey from caregivers of children enrolled in the Women, Infants and Children (WIC) program in Los Angeles, USA. WIC staff measured the child’s height and weight in the clinics. The final sample included 2278 low-income children (2-4 y) in the WIC program in Los Angeles County (LAC). Screen time was [significant (p≤0.01)] inversely related to vegetable intake and positively related to flavored milk, 100% juice, sugar sweetened beverages (SSB), and sweets. The odds of participants eating 1-4+ servings of fast food per week was 9-fold times higher in the children who reported 3+ hrs/day of screen time compared to those who reported <1 hr/day (OR=9.83, 95% CI 4.74 to 20.37; p<0.001). Screen time was not associated to obesity and/or overweight prevalence. These findings suggest screen time is associated to unhealthy dietary patterns, particularly increased sugar consumption, in low-income young children and should be taken into consideration for future interventions.

Oral Health Knowledge and Practices of WIC Staff at Florida WIC Program.

This study was conducted to assess the oral health knowledge, practices and confidence of staff in the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) by administering an anonymous self-completed survey to 39 WIC Clinic staff in Northern Florida. The survey instrument was a 28-item questionnaire adapted from previous validated surveys and covered questions on oral health knowledge, confidence and general practices related to oral health. Survey data were analyzed by descriptive statistics. The majority of WIC staff is knowledgeable about the role of the caregiver in cleaning the child's teeth and the role of bottle use in dental caries. Only 7 (25%) of total 28 WIC staff indicated that fluoridated toothpaste could be used for children younger than 2years of age. Only 18 (64%) agreed that the cariogenic bacteria could be transmitted from mother to child. Nutritionists reported greater confidence compared to others in oral health tasks. Only 6 (67%) of the nutritionists reported to counsel caregivers on the importance of regular tooth brushing. Only 4 (44%) nutritionists reported to refer WIC clients to dental care. These results indicate that WIC staff has a limited knowledge on the age recommendations for the fluoride toothpaste use and on the transmission of the cariogenic bacteria. Many do not provide oral health counseling to caregivers. WIC staff with more education is more likely to discuss oral health issues. WIC staff is in need for oral health training and education to provide oral health counseling for at risk WIC population.

Maternal Nutrition and Pregnancy Outcome—A Look Back

What to eat during pregnancy has been a topic of interest for centuries. Initially, there were many philosophical beliefs about what pregnant women should eat to avoid “marking” their baby. Observations that poor women tended to have worse pregnancy outcomes than did women with adequate incomes showed that the quality of the mother’s diet was linked to the baby’s health. Natural experiments, such as severe food deprivation during World War II, further demonstrated the critical role of maternal nutrition in pregnancy outcomes. Shortly thereafter, researchers showed that prepregnancy nutrition also influenced the course of pregnancy with underweight women tending to have poor outcomes. These findings were the foundation for establishing programs providing dietary counseling and food supplements to at-risk pregnant women. The first major program was in Montreal, which became the basis for the US WIC (Women, Infants, and Children) program that started in 1972 and continues to today. Numerous food or nutrient intervention trials were done over the next 40 years demonstrating that providing undernourished women with nutrient-rich foods improved fetal growth. Supplementation with iron, folate, or micronutrient tended to have smaller effects. Looking back over the historical studies of maternal nutrition provides insights for how to move forward. The data suggest that intervening prior to conception, as well as during pregnancy, improves the baby’s growth and long-term health especially in underweight or undernourished women. Thus, prenatal nutrition programs should span the woman’s reproductive cycle rather than pregnancy alone.

Integrating Perinatal Depression Screening Into WIC at a Federally Qualified Health Center.

Perinatal depression (PD) is a prevalent condition among low-income women, yet screening during pregnancy and in the first year postpartum is not routine practice in the United States. A team of academic and community partners share experiences with integrating depression screening into a Special Supplemental Nutrition Program for Women Infants and Children (WIC) that is co-located at an urban Federally Qualified Health Center (FQHC). Academic and community partners shared an interest in integrating depression screening into WIC; however, there were implementation challenges. The partners identified strategies to mitigate barriers to screening in the WIC program. As a result, more than 1,000 pregnant and postpartum women were screened for depression and referred for additional services. Successful integration of the Patient Health Questionnaire, a 2-question validated depression screener in this co-located WIC program, demonstrates the feasibility of this approach for other communities.

Racial/ethnic and Weight Status Differences in Food Preparation among WIC Participants.

The main purpose of this study was to examine whether the Supplemental Nutrition Program for Women, Infants and Children (WIC) helped mothers of overweight/obese preschool children to cut down on dietary fat and sugar intake for their families. Data from the Children Eating Well for Health (CHEW) Nutrition Survey, a probability sample of 150 (50 each White, Black and Hispanic) families with preschoolers participating in the WIC program in Nashville/Davidson County, Tennessee, were analyzed using logistic regression modeling. Mothers who reported that the WIC program helped them reduce fat intake were 2.5 times more likely to have an overweight/obese child and 2.1 times more likely to be obese themselves. No significant effects were found for adding sugar. These results suggest that the mothers in this sample were applying WIC nutritional counseling to use food preparation techniques that cut down on added fats for themselves and their children who were at risk due to weight status.

Using an “App” for Online Nutrition Education with Participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

As technology advances, users are shifting from desktop computers to mobile phones as tools for online learning. With these advances, there is demand for health educators to develop new platforms for learning which are tailored to individual needs. WIC is a national program that reaches more than 8.5 million low‐income mothers and children monthly and provides valuable nutrition education to their participants. The PHFE WIC Program is the largest local WIC agency in the country, serving approximately 4% of the nation's total and 23% of California's total WIC participants. As a leader and innovator in nutrition education, PHFE WIC seeks to continually improve the delivery of online nutrition. Preliminary data of online nutrition education in the PHFE‐WIC program in CA from 2011‐2014 found a significant shift from desktop computers to mobile devices as platforms for online nutrition education, with over 50% of participants using mobile devices. Use of an iPhone/Apple device was 18.5% in 2013, and 24% so far in 2014. Use of an android device was 36.1% in 2013 and 34.3% so far for 2014. Recognizing that more participants are accessing online nutrition education with their mobile devices, we are currently piloting an online nutrition education project which compares the use of a mobile phone “app” with the traditional online presentation platform. The “app” will utilize interactive forms of learning as well as presentation style learning, with the goal of increasing the efficacy of the current platform. We will present preliminary findings from survey and focus group data and discuss possible implications for future online nutrition education with mobile device “apps”.

A Wicked Problem? Cost Containment in the Women, Infants and Children Program

AbstractThe Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Program is a key part of America's safety net, but its structure fails to incentivize participants to be cost‐conscious in their purchases and may cause retailers to attach excessive markups to WIC products. We investigate cost containment in the WIC Program, with a focus on California. Results show that smaller vendors often charge considerably higher prices for WIC foods than their larger counterparts. However, larger vendors do not mark up WIC foods more or promote them less than comparable control products. Cost containment can be improved by targeting WIC Program sales to larger vendors when it is possible to do so without compromising participant access, and using large‐vendor prices as a benchmark to limit prices set by smaller vendors.

'Fit Moms/Mamás Activas' internet-based weight control program with group support to reduce postpartum weight retention in low-income women: study protocol for a randomized controlled trial.

BackgroundHigh postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women.Methods/DesignFit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m2 or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures.DiscussionFit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities.Trial registrationThis trial was registered with Clinicaltrials.gov (identifier: NCT01408147) on 29 July 2011.