Krishna K Upadhya1, Kevin J Psoter2, Katherine A Connor2, Kamila B Mistry3, Daniel J Levy4, Tina L Cheng5. 1. Department of Pediatrics, Johns Hopkins University School of Medicine, (KK Upadhya, KJ Psoter, KA Connor, KB Mistry, DJ Levy, and TL Cheng), Baltimore, Md; Division of Adolescent and Young Adult Medicine, Children's National Medical Center, (KK Upadhya), Washington, DC. 2. Department of Pediatrics, Johns Hopkins University School of Medicine, (KK Upadhya, KJ Psoter, KA Connor, KB Mistry, DJ Levy, and TL Cheng), Baltimore, Md. 3. Department of Pediatrics, Johns Hopkins University School of Medicine, (KK Upadhya, KJ Psoter, KA Connor, KB Mistry, DJ Levy, and TL Cheng), Baltimore, Md; Office of Extramural Research, Education and Priority Populations, Agency for Healthcare Research and Quality, (KB Mistry), Rockville, Md. 4. Department of Pediatrics, Johns Hopkins University School of Medicine, (KK Upadhya, KJ Psoter, KA Connor, KB Mistry, DJ Levy, and TL Cheng), Baltimore, Md; Child and Teen Wellness Center, (DJ Levy), Owings Mills, Md. 5. Department of Pediatrics, Johns Hopkins University School of Medicine, (KK Upadhya, KJ Psoter, KA Connor, KB Mistry, DJ Levy, and TL Cheng), Baltimore, Md; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, (TL Cheng), Baltimore, Md. Electronic address: tcheng2@jhmi.edu.
Abstract
OBJECTIVE: Recognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial. METHODS:Pediatric clinicians were randomized to a screening and brief educational intervention group or usual care comparison group. Intervention group clinicians received training on pre/interconception care, including recommended counseling and referral resources for needs identified. Women presenting to primary care with their child ≤12 months were enrolled and assigned to the group corresponding to the assignment of their child's clinician. Mothers seen by clinicians in the intervention group completed a pre/interconception health screening tool and discussed results with their child's clinician during the visit. These mothers were compared to mothers seen by comparison group clinicians who did not receive the screening tool or clinician discussion. All enrolled mothers (Intervention and Comparison) received written preconception health information and a 90-day supply of multivitamins. Primary outcomes at 6 and 12 months post enrollment included contraception use, pregnancy, and access to and use of preventive health care. Secondary outcomes included daily folic acid supplementation, smoking, and substance use. RESULTS:A total of 415 women were enrolled and those who had at least 1 follow-up assessment were included in the analysis (n = 383). There was no significant effect of the intervention on contraceptive use, pregnancy incidence, or use of preventive care. Assignment to the intervention increased the odds of daily folic acid use (odds ratio 1.82, 95% confidence interval 1.25, 2.63) during follow-up. Intervention mothers were less likely to smoke at 6, but not 12 months. CONCLUSIONS: Pediatric visits are an opportune location for addressing maternal health and this intervention demonstrated feasibility and improved outcomes for some but not all outcomes. Attention to maternal health needs in pediatric visits during infancy may be important for maintaining positive pre/interconception health behaviors.
RCT Entities:
OBJECTIVE: Recognizing that pediatric primary care focuses on family health and is an important location of contact for women of childbearing age, this project assessed the effectiveness of a pre/interconception women's health intervention delivered during pediatric primary care using a cluster randomized trial. METHODS: Pediatric clinicians were randomized to a screening and brief educational intervention group or usual care comparison group. Intervention group clinicians received training on pre/interconception care, including recommended counseling and referral resources for needs identified. Women presenting to primary care with their child ≤12 months were enrolled and assigned to the group corresponding to the assignment of their child's clinician. Mothers seen by clinicians in the intervention group completed a pre/interconception health screening tool and discussed results with their child's clinician during the visit. These mothers were compared to mothers seen by comparison group clinicians who did not receive the screening tool or clinician discussion. All enrolled mothers (Intervention and Comparison) received written preconception health information and a 90-day supply of multivitamins. Primary outcomes at 6 and 12 months post enrollment included contraception use, pregnancy, and access to and use of preventive health care. Secondary outcomes included daily folic acid supplementation, smoking, and substance use. RESULTS: A total of 415 women were enrolled and those who had at least 1 follow-up assessment were included in the analysis (n = 383). There was no significant effect of the intervention on contraceptive use, pregnancy incidence, or use of preventive care. Assignment to the intervention increased the odds of daily folic acid use (odds ratio 1.82, 95% confidence interval 1.25, 2.63) during follow-up. Intervention mothers were less likely to smoke at 6, but not 12 months. CONCLUSIONS: Pediatric visits are an opportune location for addressing maternal health and this intervention demonstrated feasibility and improved outcomes for some but not all outcomes. Attention to maternal health needs in pediatric visits during infancy may be important for maintaining positive pre/interconception health behaviors.
Authors: Mario P DeMarco; Maha Shafqat; Michael A Horst; Sukanya Srinivasan; Daniel J Frayne; Lisa Schlar; Wendy Brooks Barr Journal: Matern Child Health J Date: 2020-11-27