Between Pregnancy and Age Two - The First 1,000 Days and Its Impact on Childhood Obesity

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Childhood obesity is a growing problem, especially in Texas. With about one third of Texan children considered either overweight or obese, it is critical to recognize the factors that contribute to childhood obesity and the types of interventions that could prevent it.

There is increasing awareness that the first 1,000 days – the time from pregnancy until a child turns 2 – are key to preventing childhood obesity. This is particularly true among racial and ethnic minority communities. And yet, until recently, there hasn’t been a systematic review of the research that focuses on factors in the first 1,000 days that can impact childhood obesity.

A new Robert Wood Johnson Healthy Eating Research issue brief – which is based on two review papers looking at studies published between 1980 and 2014 – is the first of its kind to examine the evidence on factors in the first 1,000 days associated with an increased risk of childhood obesity and interventions in the first 1,000 days that could prevent childhood obesity later in life.

The review of nearly 300 studies found that several risk factors were consistently associated with childhood overweight or obesity later in life:

  • higher maternal pre-pregnancy body mass index (BMI);
  • maternal excess weight gain during pregnancy;
  • prenatal tobacco exposure;
  • higher infant birth weight; and
  • higher infant weight gain.

Additionally, a smaller number of studies found that other factors were associated with developing childhood obesity later in life, such as gestational diabetes during pregnancy, insufficient sleep for the infant, and socio-economic status during the first 1,000 days.

The report also looks at evidence on interventions during the first 1,000 days that could prevent or reduce the risk of childhood obesity. Of the interventions reviewed, most interventions were found to be effective by using home visits to focus on individual-level or family-level behavior changes, using individual or group counseling in clinical settings, or using a combination of home and group visits. For example, two home visiting interventions – specifically, home visits from nurses and community health workers who provide education on infant diet, feeding practices, and maternal diet and exercise – had a demonstrated effect on improving child BMI measures.

Identifying the factors that contribute to childhood obesity is just the first step in reducing childhood obesity. The evidence raised in this report makes clear that a child’s health and wellbeing are impacted by a woman’s health during pregnancy, the care she receives during pregnancy, as well as the care a child receives after birth.

To truly address the risk factors associated with childhood obesity later in life, we must ensure access to prenatal care during pregnancy and postpartum care after birth of a child. In Texas, too many women experience barriers to prenatal care access, as highlighted in the recent San Antonio Express-News three-part series examining the challenges to receiving early prenatal care. The 2015 Healthy Texas Babies Data Book makes clear that late entry into prenatal care is a statewide problem – a problem that disproportionately impacts Hispanic and African American women in Texas and has devastating consequences for children and their families.

Moreover, Medicaid plays a key role in child and maternal health, and yet, women who are eligible for Medicaid during pregnancy lose their coverage too soon in Texas, just 60 days after birth of a child. Too often the end of this 60 day period marks the end of access to any health services for these women. The need for postpartum care extends well beyond 60 days – it’s a critical time for women to access basic health care, interconception care, screening and treatment for postpartum depression, breastfeeding counseling, and care to manage chronic conditions like diabetes and hypertension. Access to these services is essential for achieving healthier outcomes for moms and babies and addressing the risk factors associated with childhood obesity.

Fortunately, this interim in the legislature, the Texas House Health and Human Services Committee will explore policy options to improve birth outcomes and we look forward to working with committee members and health partners in identifying smart policy steps to increase access to prenatal and postpartum care in Texas.

We can also build on the state’s effective home visitation program and improve access to these evidence-based programs over time to ensure all new mothers who would benefit have access in their community. The research is clear that investing in effective intervention programs during the first 1,000 days will pay off for Texas by ensuring more healthy pregnancies, healthy childhoods, and stronger families.