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

Stephanie E. Rosener; Wendy B. Barr; Daniel J. Frayne; Joshua H. Barash; Megan E. Gross; Ian M. Bennett

doi:10.1370/afm.1933

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Table 1

Characteristics of Respondents (N = 658)

Maternal Characteristic^a	Respondents, %
Race/ethnicity
White	32.7
Black	35.0
Asian	3.0
Other	28.3
Hispanic	32.9
Insurance status
Government	73.6
Private	15.8
Self-pay	10.6
Medical history
Diabetes	2.2
Hypertension	6.1
Seizures	1.6
Preterm birth	16.6
Survey language preference
English	84.2
Spanish	15.8
Source of care
Received pregnancy care from child’s physician	57.0
Receives care from same practice as child (shared medical home)	74.2

↵a Mean age was 26.5 years.

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Table 2

Maternal Health, Behaviors, Beliefs, and Related Interconception Care

Characteristic	Respondents, %
Depression
History of depression (ever)	19.1
History of other psychiatric condition	12.7
History of depression since index child’s birth	59.0
Depression screening performed	16.1
Depression addressed (if depressed since index child’s birth)	75.3
Folic acid
Not currently using folic acid supplement	58.1
Folic acid use addressed	44.4
Smoking
Currently smoking	24.5
Smoking addressed (if currently smoking)	80.3
Family planning
Pregnant since index child’s birth	16.8
Currently using contraception	73.7
Family planning addressed	70.6
Health beliefs
“I believe that my health affects the health of my children and children from future pregnancies.”	82.9
“I am willing to take advice about my health that affects my children from my child’s doctor.”	94.7

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Table 3

Comparison of Health Advice and Beliefs Among Mothers by Source of Care

Characteristic	Respondents, %		Unadjusted OR	Adjusted OR^b	Adjusted P Value
Characteristic	Same Practice^a	Different Practice	Unadjusted OR	Adjusted OR^b	Adjusted P Value
Depression
Depression screening done	63.9	45.6	2.11	3.04	.000
Report receiving some treatment advice (if told had depression)	76.0	71.4	1.27	1.27	.67
Folic acid use addressed	45.2	42.2	1.13	1.39	.12
Smoking addressed (if currently smoking)	80.5	78.3	1.15	1.15	.81
Family planning addressed	76.1	57.1	2.44	2.31	.00
Health belief: “I am willing to take advice about my health that affects my children from my child’s doctor.”	94.6	94.8	0.97	0.97	.94

OR = odds ratio.
↵a Shared medical home.
↵b Controlled for intraclass correlation by location.

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Supplemental data: Appendixes 1-4 - PDF file.
The Article in Brief

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

Stephanie E. Rosener , and colleagues

Background Interconception Care (ICC)--care provided to mothers between pregnancies--can improve health outcomes for women, newborns and children. Well-child visits are an opportunity for interconception care of mothers prior to their next pregnancy. This study investigates ICC practices by family physicians at well-child visits.

What This Study Found A substantial portion of mothers accompanying their children to well-child visits have risk factors for adverse subsequent birth outcomes. Family physicians routinely provide key elements of interconception care at well-child visits, and mothers are highly receptive to advice from their child's physician even if they receive primary care elsewhere. Seventeen percent of mothers surveyed reported a previous preterm birth, 19 percent reported a history of depression, 25 percent were smoking, 26 percent were not using contraception, and 58 percent were not taking folic acid. Regarding advice, 80 percent of mothers who smoked were counseled to quit, 59 percent reported depression screening, 71 percent discussed contraception, and 44 percent discussed folic acid. Most mothers were willing to accept health advice from their child's physician regardless of whether they shared a medical home.