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A randomized controlled trial of prenatal pediatric visits for urban, low-income families
J R Serwint1, M E Wilson, J W Vogelhut
1Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland, USA.
Insights
Prenatal pediatric visits positively influence breastfeeding decisions and reduce emergency room visits for urban, low-income families. These visits also enhance the early doctor-patient relationship, though they don't affect breastfeeding duration or safety seat use.
Area of Science:
- Pediatrics
- Maternal and Child Health
- Health Services Research
Background:
- Prenatal pediatric visits are recommended for parental counseling and relationship building.
- The American Academy of Pediatrics advocates for these visits to improve infant care.
- Hypothesized impacts include effects on breastfeeding, health behaviors, and healthcare utilization.
Purpose of the Study:
- To evaluate the impact of prenatal pediatric visits on health care behaviors and utilization.
- To assess the influence on breastfeeding decisions and the doctor-patient relationship.
- To examine outcomes in urban, low-income families.
Main Methods:
- A randomized controlled trial was conducted with urban, low-income pregnant women.
- Outcomes measured included breastfeeding decisions, car seat use, circumcision, health maintenance, and ER visits.
- Data collected via maternal interviews, nursery record review, and physician interviews.
Main Results:
- 45% of intervention group mothers favored breastfeeding post-enrollment vs. 14% in control.
- Intervention group had fewer emergency room visits (0.58 vs. 1.0).
- Pediatricians felt they knew intervention mothers better (54% vs. 29%), but mothers' perception was similar.
Conclusions:
- Prenatal pediatric visits show potential benefits for health care outcomes.
- Positive effects observed in breastfeeding decisions, reduced ER visits, and initial doctor-patient relationship.
- Urban practices should consider promoting prenatal pediatric visits.
Background:
Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues, establish a supportive relationship, and provide pediatric practice information to parents. We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions, health care behaviors, health care utilization, and the doctor-patient relationship.
Methods:
We conducted a randomized controlled trial of prenatal pediatric visits for urban, low-income families to measure the impact on breastfeeding decisions, infant car safety seat use, circumcision, health maintenance, and emergency room visits and the pediatrician's perception that he/she would know the mother better. Pregnant women were recruited prenatally from the obstetrics clinic. Outcomes were measured by maternal interview prenatally and when the infant was 2 months old, in addition to review of the nursery record. Physicians were interviewed after the 2-month visit. Health care utilization was measured by chart review at 7 months.
Results:
A total of 156 pregnant women were enrolled and randomized, 81 to the intervention group and 75 to the control group. Of mothers who breastfed, 45% in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14% in the control group. Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits, 0.58 compared with 1.0. Pediatricians were more likely to think that they knew mothers in the intervention group well, 54% versus 29% in the control group, yet 67% of mothers in both groups agreed their pediatrician knew them well. There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days, infant car safety seat use, circumcision, or health maintenance visits.
Conclusions:
Prenatal pediatric visits have potential impact on a variety of health care outcomes. Among urban, low-income mothers, we found beneficial effects on breastfeeding decisions, a decrease in emergency department visits, and an initial impact on the doctor-patient relationship. We suggest urban practices actively promote prenatal pediatric visits.