Does the provision of postnatal parenting support in primary care improve cardiometabolic health in early childhood among at-risk-families?

PROJECT SUMMARY:
Worsening population-level trends in cardiometabolic health highlight the profound need to move away
from traditional disease models focused on the remediation of downstream cardiometabolic risk factors to instead
focus on relevant upstream exposures. Relevant upstream exposures include early life adversities (ELA), a
unique subset of social determinants of health that occur early in life and are hypothesized to become biologically
embedded, thereby shaping life course trajectories of health and disease risk over time. A robust literature shows
ELA exposures confer prospective risk for cardiometabolic disease, yet few—albeit promising—studies have
examined whether early intervention in ELA-exposed children may lessen this risk. Review of relevant literatures
suggests generally that 1) earlier intervention is more effective; 2) intervention benefits are greatest in families
most in need; 3) parenting is a mechanism through which early intervention benefits are transmitted; and 4)
existing parenting interventions, deemed successful with respect to parent-child behavioral and relationship
outcomes, are candidates for testing in relation to child physical health outcomes. Building on this foundation,
the proposed study represents a unique and time-sensitive opportunity to extend the aims of an existing RCT in
which a parenting intervention—Promoting First Relationships® (PFR) versus no intervention—was implemented
as an adjuvant to depression treatment in a sample of low income, postnatal women. The purpose of the
proposed study is to determine whether benefits of the PFR intervention, originally designed to impact parent-
child behavioral and relationship outcomes in infancy may extend to the child’s cardiometabolic health in early
childhood. It is hypothesized that the PFR intervention will augment an upstream resiliency factor—parenting
quality—at an early period of vulnerability, potentially benefiting the child’s cardiometabolic health. Expected
intervention effects on the more distal child cardiometabolic health outcomes are hypothesized to be partially
attributable to changes in the more proximal intervention-related targets, including maternal sensitivity, parent
understanding, mother-child relationship quality, and child self-regulation. The proposed study seeks NIH funding
to support the return of 214 mother-child dyads (85% of 252 total families) who participated in the original RCT.
The majority of families (80%) belong to a minority race/ethnic group, 32% are Spanish-speaking, and all are
considered low income. Families will complete two home-based visits between child’s age 5-6 and 7-8 years.
These visits will entail assessments that parallel measures in the original study regarding parent-child behavioral
and relationship outcomes but will also include health-focused assessments in domains known to predict long-
term risk for disease, including cardiovascular health, metabolic health, and inflammation. Health indicators will
be derived from data sources including anthropometric and blood pressure assessments, a dried blood spot
collection, activity and sleep monitoring, and interviewer-administered questionnaires. Results will extend
broadly to vulnerable families at disproportionate risk for poor cardiometabolic health.

Grant Number: 5R01HL153136-05
NIH Institute/Center: NIH
Principal Investigator: Maria Bleil