Effectiveness of a Pediatric Primary Care Intervention to Increase Maternal Folate Use: Results from a Cluster Randomized Controlled Trial

Nymisha Chilukuri, Tina L Cheng, Kevin Psoter, Kamila B. Mistry, Katherine A. Connor, Daniel J. Levy, Krishna K. Upadhya

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To assess the impact of provision of folate vitamins and a preconception health intervention on folate use among mothers bringing infants to pediatric primary care.

STUDY DESIGN: We conducted a cluster randomized trial in mothers presenting with their infants (<12 months) at 4 urban pediatric practices in the Baltimore, Maryland, metropolitan area. There were 45 clinicians randomized into an intervention group (15-item preconception health screening and counseling and 90-day multivitamin supply) and control group (preconception health and community resource handouts and 90-day multivitamin supply). Participating mothers were enrolled in the study group assigned to their child's clinician. Baseline and 6-month follow-up interviews were performed. The outcome was daily use of folate, multivitamin, and a prenatal vitamin containing folate. Primary independent variables were time of assessment and mother's study group (intervention or control groups). Covariates investigated were mother's and child's age, race/ethnicity, education, marital status, income, insurance status, previous live births, and intention to have a pregnancy in the next 6 months.

RESULTS: We enrolled 415 mothers at baseline who were majority African American and low income. Of the 415 enrolled participants, 352 (85%) completed follow-up interviews. Among all participants, daily vitamin intake increased from baseline to 6-month follow-up (33.8% vs 42.6%; P = .016). After adjustment for covariates and clustered design, there was an augmented effect in the intervention vs control group (aOR, 2.04; 95% CI, 1.04-3.98).

CONCLUSIONS: Offering vitamins and recommending folate intake to mothers within pediatric practice can increase use. Pediatric practice is an important contact point and context for improving maternal folate use.

TRIAL REGISTRATION: ClinicalTrials.govNCT02049554.

Original languageEnglish (US)
Pages (from-to)247-252
Number of pages6
JournalThe Journal of Pediatrics
Volume192
DOIs
StatePublished - Jan 1 2018

Fingerprint

Folic Acid
Primary Health Care
Randomized Controlled Trials
Mothers
Pediatrics
Vitamins
Control Groups
Interviews
Baltimore
Insurance Coverage
Health Resources
Health
Marital Status
Live Birth
African Americans
Counseling
Education
Pregnancy

Keywords

  • folic acid
  • nutrition
  • preconception care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Effectiveness of a Pediatric Primary Care Intervention to Increase Maternal Folate Use : Results from a Cluster Randomized Controlled Trial. / Chilukuri, Nymisha; Cheng, Tina L; Psoter, Kevin; Mistry, Kamila B.; Connor, Katherine A.; Levy, Daniel J.; Upadhya, Krishna K.

In: The Journal of Pediatrics, Vol. 192, 01.01.2018, p. 247-252.

Research output: Contribution to journalArticle

Chilukuri, Nymisha ; Cheng, Tina L ; Psoter, Kevin ; Mistry, Kamila B. ; Connor, Katherine A. ; Levy, Daniel J. ; Upadhya, Krishna K. / Effectiveness of a Pediatric Primary Care Intervention to Increase Maternal Folate Use : Results from a Cluster Randomized Controlled Trial. In: The Journal of Pediatrics. 2018 ; Vol. 192. pp. 247-252.
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AB - OBJECTIVE: To assess the impact of provision of folate vitamins and a preconception health intervention on folate use among mothers bringing infants to pediatric primary care.STUDY DESIGN: We conducted a cluster randomized trial in mothers presenting with their infants (<12 months) at 4 urban pediatric practices in the Baltimore, Maryland, metropolitan area. There were 45 clinicians randomized into an intervention group (15-item preconception health screening and counseling and 90-day multivitamin supply) and control group (preconception health and community resource handouts and 90-day multivitamin supply). Participating mothers were enrolled in the study group assigned to their child's clinician. Baseline and 6-month follow-up interviews were performed. The outcome was daily use of folate, multivitamin, and a prenatal vitamin containing folate. Primary independent variables were time of assessment and mother's study group (intervention or control groups). Covariates investigated were mother's and child's age, race/ethnicity, education, marital status, income, insurance status, previous live births, and intention to have a pregnancy in the next 6 months.RESULTS: We enrolled 415 mothers at baseline who were majority African American and low income. Of the 415 enrolled participants, 352 (85%) completed follow-up interviews. Among all participants, daily vitamin intake increased from baseline to 6-month follow-up (33.8% vs 42.6%; P = .016). After adjustment for covariates and clustered design, there was an augmented effect in the intervention vs control group (aOR, 2.04; 95% CI, 1.04-3.98).CONCLUSIONS: Offering vitamins and recommending folate intake to mothers within pediatric practice can increase use. Pediatric practice is an important contact point and context for improving maternal folate use.TRIAL REGISTRATION: ClinicalTrials.govNCT02049554.

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