(SDAR) Interconception opportunities to address mental health and obesogenic risks

Need: Preconception care is health care delivered to adults with the goal of improving outcomes in subsequent pregnancies. It is a strategy to improve birth outcomes decrease health care costs and increase health equity (Title V National Performance Domain 1: Well-Woman Visits and Preconception/Interconception Health).1 Despite its promise only one third of women report receiving preconception care in the year prior to a first birth and fewer report receiving such care in the interconception period.2 The interconception period is a critical life course phase for both mothers and infants. For mothers optimizing health in this period may improve outcomes in future pregnancies and beyond and ensure capacity for optimal parenting.1 For infants growth and development in this period predict future health and are dependent on parental health.3 4 Mothers interact with health systems both as patients in adult systems and as parents in pediatric systems. It is currently unknown in what settings and how frequently there are opportunities for interconception care. This study addresses this gap by characterizing health care utilization patterns of mother-infant dyads in the year following birth. Aligning with DHS clinical priorities around mental health and childhood obesity this analysis focuses on mothers with a high need for interconception services based on diagnoses of depression or anxiety or of obesity diabetes or hypertension. These mental health conditions and cardiovascular risks are both common and interrelated. Children whose parents experience these conditions are more likely to develop these conditions themselves.5-8 Yet these conditions are also modifiable suggesting that services during the interconception period might change long-term health trajectories for both parents and children. Methods: This cohort study uses Medicaid Analytic eXtract (MAX) data. The study team has already linked approximately 100 000 mother-infant dyads born in 20 states from 2010 - 2012 with continuous Medicaid eligibility for one year following birth. We will define interconception utilization for dyads whose mothers had specific health risks identified during pregnancy or the first three months postpartum. Risks of interest include depression anxiety obesity hypertension and diabetes. Based on national data we expect these diagnoses to occur in 30% of dyads.9-12 We will then link utilization patterns to subsequent health outcomes. Significance: Characterizing missed opportunities for interconception care for high risk womenwill support development of tailored programs to address critical interconception needs.