Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study

Abstract

PURPOSE Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. METHODSWe surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child's physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice.RESULTS Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P <.05). Most mothers, nearly 95%, were willing to accept health advice from their child's physician regardless of whether a medical home was shared (P >.05).CONCLUSIONS Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child's physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes. 2016;14:350-355. doi: 10.1370/afm.1933. Ann Fam Med INTRODUCTIONI nterconception care (ICC) is defined as care provided to mothers between pregnancies to improve health outcomes for women, newborns, and children.1 It includes interventions that modify risk factors in order to promote healthy outcomes of subsequent pregnancies.2 In 2006, the Centers for Disease Control and Prevention Work Group and Select Panel on Preconception Care recommended risk assessment and intervention in the interconception period, especially for women with previous adverse birth outcomes.3 ICC recommendations regarding maternal depression, tobacco use, folic acid supplementation, and family planning are supported by evidence suggesting that addressing these factors reduces poor birth outcomes. [4][5][6][7][8][9][10][11][12][13][14] ICC has been broadly advocated but not widely implemented. 15,16 Barriers include limited access to health care between pregnancies, maternal focus on their infant to the exclusion of their own personal health needs, 351inadequate knowledge of ICC among clinicians, and lack of an established ICC model. Continuity of care with the same primary care clinician or practice over time has been associated with improved ou...

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“…care provided between pregnancies, and that a specific role could be assigned to youth healthcare physicians providing preventive child healthcare. The potential of interconception care to new mothers is increasingly being discussed in the literature, and it is stated that its unique position to reach women and its expertise in preventive healthcare are facilitating factors [ 37 , 38 ]. However, a disadvantage could be that in some cases, parents have already been confronted with the birth of an affected child without being aware of their increased risk.…”

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“…19 The IMPLIC-IT network has demonstrated that well-child visits in family medicine clinics can be used to identify and support high-risk mothers and children 20 and that mothers are interested in health advice from their child's physician even if they receive their health care from a different provider. 21 Enhancing the knowledge base of PDs on these approaches may be one avenue to promote change given the association we found between the self-reported knowledge of PDs on this topic and the comprehensiveness of the approach to resident training on this topic. A limitation is that our study relied on PD report to describe the training and clinical experiences of residents.…”

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“…For instance, other studies focusing on the promotion of folic acid supplementation in routine PCHC practice have shown promising results with regards to increased use and intention [18, 19]. Other encouraging, recently reported, ICC related practices that were aimed at mothers during well-child visits, include screening and addressing tobacco use, depression risk and contraception use [39, 40]. As such, standardization of certain ICC items in PCHC could make it accessible for all women while warranting sufficient management support and resources, which could improve feasibility.…”