Closing the Health Equity Gap for Mothers and Babies
On January 23rd, PHAC Acting Director for the Centre for Health Promotion, Marla Israel, and Dr. Nazeem Muhajarine, Professor and Department Head at the University of Saskatchewan Population Health and Evaluation Research Unit (SPHERU) hosted a Fireside Chat to discuss the recent quantitative evaluation of CPNP programs conducted by SPHERU and entitled Understanding the impact of the Canada Prenatal Nutrition Program that was published in the September 2012 edition of the Canadian Journal of Public Health.
The research project set out to answer 2 primary and 2 secondary questions:
- Are higher levels of program exposure* related to more positive changes in personal health practices among CPNP clients?
- Are higher levels of program exposure related to better birth outcomes among CPNP clients?
a) Is receiving particular CPNP services related to health practices and birth outcomes?
b) Does the impact of the CPNP on birth outcomes vary across different subgroups of clients?
*Program exposure was defined as a combination of how early into a pregnancy the participant joined the CPNP program, how often they participated in the program, and number of overall weeks they were involved with the program.
Health practices were defined as:
- Weight gain in pregnancy relative to recommended weight gain
- Increased use of vitamin/mineral supplements
- Smoking cessation
- Smoking reduction
- Quitting drinking alcohol
- Breastfeeding initiation
- Breastfeeding duration
Birth outcomes were defined as:
- Pre-term birth (defined as gestational age of less than 37 weeks)
- Low birth weight (birth weight of less than 2500g)
- Small for gestational age
- Large for gestational age
- Poor neonatal health
The study recognized that women receive a broad range of services from CPNP programs, including food supplements, dietary assessment, one-on-one nutrition education/counselling, group nutrition counselling, lifestyle education/counselling, and a range of other services.
In terms of population sub-groups, the study examined a range of sociodemographic risk indicators including:
- Younger than 19 years of age or older than 34 years of age
- Having lived in Canada for less than 10 years
- Aboriginal ancestry
- Single, widowed, divorced or separated
- No high school diploma
- Monthly household income of less than $1,900
- Food insecurity
Pregnancy-related risk indicators were also examined:
- History of miscarriages
- History of stillbirths
- History of low birth weight infant(s)
- Consulted a doctor/midwife/nurse/practitioner since being pregnant
- Interval between births
- BMI and weight gain during pregnancy
#1 CPNP exposure and health practice in pregnancy
The study found that overall, greater CPNP exposure was related to healthier behaviour during pregnancy, except for gaining more than the recommended amount of weight. Specifically, CPNP program participants were more likely to:
- Increase the use of vitamin supplements
- Cut down on the number of cigarettes smoked
- Quit drinking alcohol
- Initiate breastfeeding
- Breastfeed their infants longer (4 times more likely)
#2 CPNP services and health practices
This study found that group nutrition counselling and one-on-one nutrition education/counselling had the greatest impact on program participants.
#3 CPNP exposure and birth outcomes
Initiating contact earlier in a pregnancy, having greater contact with a CPNP program and remaining enrolled longer in the program were all associated with a lower likelihood of:
- Pre-term birth
- Low birth rate
- Having a small for gestational age infant
- Poor neonatal health
#4 CPNP services and birth outcomes
Group nutritional counselling was the only service consistently positively related to lower risk of preterm birth, low birth weight and poor neonatal health.
#5 CPNP exposure and large for gestational age babies
The study noted that increased exposure to a CPNP program was also linked to large for gestational age birth outcomes. This potential link is something the study recommends for further examination.
#6 CPNP effects on subgroups of clients
No great differences across sociodemographic groups were found. Slightly more and/or stronger relationships were found for:
- Married vs single participants
- Recent immigrants vs those who have been in Canada for more than 10 years
- Participants who had not completed high school and those who had
- Participants with food security concerns vs those without these concerns
In conclusion, it was found that CPNP programs across Canada:
- Had a demonstrable positive impact on reducing unhealthy practices during pregnancy.
- Had a demonstrable positive impact on reducing risk of poor birth outcomes.
- Had a demonstrable strong positive impact on breastfeeding initiation and duration of breastfeeding.
- Had a great impact when offering group counselling services.
- Impact clients from a wide range of sociodemographic backgrounds in similar ways.
- May be associated with excess weight gain and large for gestational babies.
Please click here to find the full research study.