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Table 2 Nutritional and health outcomes associated with comprehensive food subsidy programs for pregnant/postpartum women

From: Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review

First Author, Year Intervention, Participants

Nutritional outcomes

Health outcomes

Bailey 1983[48]

Dietary intake

Perinatal outcomes

Standard WIC program

Mean (SD)

I

C

p

Mean (SD))

I

C

p

 

Iron, mg

17 (10)

16 (6)

NS

Birth weight, g

3229 (546)

3276 (563)

NS

 

Vitamin B6, mg

1.4 (1.1)

1.1 (0.7)

NS

Low birth weight, %(<2500g)

5

10

NS

 

Protein, g

90 (39)

105(39)

<0.05

    

Pregnant women

Folic acid, μg

264 (216)

239 (159)

<0.05

Ponderal index, g/cm [3]

2.6 (1.2)

2.4 (0.3)

NS

 

Energy, kcal

2390 (916)

2496 (879)

<0.05

(Infant weight x100/length [3])

 

Biomarkers

Birth weight

     

Smokers, g

3286 (515)

2976 (596)

 

Mean (SD)

I

C

p

Non-smokers, g

3218 (538)

3461 (520)

 

Serum iron, ug/dL

106 (44)

99 (42)

NS

p<0.05 for smoking status of control groups only

 

PlasmaVit. B6, ng/ml

4.6 (6.8)

3.3 (1.8)

NS

 
 

Transferrin sat. %

37 (23)

23 (10)

<0.05

 
 

Serum folate, ng/ml

14 (11)

26 (26)

<0.05

 
 

RBC folate, ng/ml

353 (278)

602 (321)

NS

 
 

Haematocrit, %

35 (3)

35 (3)

NS

 

Metcoff 1985[42]

Biomarkers

Perinatal outcomes

 

Mean (SD)

I

C

p

Mean

I

C

p

Standard WIC program

Leukocyte protein synthesis**

 

Pregnant participants

pMol 3H-leucine/h

126.6 (33.2)

115.2 (34.3)

0.009

Birth weight, g*

Results from 410 mother-baby pairs with complete data available

 

All births†

3254

3163

0.040

 

Alanine**

334 (68.4)

350 (70.2)

0.046

Smokers >10 cig/day

3234(n=68)

3059 (n=53)

0.017

 

Cystine**

68 (13.7)

72 (11.7)

0.001

Low birth weight, %

8.7

6.9

0.40

 

**Adjusted for week of gestation for initial measurement, initial value, elapsed interval between measurements

Maternal outcomes

 
     

Maternal wt gain, kg

16.1

14.7

0.19

     

Biceps skin fold, mm

16.2

14.7

0.059

     

*Adjusted for gestational age, sex of baby, prenatal care, smoking, interval since last pregnancy, race, history of previous LBW baby

     

†After adjusting for maternal weight at entry to study, the effect of WIC on all births was not statistically significant

Caan 1987[38]

 

Perinatal outcomes

 

Mean (SE)

I

C

p

 

Birthweight, g*

3468 (30.0)

3337 (31.1)

0.003

WIC program maintained for 6 months post-partum for non-lactating women instead of normal 0–2 months

 

Ponderal index,002A g x 100/cm3

2.72 (0.03)

2.73 (0.02)

NS

 

Low birth weight, %

3.2

5.1

0.08

 

Macrosomia, OR

(95% CI) (I vs C)

1.30 (0.70-2.42)

NS

Pregnant women in subsequent pregnancy

    

Maternal outcomes

 

Mean (SE)

I

C

p

 

Hb, g/dL**

12.43 (0.08)

12.14 (0.08)

0.02

 

Low Hb, OR (95%CI) (I vs C)

0.65

(0.45-1.07)

0.07

 

Mat. de Quetelets index lb/in [2] x100†

3.43 (0.36)

3.59 (0.36)

0.003

 

*Adjusted for parity, pregravid weight/height, infant sex, birth weight of last infant, race and smoking status

 

**Adjusted for race, parity, BMI, duration of gestation at time of measurement and anaemia status during 1st pregnancy

 

† Adjusted for race, age, interbirth interval, birth weight of first infant, weight status in first pregnancy, smoking status

Rush 1988a[44]

 

Perinatal outcomes

 

Mean

All births

WIC births

p

Standard WIC program

 

Birth weight, g

3335

3358

<0.01

Pregnant women

 

Low birth weight (<2500g), %

6.84

6.41

NS

 

Fetal mortality, >28 wk gest/1000

6.21

4.09

NS

 

Infant mortality/1000

   
 

0-27days, total

10.59

8.30

NS

 

28-364 days

3.77

4.46

NS

 

Duration of gestation, weeks

39.06

39.26

<0.05

Rush 1988b,c[45, 47]

Dietary intake*

Perinatal outcomes*

 

Mean

I

C

p

Mean

I

C

p

 

Protein, g

80.76

75.54

<0.01

Birth weight, g

3292

3285

NS

     

Low birth weight (<2501g), %

5.62

6.75

NS

Standard WIC program

Calcium, mg

1003.7

871.0

<0.001

Duration gestation, days

279.0

279.3

NS

 

