Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study
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FROM THE FIELD
Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study Mario P. DeMarco1 · Maha Shafqat2 · Michael A. Horst2 · Sukanya Srinivasan3 · Daniel J. Frayne4 · Lisa Schlar5 · Wendy Brooks Barr6 Accepted: 6 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including folic acid reduce the incidence of these birth defects. Most women do not take recommended levels of folic acid prior to conception or during the interconception period. Methods The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) ICC model was implemented to screen mothers who attend well child visits (WCVs) for their children aged 0–24 months. Mothers were queried for maternal behavioral risks known to affect pregnancy including multivitamin use and use of family planning methods to enhance birth spacing. When appropriate, interventions targeted at those at risk behaviors are offered. A mixed effects logistic regression model was used to calculate the odds ratio (OR) of behavior change in MVI use among mothers who reported not using MVIs. Results 37.7% of mothers reported not using MVIs at WCVs. 64.0% of mothers received an intervention to improve MVI use in this model. Mothers who received an intervention were more likely to report taking an MVI at the subsequent WCV if they received advice to take MVIs (OR 1.64) or directly received MVI samples (OR 3.09). Conclusions Dedicated maternal counseling during pediatric WCVs is an opportunity to influence behavioral change in women at risk of becoming pregnant. Direct provision of MVIs increases the odds that women will report taking them at a higher rate than provider advice or no counseling at all. Keywords Multivitamin · Folic acid · Congenital anomalies · Neural tube defects · Interconception care · Preconception
Significance Statement What is Already Known About This Subject? * Mario P. DeMarco [email protected] 1
Department of Family Medicine and Community Health, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA 19104, USA
2
Penn Medicine Lancaster General Health Research Institute, Lancaster, PA, USA
3
UPMC McKeesport Family Medicine Residency, Pittsburgh, PA, USA
4
UNC Health Sciences at MAHEC, Asheville, NC, USA
5
UPMC Shadyside Family Medicine Residency, Pittsburgh, PA, USA
6
Department of Family Medicine, Tufts University School of Medicine, Boston, USA
Current clinical guidelines strongly recommend folate supplementation for women prior to conception. Public health approaches including fortification of foods such as flour, grain and cereal have addressed but have not eliminated the need for specific folate supplementation.
What Does This Study Add? Clinical systems aimed at improving the rates of supp
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