Interconception Care for Mothers at Well Child Visits After Implementation of the IMPLICIT Model

• Published in: Maternal and child health journal Vol. 25; no. 8; pp. 1193 - 1199
• Main Authors: Frayne, Daniel, Hughes, Phillip, Lugo, Brunilda, Foley, Kathy, Rosener, Stephanie, Barr, Wendy B., Davis, Scott A., Knoll, Heidi, Krajick, Kayla, Bennett, Ian M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2021; Springer; Springer Nature B.V
• Subjects: Care and treatment; Children & youth; Childrens health; Community health services; Counseling; Electronic health records; Families & family life; Family planning; Folic acid; From the Field; Gynecology; Intervention; Maternal & child health; Maternal and Child Health; Maternal health services; Medical screening; Medicine; Medicine & Public Health; Mothers; Patient education; Pediatrics; Population Economics; Pregnancy; Pregnancy, Complications of; Prevention; Public Health; Quality management; Risk factors; Sociology; Vitamin B; Womens health; United States; Maternal risk factors; Screening; Pregnancy outcomes; Interconception care; Prenatal care
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-021-03137-z

Introduction
Interconception care (ICC) is recommended to reduce maternal risk factors for poor birth outcomes between pregnancies. The IMPLICIT ICC model includes screening and brief intervention for mothers at well child visits (WCVs) for smoking, depression, multivitamin use, and family planning. Prior studies demonstrate feasibility and acceptability among providers and mothers, but not whether mothers recall receipt of targeted messages.
Methods
Mothers accompanying their child at 12- and 24-month WCVs at four sites of a family medicine academic practice were surveyed pre (2012) and post (2018) ICC model implementation. Survey items assessed health history, behaviors, and report of whether their child’s physician addressed maternal depression, tobacco use, family planning, and folic acid supplementation during WCVs. Pre and post results are compared using logistic regression adjusting for demographics and insurance.
Results
Our sample included 307 distinct mothers with 108 and 199 respondents in the pre and post periods, respectively. Mothers were more likely to report discussions with their child’s doctor post-intervention for family planning (31% pre to 86% post; aOR 18.65), depression screening (63–85%; aOR 5.22), and taking a folic acid supplement (53–68%; aOR 2.54). Among mothers who smoked, the percentage that reported their child’s doctor recommended cessation increased from 56 to 75% (aOR = 3.66).
Discussion
The IMPLICIT ICC model resulted in increased reported health care provider discussions of four key areas of interconception health by mothers attending WCVs. This model holds promise as a primary care strategy to systematically address maternal risks associated with poor pregnancy outcomes.