Ability of the Higgins Nutrition Intervention Program to improve adolescent pregnancy outcome.

OBJECTIVES: To determine the extent to which birth weight can be increased and the risk for adverse pregnancy outcome decreased when pregnant adolescents participated in the Higgins Nutrition Intervention Program; and to describe the dietary components of the program, including their variation as a function of diagnosed risk for adverse pregnancy outcome. DESIGN: Retrospective cohort study involving review of medical charts. SUBJECTS/SETTING: Developed as an adjunct to routine prenatal care, the Higgins Nutrition Intervention Program consists of an assessment of each pregnant adolescent's risk profile for adverse pregnancy outcomes and an individualized nutritional rehabilitation program based on that profile. The intervention group for this evaluation consisted of 1,203 pregnant adolescents who participated in the Higgins program at the Montreal Diet Dispensary between 1981 and 1991. The nonintervention group consisted of a randomly selected group of 1,203 pregnant adolescents known not to have participated in the program. OUTCOMES MEASURED: Birth weight; rates of low birth weight, very low birth weight, preterm delivery, fetal growth retardation, perinatal morbidity and mortality; and maternal morbidity. STATISTICAL ANALYSIS: Means and proportions were used to describe risk profiles and pregnancy outcomes in the two groups. Analysis of covariance and logistic regression were used to compare pregnancy outcomes while controlling for the effect of key confounding variables. RESULTS: Results from multivariable analyses showed that infants in the intervention group weighed an average of 55 g more (P < .05) than infants in the nonintervention group; their low-birth-weight rate was 39% lower (P < .001) and their very-low-birth-weight rate was 56% lower (P < .01). Individually determined dietary prescriptions for the adolescents in the intervention group recommended increases in daily consumption averaging approximately 900 kcal energy and 52 g protein. The lowest daily increases (approximately 150 kcal energy and 2 g protein) were recommended to the group with no diagnosed risks; the greatest increases (approximately 1,300 kcal energy and 76 g protein) were recommended to the group with multiple risk conditions. Although none of the risk/intervention groups achieved their prescribed increases during intervention, increases in actual intake generally followed the pattern of the prescribed increases; that is, the greater the prescribed increase, the greater the actual increase. CONCLUSIONS: These results suggest that the Higgins Nutrition Intervention Program, in which nutrition intervention is individualized as a function of diagnosed risk, significantly improves the outcome of adolescent pregnancy.

Twin pregnancy: the impact of the Higgins Nutrition Intervention Program on maternal and neonatal outcomes.

Perinatal outcomes were compared between 354 twins treated with the Higgins Nutrition Intervention Program and 686 untreated twins. After differing distributions of key confounding variables were adjusted for, the twins in the intervention group weighed an average of 80 g more (P less than 0.06) than the nonintervention twins; their low-birth-weight rate was 25% lower (P less than 0.05) and their very-low-birth-weight rate was almost 50% lower (P less than 0.05). Although the rate of preterm delivery was 30% lower in the intervention group (P less than 0.05), the rates of intrauterine growth retardation were similar in the two groups. Fetal mortality was slightly higher (14 vs 12 per 1000, NS), but early neonatal mortality was fivefold lower (3 vs 19 per 1000, P less than 0.06) in the intervention group. Maternal morbidity was significantly lower (P less than 0.05) in the intervention group. There was a trend towards lower infant morbidity in the intervention group. These results suggest that nutritional intervention can significantly improve twin-pregnancy outcome.