Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices.
OBJECTIVE
To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families.


METHODS
The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall.


RESULTS
A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P = .004).


CONCLUSIONS
Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention.


BACKGROUND
ClinicalTrials.gov: NCT01541761.
Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY. Electronic address: rgross@montefiore.org.
Rachel S
RS
Gross
Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Alan L
AL
Mendelsohn
Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Michelle B
MB
Gross
Research and Evaluation Unit, Public Health Solutions, New York, NY.
Roberta
R
Scheinmann
Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Mary Jo
MJ
Messito
D001942:Breast Feeding; D037001:Directive Counseling; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007224:Infant Care; D007231:Infant, Newborn; D008297:Male; D063766:Pediatric Obesity / Q000208:ethnology / Q000517:prevention & control*; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care; D011320:Primary Health Care; D011322:Primary Prevention / Q000379:methods*
Hispanic; feeding knowledge; pregnancy