Mario P DeMarco1, Maha Shafqat2, Michael A Horst2, Sukanya Srinivasan3, Daniel J Frayne4, Lisa Schlar5, Wendy Brooks Barr6. 1. Department of Family Medicine and Community Health, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA. mario.demarco@pennmedicine.upenn.edu. 2. Penn Medicine Lancaster General Health Research Institute, Lancaster, PA, USA. 3. UPMC McKeesport Family Medicine Residency, Pittsburgh, PA, USA. 4. UNC Health Sciences at MAHEC, Asheville, NC, USA. 5. UPMC Shadyside Family Medicine Residency, Pittsburgh, PA, USA. 6. Department of Family Medicine, Tufts University School of Medicine, Boston, USA.
Abstract
INTRODUCTION: Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including folic acid reduce the incidence of these birth defects. Most women do not take recommended levels of folic acid prior to conception or during the interconception period. METHODS: The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) ICC model was implemented to screen mothers who attend well child visits (WCVs) for their children aged 0-24 months. Mothers were queried for maternal behavioral risks known to affect pregnancy including multivitamin use and use of family planning methods to enhance birth spacing. When appropriate, interventions targeted at those at risk behaviors are offered. A mixed effects logistic regression model was used to calculate the odds ratio (OR) of behavior change in MVI use among mothers who reported not using MVIs. RESULTS: 37.7% of mothers reported not using MVIs at WCVs. 64.0% of mothers received an intervention to improve MVI use in this model. Mothers who received an intervention were more likely to report taking an MVI at the subsequent WCV if they received advice to take MVIs (OR 1.64) or directly received MVI samples (OR 3.09). CONCLUSIONS: Dedicated maternal counseling during pediatric WCVs is an opportunity to influence behavioral change in women at risk of becoming pregnant. Direct provision of MVIs increases the odds that women will report taking them at a higher rate than provider advice or no counseling at all.
INTRODUCTION: Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including folic acid reduce the incidence of these birth defects. Most women do not take recommended levels of folic acid prior to conception or during the interconception period. METHODS: The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) ICC model was implemented to screen mothers who attend well child visits (WCVs) for their children aged 0-24 months. Mothers were queried for maternal behavioral risks known to affect pregnancy including multivitamin use and use of family planning methods to enhance birth spacing. When appropriate, interventions targeted at those at risk behaviors are offered. A mixed effects logistic regression model was used to calculate the odds ratio (OR) of behavior change in MVI use among mothers who reported not using MVIs. RESULTS: 37.7% of mothers reported not using MVIs at WCVs. 64.0% of mothers received an intervention to improve MVI use in this model. Mothers who received an intervention were more likely to report taking an MVI at the subsequent WCV if they received advice to take MVIs (OR 1.64) or directly received MVI samples (OR 3.09). CONCLUSIONS: Dedicated maternal counseling during pediatric WCVs is an opportunity to influence behavioral change in women at risk of becoming pregnant. Direct provision of MVIs increases the odds that women will report taking them at a higher rate than provider advice or no counseling at all.
Authors: Breige McNulty; Kristina Pentieva; Barry Marshall; Mary Ward; Anne M Molloy; John M Scott; Helene McNulty Journal: Hum Reprod Date: 2011-03-25 Impact factor: 6.918
Authors: Carol S Weisman; Marianne M Hillemeier; Danielle Symons Downs; Mark E Feinberg; Cynthia H Chuang; John J Botti; Anne-Marie Dyer Journal: Womens Health Issues Date: 2011-05-04
Authors: Cynthia H Chuang; Carol S Weisman; Marianne M Hillemeier; Eleanor Bimla Schwarz; Fabian T Camacho; Anne-Marie Dyer Journal: Matern Child Health J Date: 2009-02-12
Authors: Krishna K Upadhya; Kevin J Psoter; Katherine A Connor; Kamila B Mistry; Daniel J Levy; Tina L Cheng Journal: Acad Pediatr Date: 2019-10-17 Impact factor: 3.107
Authors: Jennifer Williams; Cara T Mai; Joe Mulinare; Jennifer Isenburg; Timothy J Flood; Mary Ethen; Barbara Frohnert; Russell S Kirby Journal: MMWR Morb Mortal Wkly Rep Date: 2015-01-16 Impact factor: 17.586