Upstream Interventions in Clinical Settings Focused on Nutrition to Prevent Obesity During the First 1000 Days: A Scoping Review

Nutritional exposures during pregnancy and the first 2 y of a child's life influence growth and risk for obesity. Upstream interventions that involve policy, systems, and/or environmental approaches may support equitable nutrition and healthy growth early in life. Yet little is known about the application of these interventions in clinical settings. This scoping review characterized the breadth, generalizability, and methodological rigor of nutrition-focused, upstream interventions for obesity prevention during the first 1000 d in clinical settings. Eight databases were searched in November 2022 for policy, systems, and/or environmental approaches conducted during the first 1000 d. Titles, abstracts, and full texts were independently screened in duplicate, with conflicts resolved by a third reviewer. Extracted elements included study characteristics, reach, effectiveness, adoption, implementation, maintenance, and the Downs and Black study quality checklist. Of the 73,969 records identified, 185 reports representing 126 studies were included. Studies frequently involved combinations of system (98%), environmental (56%), and/or individual (87%) approaches in prenatal care (35%), hospital (22%), or primary care (21%) settings. Over half (62%) were conducted with socially disadvantaged families. More studies reported positive effects on feeding practices (71%), child diet (70%), breastfeeding (67%), and maternal diet (62%), compared with child (31%) or maternal (48%) weight and growth outcomes. Variation in outcome reporting and measurement limited the ability to make conclusions regarding effectiveness. Maintenance of upstream approaches was seldom reported. Study quality ranged from poor to good. Results suggest the promise of scaling adoption of policy, systems, and/or environmental approaches that enhance standard clinical care by incorporating nutrition-focused elements to support healthy feeding behaviors and growth. To achieve equitable nutrition and healthy growth early during the first 1000 d, implementation and evaluation of upstream policy efforts that integrate social and health care within and in collaboration with agencies beyond clinical settings may be warranted. This trial was registered at Open Science Framework Registry as osf.io/bqck5 (https://doi.org/10.17605/OSF.IO/SXZMK).