Effectiveness of a normative nutrition intervention (diet, physical activity and breastfeeding) on maternal nutrition and offspring growth: the Chilean maternal and infant nutrition cohort study (CHiMINCs).
BACKGROUND
Maternal obesity before and during pregnancy predicts maternal and infant risks of obesity and its associated metabolic conditions. Dietary and physical activity recommendations during pregnancy as well as weight monitoring are currently available in the Chilean primary health care system. However some of these recommendations are not updated and most of them are poorly implemented. We seek to assess the effectiveness of an intervention that enhances the implementation of updated nutrition health care standards (diet, physical activity, and breastfeeding promotion) during pregnancy on maternal weight gain and infant growth.


METHODS



METHODS
Cluster randomized controlled trial. The cluster units will be 12 primary health care centers from two counties (La Florida and Puente Alto) from the South-East Area of Santiago randomly allocated to: 1) enhanced nutrition health care standards (intervention group) or 2) routine care (control group).


METHODS
Women seeking prenatal care before 15 weeks of gestation, residing within a catchment area of selected health centers, and who express that they are not planning to change residence will be invited to participate in the study. Pregnant women classified as high risk according to the Chilean norms (i.e age <16 or >40 years, multiple gestation, pre-gestational medical conditions, previous pregnancy-related issues) and/or underweight will be excluded.


METHODS
Pregnant women who attend intervened health care centers starting at their first prenatal visit will receive advice regarding optimal weight gain during pregnancy and diet and physical activity counseling-support. Pregnant women who attend control health clinics will receive routine antenatal care according to national guidelines. We plan to recruit 200 women in each health center. Assuming a 20% loss to follow up, we expect to include 960 women per arm.


METHODS
1) Achievement of adequate weight gain based on IOM 2009 recommendations and adequate glycaemic control at 24-28 weeks of pregnancy according to ADA 2011, and 2) healthy infant growth during the first year of age based on WHO standards.


CONCLUSIONS
We expect that the intervention will benefit the participants in achieving adequate weight gain & metabolic control during pregnancy as well as adequate infant growth as a result of an increased impact of standard nutrition and health care practices. Gathered information should contribute to a better understanding of how to develop effective interventions to halt the maternal obesity epidemic and its associated co-morbidities in the Chilean population.


BACKGROUND
Clinicaltrials.gov Identifier: NCT01916603.
Institute of Nutrition and Food Technology (INTA), University of Chile, Avenida El Líbano 5524, Macul, Santiago, Chile. mgarmendia@inta.uchile.cl.
Maria Luisa
ML
Garmendia
Institute of Nutrition and Food Technology (INTA), University of Chile, Avenida El Líbano 5524, Macul, Santiago, Chile.
Camila
C
Corvalan
Department of Women and Newborn Health Promotion, Faculty of Medicine, University of Chile, Santiago, Chile.
Marcela
M
Araya
Department of Obstetrics and Gynecology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
Paola
P
Casanello
Department of Obstetrics and Gynecology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.|Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile.
Juan Pedro
JP
Kusanovic
Institute of Nutrition and Food Technology (INTA), University of Chile, Avenida El Líbano 5524, Macul, Santiago, Chile.|Department of Pediatrics, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.|London School of Hygiene and Tropical Medicine, London, UK.
Ricardo
R
Uauy
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002657:Child Development; D002677:Chile; D015331:Cohort Studies; D004032:Diet; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D009043:Motor Activity; D009752:Nutritional Status; D009765:Obesity / Q000628:therapy*; D050177:Overweight / Q000628:therapy; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods*; D015397:Program Evaluation; D015430:Weight Gain; D055815:Young Adult