Effect of the introduction of ‘Healthy Start’ on dietary behaviour during and after pregnancy: early results from the ‘before and after’ Sheffield study

British Journal of Nutrition
Q1
Nov 2008
Citations:32
Influential Citations:2
Observational Studies (Human)
80
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Methods
Before-and-after study in Sheffield, UK; participants were low-income, Caucasian pregnant and postpartum women who were beneficiaries or eligible for Welfare Food Scheme (phase 1) or Healthy Start (phase 2). Phase 1: 176 participants (90 pregnant, 86 postpartum); Phase 2: 160 participants (96 pregnant, 64 postpartum). Dietary intakes assessed by validated, interviewer-administered semi-quantified FFQ at 20 weeks gestation and monthly during the first year postpartum; data analyzed with appropriate statistical tests; ethical approval obtained.
Intervention
Healthy Start vouchers redeemable for fresh fruit and vegetables, plus milk and infant formula; vouchers available to eligible low-income pregnant and postpartum women; duration aligned with HS program implementation (introduced November 2006) during the study period.
Results
Energy and nutrient intakes were higher with Healthy Start. Pregnant HS women consumed 2.6 MJ/d more energy; postpartum HS women 1.7 MJ/d more energy than Welfare Food Scheme counterparts. HS increased mean intakes of calcium, iron, folate and vitamin C; HS participants were more likely to meet recommended intakes for energy, calcium, iron, folate and vitamin C. Pregnant HS women ate more fruit/vegetables (3.3 vs 2.5 portions/day; P=0.004); 15% met five-a-day vs 2.4% with WFS. Postpartum HS women ate more fruit/vegetables (3.3 vs 2.7 portions/day; P=0.023); 19% vs 11.5% met five-a-day (P=0.262). Increases in energy primarily from milk consumption, with additional contributions from other foods. After adjusting for education and age, differences in energy, Ca, folate, Fe and vitamin C largely persisted, though some differences were explained by factors such as employment status and preconception folic acid use. Conclusion: Short-term introduction of Healthy Start is associated with improved dietary intakes and greater fruit/vegetable consumption among pregnant and postpartum low-income women, suggesting potential benefits for nutrient adequacy; however, causality cannot be established due to non-randomized design and reliance on self-reported dietary data; further robust evaluation is warranted.
Limitations
Non-randomized before-after design; potential selection bias; cross-sectional; inability to infer causality; reliance on self-reported FFQ with possibility of misreporting; energy intake not energy-adjusted; limited generalizability to non-Caucasian or other populations; short-term assessment only.

Abstract

The aim of the study was to examine the effect of the introduction of a new food-support benefit ‘Healthy Start’ (HS) on dietary intakes and eating patterns of low-income, Caucasian, pregnant and postpartum women living in Sheffield (UK). A before-an...