Evaluation of dietary intervention and pregnancy outcomes among food insecure women attending the Montreal Diet Dispensary program
Bibliographic record
Abstract
Since 1950, the Montreal Diet Dispensary has been aiming to reduce health inequalities among pregnant women with low socio-economic status through a nutritional support program called the Higgins' intervention. In the past, the intervention was shown to be successful in reducing the rate of low-birth weight (LBW) as well as preterm births (PTB). The objective of this thesis was to conduct an outcome evaluation of the Higgins' intervention in a changing demographic population predominantly composed of visible minority and newly immigrated women. The program evaluation was done using an electronic database established in June 2013 where 1387 pregnancies were analyzed. The rate of LBW was 4.18% (95% confidence interval (CI): 3.13, 5.24), small-for-gestational age (SGA) 5.47% (95%CI: 4.28, 6.68) and PTB was 4.76% (95%CI: 3.64, 5.88). The prevalence of these outcomes were considered significantly lower than the Canadian statistics as all CIs did not overlap. Large-for-gestational age rate was 10.60% (95%CI: 8.98, 12.22) which was significantly higher than Montreal but similar to the Canadian rate. Prevalence of maternal outcomes were 17.15% (95%CI: 15.05, 19.25) for gestational diabetes (GDM), anemia was 44.88% (95%CI: 41.90, 47.86) and hypertension (HTN) was 3.82% (95%CI: 2.81, 4.83). Immigrants had similar odds of developing adverse perinatal outcomes as Canadian-born women. Black women were more at risk of having a PTB (adjusted odd ratio (aOR)=1.79, 95%CI: 1.01, 3.19) with African women mostly contributing to the increased risk (aOR=2.67, 95%CI: 1.44, 4.9). Anemia prevalence was also significantly higher in Black women compared to White (aOR=1.74, 95%CI: 1.29, 2.35). Anemia rates were higher among immigrants who were in Canada for more than 5 years (5-10 y aOR=1.99, 95%CI: 1.05, 3.78; > 10 y aOR=2.01, 95%CI: 1.01, 3.99) compared to Canadian-born. Asian women had an increased risk of having a SGA infant (aOR=2.35, 95%CI: 1.21, 4.56;) and GDM (aOR=1.86, 95%CI: 1.17, 2.98) compared to White women. This risk was particularly higher among women from South Asia who had 2.88-times the risk of developing GDM (2.88, 95%CI: 1.03, 8.07) compared to North Americans. The Higgins' intervention supported infant health as evidenced by lower infant complications, but disparities in birth outcomes were still present in this high risk population. As evidenced by high prevalence rates, the late nutritional intervention did not contribute to the prevention of anemia and GDM. Earlier nutritional intervention, prioritization of high risk groups of women and adaptation of the intervention would be needed to further reduce outcomes discrepancies among this vulnerable population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".