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The Canada Prenatal Nutrition Program (CPNP) consists of approximately 330 community-based projects in about 2,000 communities across Canada. The goal of the program is to support pregnant women facing challenges that put their health and the health of their infants at risk. These challenges can include poverty, teen pregnancy, social and geographic isolation, substance use and family violence. The CPNP also provides culturally sensitive prenatal support for Aboriginal women and recent immigrants.

Operating since 1994, the program serves approximately 50,000 women a year. It encompasses a comprehensive range of services,  including nutrition counseling; provision of prenatal vitamins, food and food coupons; prenatal health and lifestyle counseling; breastfeeding education and support; food preparation training; education and support on infant care and child development; and referrals to other agencies and services.

Evaluation of the Canada Prenatal Nutrition Program has been ongoing since it started (see more here), but I was interested in the findings of a study published in the Canadian Journal of Public Health which used an innovative approach to looking at the impact of the program on women and their infants. Because it is not possible to compare the outcomes of women who participated in the program with a similar group of women who did not participate in the program (i.e., with a “control group”), the researchers compared women who received a higher “dose” of CPNP services with those receiving a lower “dose” of CPNP services. They looked at three aspects:

  1. program initiation (when in her pregnancy a woman started attending the program);
  2. program intensity (number of contacts a woman had with the program); and
  3. program duration (number of weeks a woman was involved in the program).

Overall, women with a higher CPNP “dose” tended to make more positive health behaviour changes and to have fewer negative birth outcomes than those with overall low exposure to the program. They were more likely to reduce the number of cigarettes they smoked and to cease drinking; to breastfeed their infants and to breastfeed for longer; and to increase the use of vitamin/mineral supplements from never to daily.

In terms of tobacco and alcohol use, over three quarters of women were smokers at program entry, most smoking fewer than 20 cigarettes a day. Slightly more than half were exposed to second-hand smoke during their pregnancy. More than 40% of women indicated that they had consumed alcohol since becoming pregnant, over half of whom reported having at least five drinks in one day.

The majority of women (84.2%) reported quitting drinking during pregnancy; women who scored ‘high’ on overall CPNP exposure were 42% more likely to quit drinking. Earlier program initiation, higher program intensity, and longer program duration were all related to a higher likelihood of cutting out alcohol during pregnancy.

References

Muhajarine, N., Ng, J., Bowen, A., Cushon, J., and Johnson, S. (2012). Understanding the Impact of the Canada Prenatal Nutrition Program: A Quantitative Evaluation. Canadian Journal of Public Health, 103(7 Suppl 1): eS26-31. Download free full-text here.

Muhajarine N., Ng , J., Green, K., Bowen, A., Cushon, J., Johnson, S., and Macqueen, Smith F. (2009). Understanding the Impact of the Canada Prenatal Nutrition Program: A Quantitative Evaluation. Submitted to the Public Health Agency of Canada (PHAC). Saskatoon, SK: Saskatchewan Population Health and Evaluation Research Unit.