Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study
Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study
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DOI：
10.1007/s10995-020-03055-6
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发表时间：
2020-11-27
影响因子：
2.3
通讯作者：
Barr, Wendy Brooks
中科院分区：
文献类型：
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作者：
DeMarco, Mario P.;Shafqat, Maha;Barr, Wendy Brooks
在美国，每年有3%的婴儿出生时患有先天性异常，其中3000名婴儿患有神经管缺陷。包括叶酸在内的多种维生素（MVIs）可以减少这些出生缺陷的发生率。大多数妇女在怀孕前或怀孕期间没有服用推荐的叶酸水平。方法采用持续改善技术（Continuous Improvement Techniques，隐式）ICC模型对0 ~ 24月龄儿童进行健康访婴（well child探视，wcv）的母亲进行筛查，以减少早产和低出生体重儿。研究人员询问了母亲是否存在已知的影响怀孕的行为风险，包括使用多种维生素和使用计划生育方法来提高生育间隔。在适当情况下，针对有危险行为的人提供干预措施。采用混合效应logistic回归模型计算未使用MVI的母亲使用MVI后行为改变的比值比（OR）。结果37.7%的母亲报告在wcv中未使用MVIs。在该模型中，64.0%的母亲接受了改善MVI使用的干预。接受干预的母亲更有可能在随后的WCV中报告接受了MVI，如果她们接受了MVI的建议（OR为1.64）或直接接受了MVI样本（OR为3.09）。结论：在儿童wcv期间，专门的产妇咨询是影响有怀孕风险妇女行为改变的一个机会。直接提供MVIs增加了妇女报告服用它们的几率，其比例高于提供者建议或根本没有咨询。
Introduction Each year, 3% of infants in the Unites States (US) are born with congenital anomalies, including 3000 with neural tube defects. Multivitamins (MVIs) including folic acid reduce the incidence of these birth defects. Most women do not take recommended levels of folic acid prior to conception or during the interconception period. Methods The Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) ICC model was implemented to screen mothers who attend well child visits (WCVs) for their children aged 0-24 months. Mothers were queried for maternal behavioral risks known to affect pregnancy including multivitamin use and use of family planning methods to enhance birth spacing. When appropriate, interventions targeted at those at risk behaviors are offered. A mixed effects logistic regression model was used to calculate the odds ratio (OR) of behavior change in MVI use among mothers who reported not using MVIs. Results 37.7% of mothers reported not using MVIs at WCVs. 64.0% of mothers received an intervention to improve MVI use in this model. Mothers who received an intervention were more likely to report taking an MVI at the subsequent WCV if they received advice to take MVIs (OR 1.64) or directly received MVI samples (OR 3.09). Conclusions Dedicated maternal counseling during pediatric WCVs is an opportunity to influence behavioral change in women at risk of becoming pregnant. Direct provision of MVIs increases the odds that women will report taking them at a higher rate than provider advice or no counseling at all.