Iron, mg

17.22

14.06

<0.001

Preterm births, %

   

Pregnant women

Vitamin A, mg

2.06

1.83

NS

< 33 weeks

0.30

0.90

<0.05

 

Vitamin C, mg

134.11

111.68

<0.001

< 37 weeks

9.45

12.07

NS

 

Other macro- and micronutrients had statistically significant increases in WIC participants including energy, carbohydrate, fat, magnesium, phosphorus, vitamins B1, B2, B3, B6, B12

Head circumference, cm

34.13

33.95

<0.05

     

Fetal mortality/1000

5.09

9.54

NS

 

Nutrient intake as % of RDA*

    
 

Mean

I

C

 

*Adjusted for duration of gestation and 35 other maternal characteristics including smoking status, age, race, family income and size, woman and partner′s educational and employment status, social security benefits/program participation

  

(%)

(%)

 

Maternal outcomes*

 

Energy (2400kcal)

84

79

 

Mean

I

C

p

 

Protein (74g)

109

102

 

Initial weight, kg

65.17

65.89

<0.05

 

Calcium (1200mg)

84

73

 

Follow-up weight, kg

72.17

72.17

NS

 

Magnesium (450mg)

60

54

 

(36 weeks gestation)

 

Vitamin B6 (2.6mg)

73

60

 

WIC group women initially lighter than control women had caught up with control women by 36 weeks gestation

 

Phosphorus, Vitamins A, B1, B2, B3, B12 and C were all 95%-180% of RDA at baseline and follow-up in both WIC and control groups. RDA for pregnant women aged 19–22 years old

No clinical (or statistically) significant difference in haemoglobin at baseline or follow-up. Data not shown

 

*Adjusted for duration of gestation, conception weight and 35 other maternal characteristics as above

 

*Adjusted for duration of gestation, initial intake, 35 other maternal characteristics including smoking status, age, race, family income and size, woman and partner′s educational and employment status, social security benefits and program participation

 
 

181 of the 711 controls had enrolled in WIC before follow-up. The diet intake data for this group were analysed separately and were similar to the WIC intervention group

 
 

No difference in nutrient intake for groups at baseline

 

Rush 1988c,d[45, 46]

Food purchases*†

 
 

Mean (SD)

I

C

p

 
 

Total expenditures, $

 

Standard WIC program

Recall

48.28

52.07 (33.34)

<0.001

 

Pregnant women

Diary

61.20

62.85 (39.44)

NS

 
 

Groceries, $

 
 

Recall

38.30

39.95 (22.97)

<0.05

 
 

Diary

50.50

49.15 (35.68)

NS

 
 

Meals away from home, $

 
 

Recall

3.84

4.94 (6.44)

<0.001

 
 

Diary

10.93

13.69 (16.20)

<0.001

 
 

* Adjusted for family size, income, ethnicity, presence of father in household, maternal education, amount of food stamps and free school meals, number of guests and baseline expenditure

 
 

†Baseline food expenditures differed with WIC families spending significantly less on total food, groceries and meals away from home

 

Pehrsson 2001[43]

Dietary intake

Maternal outcomes

 

Iron No data presented. No significant differences between groups. All intakes <74% RDA (15mg/day)

Mean (SD)

I

C

p

  

Haemoglobin, mmol/L*

8.01 (0.82)

7.63 (0.82)

<0.05

Standard WIC program continued for 6 months post-partum

 

g/dL

12.8 (1.31)

12.2 (1.31)

 
 

Vitamin C No data presented. No significant differences between groups. All intakes >150% RDA (60mg/day)

Anaemia, % *

17

51

<0.05

 

(Hb<7.45mmol/L or 12g/dL)

Postpartum women

Biomarkers*

*Results at 6 month follow-up

 

Mean (SD)

I

C

p

 
 

Ferritin, ug/L

36 (20.1)

35 (20.3)

NS

 
 

Transferrin receptor, mg/L

6.1 (2.1)

6.5 (2.1)

NS

 
 

*Results at 6 month follow-up

 

Currie 2008[49]

 

Perinatal outcomes

  

Change in low birth weight

  

% (SD)

All parity

First birth

Teen mum

Standard Food Stamp program

 

White

−0.014 (1.05)

0.062 (1.00) (0.92)*

0.27

Pregnant women

 

Black

0.47 (1.64)

0.26 (1.43) (1.58)

0.175

  

*p<0.05

  

Fertility outcomes*

  

% increase in births

All parity

First birth

Teen mum

  

White

3.0

13.0

6.9

  

Black

12

9.0

24.6

  

*Statistically significant for blacks in all categories and white first births and teen births

Hoynes 2009[18]

 

Perinatal outcomes

Standard WIC program

 

Mean

All births

WIC births

Pregnant participants

 

Birth weight, g

3316

 
 

Change in birth weight, g

2.7

29 (estimated)

 

Low birth weight, %

7.2

 
 

Change in low birth weight

0 (−0.0784- 0.0784)

 
 

%, 95% CI

 

Fertility rates No statistically significant difference after WIC introduction

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