Interconception Care for Mothers at Well Child Visits After Implementation of the IMPLICIT Model

Area of Science:

• Public Health
• Maternal Health
• Primary Care Interventions

Background:

• Interconception care (ICC) is crucial for mitigating maternal risk factors between pregnancies to improve birth outcomes.
• The IMPLICIT ICC model integrates screening and brief interventions for smoking, depression, multivitamin use, and family planning into well-child visits (WCVs).
• Previous research confirmed the feasibility and acceptability of the IMPLICIT ICC model, but data on patient recall of targeted health messages were lacking.

Purpose of the Study:

• To evaluate the impact of the IMPLICIT ICC model on mothers' recall of discussions regarding key interconception health topics during WCVs.
• To assess whether the implementation of the IMPLICIT ICC model increased patient-reported communication about maternal health during pediatric visits.

Main Methods:

• A pre- and post-implementation survey design was employed at four family medicine practice sites.
• Mothers attending 12- and 24-month WCVs were surveyed on their health history, behaviors, and physician discussions on maternal depression, tobacco use, family planning, and folic acid.
• Logistic regression analysis was used to compare pre- (2012) and post-intervention (2018) survey results, adjusting for demographic and insurance variables.

Main Results:

• Post-intervention, mothers were significantly more likely to report discussions with their child's physician regarding family planning (31% to 86%), depression screening (63% to 85%), and folic acid supplementation (53% to 68%).
• Among mothers who smoked, the proportion reporting physician recommendations for cessation increased from 56% to 75%.
• The study included 307 mothers, with 108 in the pre-intervention period and 199 in the post-intervention period.

Conclusions:

• The IMPLICIT ICC model implementation led to a notable increase in mothers' self-reported discussions about critical interconception health areas during WCVs.
• This primary care-based model demonstrates significant potential for systematically addressing maternal health risks to prevent adverse pregnancy outcomes.