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Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study

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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.


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.


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).


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.

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The authors would like to thank all the participating members of the IMPLICIT Network for their dedication and contribution to the project’s success. Special thanks to the Family Medicine Education Consortium (FMEC) for supporting the network and to Dr. Stephen Ratcliffe for mentorship on this project.


Funding for the IMPLICIT Network was received from the March of Dimes as well as the Pennsylvania Department of Health.

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Correspondence to Mario P. DeMarco.

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DeMarco, M.P., Shafqat, M., Horst, M.A. et al. Interventions to Increase Multivitamin Use Among Women in the Interconception Period: An IMPLICIT Network Study. Matern Child Health J 25, 207–213 (2021).

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