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The Impact of the Revised WIC Food Package on Maternal Nutrition During Pregnancy and Postpartum.

ABSTRACT: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for pregnant and postpartum women and young children. The typical food package provided to recipient families was revised in October 2009 to include more whole grains, fruits, vegetables, and low-fat milk. Little is known about whether these revisions improved nutrition among women during this critical period of the life course. We conducted a quasiexperimental difference-in-differences analysis, comparing WIC recipients ("treatment" group) before and after the WIC policy change, while accounting for temporal trends among nonrecipients ("control" group). We examined nutritional outcomes among a cohort of 1,454 women recruited during pregnancy in 2006-2011 in Memphis and surrounding Shelby County, Tennessee. We found improvements in several measures of dietary quality and nutrient intake during pregnancy, although these did not persist into the postpartum period. Results were robust to numerous sensitivity analyses. At a time when federal WIC funding is threatened, this study provides some of the first evidence of the benefits of recent WIC revisions among low-income women.

SUBMITTER: Hamad R

PROVIDER: S-EPMC6670068 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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The Impact of the Revised WIC Food Package on Maternal Nutrition During Pregnancy and Postpartum.

Hamad Rita R Batra Akansha A Karasek Deborah D LeWinn Kaja Z KZ Bush Nicole R NR Davis Robert L RL Tylavsky Frances A FA

American journal of epidemiology 20190801 8

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for pregnant and postpartum women and young children. The typical food package provided to recipient families was revised in October 2009 to include more whole grains, fruits, vegetables, and low-fat milk. Little is known about whether these revisions improved nutrition among women during this critical period of the life course. We conducted a quasiexperimental difference-in-differences ...[more]

PMID: 31094428

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Project description:ImportanceThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves more than one-quarter of pregnant and postpartum women. In October 2009, the WIC food package underwent revisions to improve nutritional content. No studies have investigated the downstream effects of this revision on maternal and infant health.ObjectiveTo investigate whether the revised WIC food package improved perinatal and birth outcomes among recipients.Design, setting, and participantsWe conducted a quasi-experimental difference-in-differences analysis, comparing WIC recipients (the treatment group) before and after the package revisions while accounting for temporal trends among nonrecipients (the control group). Multivariable linear regressions were adjusted for sociodemographic covariates. This study was conducted using linked birth certificate and hospital discharge data from California from January 2007 to December 2012. Analysis began July 2018.ExposuresWhether pregnant women received the revised WIC package, which included more whole grains, fruit, vegetables, and low-fat milk.Main outcomes and measuresMeasures of maternal and infant health, including maternal preeclampsia, gestational diabetes, and gestational weight gain as well as infant gestational age, birth weight, and hospitalizations.ResultsThe sample included 2 897 537 infants born to 2 441 658 mothers. WIC recipients were more likely to be Hispanic, less educated, of greater parity, and younger than nonrecipients. The revised WIC food package was associated with reductions in maternal preeclampsia (-0.6% points; 95% CI, -0.8 to -0.4) and more than recommended gestational weight gain (-3.2% points; 95% CI, -3.6 to -2.7), increased likelihood of as recommended (2.3% points; 95% CI, 1.8 to 2.8) and less than recommended (0.9% points; 95% CI, 0.5 to 1.2) gestational weight gain, and longer gestational age (0.2 weeks; 95% CI, 0.001 to 0.034). Among infants, an increased likelihood of birth weight that was appropriate for gestational age was observed (0.9% points; 95% CI, 0.5 to 1.3). Although birth weight itself was reduced (-0.009 SDs; 95% CI, -0.016 to -0.001), this was accompanied by reductions in small for gestational age (-0.4% points; 95% CI, -0.7 to -0.1), large for gestational age (-0.5% points; 95% CI, -0.8 to -0.2), and low-birth-weight infants (-0.2% points; 95% CI, -0.4 to -0.004), suggesting that the revised food package improved distributions of birth weight.Conclusions and relevanceThe revised WIC food package, intended to improve women's nutrition during pregnancy, was associated with beneficial impacts on maternal and child health. This suggests that WIC policy may be an important lever to reduce health disparities among high-risk women and children at a critical juncture in the life course.

Project description:ContextFrequent consumption of home-prepared meals is associated with higher diet quality in children and adults. Therefore, increasing the culinary skills of women and couples during their childbearing years may be an effective strategy for the prevention of overweight and obesity.ObjectiveTo determine the impact of culinary nutrition-education interventions for women with or without their partners during preconception, pregnancy, or postpartum (PPP) on parental cooking skills, nutrition knowledge, parent/child diet quality, or health outcomes.Data sourcesEligibility criteria were defined using a PICOS framework. A systematic search strategy was developed to identify eligible studies and was implemented in 11 electronic databases. Reference lists of selected systematic reviews were manually searched for additional studies.Data extractionStudy characteristics and outcomes were extracted from eligible studies by 1 reviewer and checked by a second reviewer.Data analysisA narrative synthesis of the findings of eligible studies was prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Synthesis Without Meta-Analysis in systematic reviews reporting guideline.ResultsA total of 6951 articles were identified from the search strategy and 31 studies during pregnancy or postpartum were included. By category, the number of studies with a favorable outcome per total number of studies measuring outcome were as follows: parental food/cooking skills (n = 5 of 5), nutrition knowledge (n = 6 of 11), parent/child diet quality (n = 10 of 19), infant feeding (n = 6 of 11), eating behavior (n = 2 of 5), maternal (n = 2 of 5) and child anthropometry (n = 6 of 10), mental health and development n = (2 of 3), and clinical indictors (n = 1 of 1).ConclusionsCulinary nutrition-education interventions during pregnancy and the postpartum period show promise in improving cooking skills, diet quality, and a variety of health-related outcomes. The precise effect of these interventions during PPP is limited by the quality and heterogeneity of study designs to date.Systematic review registrationPROSPERO registration number: CRD42020154966.

Dataset Information

The Impact of the Revised WIC Food Package on Maternal Nutrition During Pregnancy and Postpartum.

Publications

The Impact of the Revised WIC Food Package on Maternal Nutrition During Pregnancy and Postpartum.

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