@article{160b4d04aaff4f1faa29cd3ec9389271,
title = "Cluster Randomized Trial of a Pre/Interconception Health Intervention for Mothers in Pediatric Visits",
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.",
keywords = "interconception care, maternal health, preconception health",
author = "Upadhya, {Krishna K.} and Psoter, {Kevin J.} and Connor, {Katherine A.} and Mistry, {Kamila B.} and Levy, {Daniel J.} and Cheng, {Tina L.}",
note = "Funding Information: We would like to acknowledge funding support for this project from Johns Hopkins HealthCare; Aetna, Abell and Straus Foundations; and The Zanvyl and Isabelle Krieger Fund. The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the US Department of Health and Human Services or its component, the Agency for Healthcare Research and Quality or the funding agencies. Contributors{\textquoteright} statements: K.K.U. conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection at the research site drafted the initial manuscript, reviewed and revised each draft of the manuscript and approved the final manuscript as submitted. K.J.P. analyzed the data, reviewed and revised each draft of the manuscript and approved the final manuscript as submitted. K.A.C. coordinated and supervised data collection at the research site, reviewed and revised each draft of the manuscript and approved the final manuscript as submitted. K.B.M. designed the data collection instruments and reviewed and revised each draft of the manuscript and approved the final manuscript as submitted. D.J.L. contributed to acquisition of data, critically reviewed the manuscript, and approved the final manuscript as submitted. T.L.C. conceptualized and designed the study, designed the data collection instruments, reviewed and revised each draft of the manuscript and approved the final manuscript as submitted. Funding Information: We would like to acknowledge funding support for this project from Johns Hopkins HealthCare; Aetna, Abell and Straus Foundations; and The Zanvyl and Isabelle Krieger Fund. The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the US Department of Health and Human Services or its component, the Agency for Healthcare Research and Quality or the funding agencies. Publisher Copyright: {\textcopyright} 2019 Academic Pediatric Association",
year = "2020",
month = jul,
doi = "10.1016/j.acap.2019.10.003",
language = "English (US)",
volume = "20",
pages = "660--669",
journal = "Academic pediatrics",
issn = "1876-2859",
publisher = "Elsevier Inc.",
number = "5",
}