Delivering Interconception Care During Well-Child Visits: An IMPLICIT Network Study

Sukanya Srinivasan, Lisa Schlar, Stephanie E. Rosener, Daniel J. Frayne, Scott G. Hartman, Michael A. Horst, Jessica L. Brubach, Stephen Ratcliffe
2018 Journal of the American Board of Family Medicine  
Preterm birth, birth defects, and unintended pregnancy are major sources of infant and maternal morbidity, mortality, and associated resource use in American health care. Interconception Care (ICC) is recommended as a strategy to improve birth outcomes by modifying maternal risks between pregnancies, but no established model currently exists. The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network developed and implemented
more » ... ed and implemented a unique approach to ICC by assessing mothers during their baby's well-child visits (WCVs) up to 24 months. Methods: Mothers who accompanied their children to WCVs at eleven eastern US family medicine residency programs underwent screening for four risk factors (tobacco use, depression risk, contraception use to avoid unintended pregnancy and prolong interpregnancy interval, and use of a multivitamin with folic acid). Positive screens in women were addressed through brief interventions or referrals to treatment. Results: Mothers accompanied their babies to 92.7% of WCVs. At more than half of WCVs (69.1%), mothers were screened for presence of ICC behavioral risks, although significant practice variation existed. Risk factors were identified at significant rates (tobacco use, 16.2%; depression risk, 8.1%; lack of contraception use, 28.2%; lack of multivitamin use, 45.4%). Women screened positive for 1 or more ICC risk factor at 64.6% of WCVs. Rates of documented interventions for women who screened positive were also substantial (tobacco use, 80.0%; depression risk, 92.8%; lack of contraception use, 76.0%; lack of multivitamin use, 58.2%). Conclusion: WCVs provide a reliable point of contact with mothers and a unique opportunity to assess and address behavioral risks for future poor birth outcomes. (J Am Board Fam Med 2018;31: 201-210.) The United States ranks 44th in the world in infant mortality and 49th in maternal mortality. 1 Despite a number of strategies intended to improve pregnancy care, the US infant mortality rate has dropped only slightly and the maternal mortality rate is rising. 2 Almost half of pregnancies in the US are unintended (mistimed or unwanted) 3 and only 22.8% percent of US women report receiving pre-This article was externally peer reviewed.
doi:10.3122/jabfm.2018.02.170227 pmid:29535236 fatcat:bbl3gglexjdihpdpsa5ekldkly