Project Sueño: Sleep & Understanding Early Nutrition in Obesity

Study Overview
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Brief Summary
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The purpose of the study is to understand how mothers think and feel about feeding their babies and putting them to sleep, understand more about programs that can support mothers taking care of babies, and how professionals can be most helpful in helping mothers make decisions about their baby's feeding and sleeping. The overarching goal is to prevent early life obesity and progression to metabolic syndrome in high-risk populations, starting with healthy toddler weights by age 2 years.

Detailed Description
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This study seeks to intervene just in time for families at highest risk of early life obesity and obesity-related comorbidities (such as Type 2 diabetes), to prevent intergenerational obesity and metabolic syndrome for Hispanic families. For those children exposed to gestational diabetes (GDM) or maternal overweight/obesity in utero, there is a critical need for effective early life strategies for secondary prevention of obesity, to interrupt intergenerational transmission. This study will offer community-embedded coaching to families learn how to responsively feed their babies using 2 models: group visits and text-based. The investigators will also assess responsive sleep practices; i.e. paying attention to an infant's sleep cues as well as hunger cues, breaking the feeding to sleep association, and not overfeeding at night. Infant and toddler sleep, both duration and quality, has not been well studied in this population for early life obesity prevention. This study is specifically exploring pathways from prenatal gestational diabetes and maternal overweight/obesity to dysregulated infant feeding and sleep. Few interventions around infant sleep exist for the Hispanic population, or resources in Spanish-language around sleep coaching; let alone analyses on parents' self-efficacy and behavior change. In this study, the investigators aim to better understand the complex socioenvironmental drivers of infant sleep and feeding behaviors, and the prenatal risks related to infant rapid weight gain, in order to target modifiable factors in this population.

Official Title
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First Thousand Days: Prevention of Early Life Obesity in Latino Infants and Toddlers

Conditions
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Infant Overweight, Infant Obesity, Infant Overnutrition, Infant Development, Metabolic Syndrome, Diabetes Mellitus Risk

Intervention / Treatment
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* Behavioral: Centering Parenting
* Behavioral: Bright by Text


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mother to infant born full term > 37 weeks, and are under 1 month of age Infant is singleton Infant has no identified health problems Infant is patient of CommUnityCare Mother is 18 years of age Mother is Latino/Hispanic ethnicity Mother is willing to commit to study follow-up visits Exclusion Criteria: Mother smokes Mother works primarily at night Infant has metabolic or chromosomal disorders, chronic neurological or respiratory conditions, or developmental disability

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A: Centering Parenting<br>At each well-child check from 2- to 24-months, a trained bilingual facilitator from the CommUnityCare Centering Parenting program will present curriculum in person during 2-hour visits in a room with 3-8 mother-baby pairs per group. During each session, each mother-baby pair will be pulled out to a private medical room for a brief individual well child appointment with the pediatrician. During this appointment, infant measurements, physical exam, and discussion of unique concerns will take place before the pair returns to the session. There are 8 scheduled well child checks by the age of two, where regular parenting topics will be covered (i.e. discipline, safety, co-parenting, sibling relationships, childcare, development). Each Centering session is expected to last approximately 2 hours, for a total commitment of approximately 16 hours across 8 group sessions over the course of 22 months for each participant. Total time of enrollment should be approximately 22-24 months. | Behavioral: Centering Parenting<br>* See Arm description.<br>|
| Active Comparator: Group B: Bright by Text<br>This group will receive standard of care individual well child checks with their regular CommUnityCare pediatrician, with standard anticipatory guidance on feeding and sleep. Additionally, this group will be enrolled in a text-based parenting coaching program. The Bright by Text program will provide parenting tips two to three times weekly; tailored through community partner United Way of Central Texas offering local parent support and resources. The Bright by Text program is a message subscription program rather than an application. Participants may decide on their own how much to engage with the text-based program, so total time commitment cannot be estimated. Total time of enrollment should be approximately 22-24 months. | Behavioral: Bright by Text<br>* See Arm description.<br>|
| No Intervention: Group C: Standard of Care<br>This group will receive standard of care individual well child checks with their regular pediatrician, with standard anticipatory guidance on feeding and sleep. Total time of enrollment should be approximately 22-24 months. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assess impact of group-based parent support coaching on infant feeding practices in first 2 years of child's life. | Assessment instruments include: Complementary Feeding History questionnaire, Nutrition Data System for Research, Expanded Food and Nutrition Education questionnaire, Infant Feeding Style Questionnaire. | 2- to 24-months of infant age | 
| Assess impact of text-based parent support coaching on infant feeding practices in first 2 years of child's life. | Assessment instruments include: Complementary Feeding History questionnaire, Nutrition Data System for Research, Expanded Food and Nutrition Education questionnaire, Infant Feeding Style Questionnaire. | 2- to 24-months of infant age | 
| Assess impact of group-based parent support coaching in first 2 years of child's life on responsive feeding and healthy sleep practices. | Assessment of parental responsive feeding practices, and infant sleep and temperament. Assessment instruments include: Complementary Feeding History questionnaire, Nutrition Data System for Research, Expanded Food and Nutrition Education questionnaire, Infant Feeding Style Questionnaire, Brief Infant Sleep Questionnaire, Children's Sleep Habits Questionnaire, Infant Toddler Temperament Tool. Sleep will additionally be assessed using 1-week sleep diaries and accelerometry at 2-, 6-, 12-, 18-, and 24-months of age. | 2- to 24-months of infant age | 
| Assess impact of text-based parent support coaching in first 2 years of child's life on responsive feeding and healthy sleep practices. | Assessment of parental responsive feeding practices, and infant sleep and temperament. Assessment instruments include: Complementary Feeding History questionnaire, Nutrition Data System for Research, Expanded Food and Nutrition Education questionnaire, Infant Feeding Style Questionnaire, Brief Infant Sleep Questionnaire, Children's Sleep Habits Questionnaire, Infant Toddler Temperament Tool. Sleep will additionally be assessed using 1-week sleep diaries and accelerometry at 2-, 6-, 12-, 18-, and 24-months of age. | 2- to 24-months of infant age | 
| Determine how parent support coaching and other predictors relate to infant and toddler growth in Latino children in first 2 years of life. | Assessment of variability of growth patterns by modeling of trajectories of weight gain in first 2 years of life. | 2- to 24-months of infant age | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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infant feeding, infant sleep, parenting practices, rapid weight gain, intergenerational obesity, diabetes prevention