TY - JOUR
T1 - Effectiveness of a Pediatric Primary Care Intervention to Increase Maternal Folate Use
T2 - Results from a Cluster Randomized Controlled Trial
AU - Chilukuri, Nymisha
AU - Cheng, Tina L.
AU - Psoter, Kevin J.
AU - Mistry, Kamila B.
AU - Connor, Katherine A.
AU - Levy, Daniel J.
AU - Upadhya, Krishna K.
N1 - Funding Information:
Funded by Abell and The Aaron and Lillie Straus Foundations, and The Zanvyl and Isabelle Krieger Fund, DC-Baltimore Research Center on Child Health Disparities (P20 MD000198) from the National Institute on Minority Health and Health Disparities. The authors declare no conflicts of interest. The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services is intended or should be inferred.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - 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.gov NCT02049554.
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.gov NCT02049554.
KW - folic acid
KW - nutrition
KW - preconception care
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U2 - 10.1016/j.jpeds.2017.09.020
DO - 10.1016/j.jpeds.2017.09.020
M3 - Article
C2 - 29246348
AN - SCOPUS:85039041912
SN - 0022-3476
VL - 192
SP - 247-252.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -