![]() ![]() ![]() We selected the 12- and 24-month well-child visits, 2 representative points in the typical interconception period, to allow evaluation of potential changes in ICC delivery as time elapsed from the index birth. Questionnaires were administered at 12 US family medicine academic practices participating in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network, a perinatal collaborative quality initiative of family medicine residency programs in the eastern United States 25 (Supplemental Appendix 1 and Supplemental Appendix 2, available at ). In this cross-sectional study, we surveyed a convenience sample of mothers 13 years of age and older accompanying their children to well-child visits at 12 months of age (range, 10–14) and 24 months of age (range, 22–26). A secondary goal was to examine maternal health behaviors, beliefs, and receptivity to health advice provided by their child’s physician. 4, 6, 8, 24 We hypothesized that mothers would report infrequent ICC at well-child visits, that approaches among physicians would vary, and that women who did not receive care from the same practice as their child would report receiving less ICC than those who shared a medical home. We focused on maternal depression, tobacco use, folic acid supplementation, and family planning because of the strength of evidence for addressing these factors when aiming to reduce poor birth outcomes. The purpose of this study was to investigate ICC practices by family physicians at well-child visits. 20– 22 Pilot studies have shown incorporation of maternal assessment into these visits to be achievable. 18, 19 Previous studies have found that most mothers accept inquiry about health behaviors and referral for services at well-child visits. 17 Evidence also suggests that mothers regularly attend their child’s health care visits even if they do not seek care for themselves between pregnancies. Continuity of care with the same primary care clinician or practice over time has been associated with improved outcomes, including increased use of preventive services, better adherence to clinician recommendations, and lower total costs, although it has not been well studied in the context of maternal and child care delivery. ![]() 15, 16 Barriers include limited access to health care between pregnancies, maternal focus on their infant to the exclusion of their own personal health needs, inadequate knowledge of ICC among clinicians, and lack of an established ICC model. ICC has been broadly advocated but not widely implemented. 3 ICC recommendations regarding maternal depression, tobacco use, folic acid supplementation, and family planning are supported by evidence suggesting that addressing these factors reduces poor birth outcomes. 2 In 2006, the Centers for Disease Control and Prevention Work Group and Select Panel on Preconception Care recommended risk assessment and intervention in the interconception period, especially for women with previous adverse birth outcomes. 1 It includes interventions that modify risk factors in order to promote healthy outcomes of subsequent pregnancies. Interconception care (ICC) is defined as care provided to mothers between pregnancies to improve health outcomes for women, newborns, and children. ![]()
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