Engaging Fathers in the First 1000 Days to Improve Perinatal Outcomes

Despite recent progress in obesity prevention the prevalence of obesity in the US remains at historically high levels. Non-Hispanic black and Hispanic men and women of typical childbearing age have higher obesity rates than non-Hispanic whites and their infants and children suffer a disproportionate share of the national obesity burden. Evidence suggests that these disparities in obesity emerge in early life and are determined by factors operating in pregnancy infancy and early childhood e.g. the "first 1000 days" - conception though 24 months of age. Substantial evidence also suggests that obesity interventions may produce the largest magnitude of effect if they support multi-level changes and are begun in the earliest stages of life.

Mounting evidence is increasingly demonstrating the important role of father's diet physical activity and obesity on their offspring's weight status and obesity risk. Father's engagement in early life has also been associated with more optimal maternal-infant health outcomes. Yet few interventions to reduce childhood obesity risk factors and improve perinatal health have included fathers or examined the influence of early life interventions on fathers' own obesity-related outcomes. Strengthening father's engagement in pregnancy and parenting has been recommended as a potential strategy for reducing health disparities but remains understudied.

The goals of this study are to implement and test a fatherhood intervention in pregnancy and infancy to influence family weight and health trajectories modify disease risk and improve health care services for mother-father-infant triads from racial/ethnic minority and health disparity populations. This MCH application will leverage the established "First 1000 Days" Program a unique Collective Impact initiative in the greater Boston area led by Dr. Elsie Taveras (PI). The initiative has built cross-sector collaborations across clinical and public health systems within community health centers to prevent obesity and related racial/ethnic and socioeconomic disparities among mother-infant dyads in early life. We now seek to expand the focus of the program beyond maternal-infant outcomes to include a systematic intervention to engage fathers in pregnancy and parenting reduce fathers' obesity-related health behaviors and address fathers' social determinants of health. Following a pilot fatherhood study conducted in 2016-207 we propose a randomized controlled trial in two large community health centers in Chelsea and Revere MA to test a fatherhood intervention that will include components that have the potential to be scalable implementable and sustained in low resource settings.

By improving the systems of prenatal and infancy care to better engage fathers this study will address MCHB Strategic Issue #1 (health service systems and MCH populations). By intervening on modifiable obesity-related risk factors and social determinants of fathers' health in pregnancy and infancy this study also addresses MCHB Strategic Issues #2 and 4 (eliminating health disparities and promoting the health of MCH populations). The study's impact lies in both accrual of scientific knowledge and implications for clinical and public health practice. Overall this study is poised to provide the foundation for a widely disseminated fatherhood intervention for obesity prevention among low-income families throughout the first 1000 days.

Whooten RC, Kwete GM, Farrar-Muir H, et al. Engaging fathers in the first 1000 days to improve perinatal outcomes and prevent obesity: rationale and design of the First Heroes randomized trial. Contemp Clin Trials. 2021;101:106253. doi:10.1016/j.cct.2020.106253 DOI:10.1016/j.cct.2020.106253 December 2020 33340750 Contemp Clin Trials

Silver SR, Whooten RC, Kwete GM, et al. Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes. BMC Pregnancy Childbirth. 2022;22(1):443. Published 2022 May 27. DOI:doi:10.1186/s12884-022-04759-z May 2022