Interconception Care in an Academic Pediatric Clinic Setting

Purpose/Objectives: Since 2018 US infant mortality, prematurity and low birth weight (LBW) birth rates have decreased across all age groups of women; however, improvements have disproportionately impacted Non-Hispanic White women. Inter-conception care (ICC) involves medical and psychosocial interventions between pregnancies to promote healthy subsequent pregnancies. The University of Mississippi Medical Center pediatric clinics provide care to predominantly minority and economically disadvantaged families, thus providing an opportunity to implement and assess pediatrician screening and intervention and maternal response to ICC.

Design/Methods: ICC screening was performed at infant wellness encounters- 2 weeks (Visit1) to 24 months of age (Visit9)- using the standardized ICC tools of the IMPLICIT Network (https://www.fmec.net/implicit). Mothers were screened for smoking status, multi-vitamin/folic acid supplementation use, pregnancy status/contraception practices and depression. Maternal health promoting responses were supported verbally. Health risk responses were met with education and resources (Figure1-2). Data assessment and pediatrician feedback occurred monthly.

Results: 1883 dyads were screened over 4155 encounters. The population was overwhelmingly Non-Hispanic Black women (79.1%; mean age 25.4 years) with a high school/ GED or greater education (43.7%). The women had a median of 2 children with 85.7% Medicaid insurance coverage.
Percentage of pediatrician screenings decreased precipitously from 59% (Visit1) to 13% (Visit9). Subsequent analyses included Vist1-Visit5 due to sample size limitations.
Maternal multi-vitamin/folic acid supplementation decreased across the 5 visits (53% to 38%). Intervention for supplementation needs was 87.4%-93.7%. Maternal reported supplementation use change between first and last visits was statistically significant (χ2(1)=6.1,p=0.01).
Maternal positive smoking status was lowest at Visit1 (7.9%) though increased to 9.4-11.8%. Intervention for positive current smoking status occurred 65.7%-89.2%. There was no statistically significant change in positive maternal smoking between first and last visits (χ2(1)=1.9,p=0.16).
Maternal reported contraception use was lowest at Visit1 (47.7%), then increased to 57.7%-62.5%. Intervention for contraception use needs was 67.6%-84.1%. Maternal contraception use change between first and last visit was statistically significant (χ2(1)=12.6,p < 0.001).
PHQ2/PHQ9 scores were at or above the clinical cutoff from 1.5%-2.8% of visits. The clinically significant PHQ9 total scores increased across the visits: Visit1 mean, 13.4±3.8 standard deviation (SD); Visit5 mean 17.8±7.2 SD. Mothers reporting suicidal ideation occurred from 0.3%-1.5% of all PHQ2/PHQ9 screens. Pediatrician intervention for positive screens occurred 98.9%-100%.

Conclusion/Discussion: Data suggests pediatrician implementation and sustained ICC screening was challenging. Interventions were performed for the majority of positive screens of varying effect. Change in maternal multivitamin/folic acid and contraception practices was significant, but smoking cessation was not. Our economically disadvantaged, predominantly Black population reported smoking status, contraception use, and depression below national averages; and multi-vitamin/folic acid supplementation above the national average. This suggests other health parameters (maternal chronic health, access to health care and health disparities) may contribute to increased LBW/prematurity and infant mortality in our population.