Effectiveness of a Pediatric Primary Care Intervention to Increase Maternal Folate Use: Results from a Cluster Randomized Controlled Trial

• Published in: The Journal of pediatrics Vol. 192; pp. 247 - 252.e1
• Main Authors: Chilukuri, Nymisha, Cheng, Tina L., Psoter, Kevin J., Mistry, Kamila B., Connor, Katherine A., Levy, Daniel J., Upadhya, Krishna K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2018
• Subjects: Adult; Directive Counseling; Female; Folic Acid; Follow-Up Studies; Health Behavior; Humans; Maternal Behavior; Maternal-Child Health Services; Models, Statistical; nutrition; Outcome Assessment (Health Care); Patient Compliance - statistics & numerical data; Pediatrics; preconception care; Preconception Care - methods; Primary Health Care - methods; Vitamin B Complex; preconception care; nutrition; CDC; folic acid
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2017.09.020

To assess the impact of provision of folate vitamins and a preconception health intervention on folate use among mothers bringing infants to pediatric primary care.
We conducted a cluster randomized trial in mothers presenting with their infants (<12 months) at 4 urban pediatric practices in the Baltimore, Maryland, metropolitan area. There were 45 clinicians randomized into an intervention group (15-item preconception health screening and counseling and 90-day multivitamin supply) and control group (preconception health and community resource handouts and 90-day multivitamin supply). Participating mothers were enrolled in the study group assigned to their child's clinician. Baseline and 6-month follow-up interviews were performed. The outcome was daily use of folate, multivitamin, and a prenatal vitamin containing folate. Primary independent variables were time of assessment and mother's study group (intervention or control groups). Covariates investigated were mother's and child's age, race/ethnicity, education, marital status, income, insurance status, previous live births, and intention to have a pregnancy in the next 6 months.
We enrolled 415 mothers at baseline who were majority African American and low income. Of the 415 enrolled participants, 352 (85%) completed follow-up interviews. Among all participants, daily vitamin intake increased from baseline to 6-month follow-up (33.8% vs 42.6%; P = .016). After adjustment for covariates and clustered design, there was an augmented effect in the intervention vs control group (aOR, 2.04; 95% CI, 1.04-3.98).
Offering vitamins and recommending folate intake to mothers within pediatric practice can increase use. Pediatric practice is an important contact point and context for improving maternal folate use.
ClinicalTrials.govNCT02049554.