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Maternal and Child Outcomes Associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Systematic Review Draft

Open for comment through Nov 2, 2021

This report is available in PDF only (Draft Report [PDF, 2.3 MB]; Appendixes [PDF, 10.8 MB]).

Main Points

Maternal and Infant Birth Outcomes

  • Maternal WIC participation during pregnancy may be associated with lower risk of preterm birth (Strength of evidence [SOE]: Low).
  • Maternal WIC participation during pregnancy may be associated with lower risk of low birth weight infants (SOE: Low).
  • The evidence was insufficient to determine whether maternal WIC participation was associated with gestational diabetes, preeclampsia, gestational hypertension, stillbirth, neonatal death, or neonatal intensive care unit (NICU) stays (SOE: Insufficient).

Maternal Dietary Outcomes

  • The evidence was insufficient to determine whether maternal WIC participation during pregnancy was associated with better maternal diet quality or food/nutrient intakes (SOE: Insufficient).

Infant and Child Health Outcomes

  • Maternal WIC participation during pregnancy may be associated with reductions in infant mortality (SOE: Low).
  • The evidence was insufficient to determine whether either maternal or child participation was associated with child health outcomes (including child mortality, morbidity, and preventive care receipt) (SOE: Insufficient).

Child Anthropometric Status or Growth

  • The evidence was insufficient to determine whether child WIC participation was associated with overweight or obesity in children (SOE: Insufficient).

Breastfeeding Outcomes

  • Maternal WIC participation may not be associated with breastfeeding initiation rate (SOE: Low)
  • The evidence was insufficient to determine whether maternal or child WIC participation was associated with longer duration of breastfeeding, breastfeeding exclusivity, or introduction of solids before 4 months of age (SOE: Insufficient).

Child Dietary Outcomes

  • Child WIC participation is likely to be associated with better child diet quality (SOE: Moderate).
  • Child WIC participation is likely to be associated with greater intakes of 100 percent fruit juice, vegetables, infant cereal/grains, and age-appropriate shifts from whole milk to lower fat milk (SOE: Moderate).
  • Household participation in WIC is likely to be associated with purchasing food of better diet quality and reduced purchasing of less healthy foods (SOE: Moderate).
  • The evidence was insufficient to determine whether child WIC participation was associated with better nutrient intakes or whether living in a WIC household was associated with diet quality or food/nutrient intakes in women (SOE: Insufficient).

Child Development and Academic Achievement

  • Maternal WIC participation may be associated with higher cognitive development scores in early childhood (SOE: Low).
  • The evidence was insufficient to determine whether child WIC participation was associated with cognitive development or whether maternal or child WIC participation was associated with other child development outcomes (SOE: Insufficient).

Structured Abstract

Objectives. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) aims to safeguard the health of low-income, nutritionally at risk pregnant and postpartum women and children less than five years old. This systematic review evaluates evidence on whether participation in WIC is associated with nutrition and health outcomes for women, infants, and children, and whether the associations vary by duration of participation or across population sub-groups (e.g., race, ethnicity, age). Because of major revisions to the Federal regulations for the WIC food package in 2009, we prioritized studies published since 2009 and included studies comparing outcomes before and after the 2009 food package change.

Data sources. Using electronic publication databases, hand searching, and websites, we conducted a literature search from January 2009 to September 2020 and a targeted search for selected outcomes from January 2000 to September 2020.

Review methods. Two reviewers independently screened search results, serially abstracted data, assessed risk of bias, and graded strength of evidence (SOE) using standard methods for observational studies.

Results. We included 77 quantitative observational studies and 16 qualitative studies, with 44 studies comparing outcomes of WIC participants with eligible non-WIC participants. WIC prenatal participation was associated with lower risk of preterm delivery (low SOE), lower risk of low birth weight (low SOE) and lower risk of infant mortality (low SOE). Maternal WIC participation was associated with higher cognitive scores for children (low SOE). Child WIC participation was associated with improved diet quality (moderate SOE) and greater intakes of 100 percent fruit juice, infant cereal/grains, and age-appropriate shifts from whole milk to low-fat milk (SOE: Moderate). Household WIC participation was associated with purchasing foods of better diet quality (moderate SOE). Maternal WIC participation was not associated with breastfeeding initiation (low SOE). The evidence was insufficient regarding WIC participation and outcomes related to maternal diet and health, child anthropometric status, and child health care utilization. The evidence was insufficient to determine how WIC participation affects outcomes across participant sub-groups.

Conclusions. Maternal WIC participation was associated with improved birth outcomes, lower infant mortality, and better child cognitive development. Child WIC participation was associated with improved diet quality. Household WIC participation was associated with purchasing foods of better diet quality. More research is needed to determine the effectiveness of WIC for all outcomes and in all segments of the eligible population.