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Maternal Outcomes

James A. Taylor, MD; Kathi J. Kemper, MD, MPH

Arch Pediatr Adolesc Med. 1998;152:579-584.

Objective  To determine if participation in group sessions as part of health supervision visits for infants improves outcomes compared with individual visits in high-risk mothers.

Study design  Randomized controlled clinical trial.

Participants  Mothers of young infants who had at least 1 of the following risk factors: aged younger than 20 years at delivery, participation in Medicaid, less than a high school education, previous or ongoing substance abuse, or history of abuse as a child.

Setting  Two urban university pediatric clinics in Seattle, Wash.

Interventions  Mother-infant dyads were randomized to receive group well-child care (GWCC) or individual well-child care (IWCC) before the infant was 4 months old; the intervention continued until the child was 15 months old. Mothers completed the Sense of Competence and Social Isolation subscales from the Parenting Stress Index and Sarason's Social Support Questionnaire at enrollment and again on completion of the study. During the 11-month study period, 7 health supervision visits were scheduled for each mother-infant dyad. Social workers met periodically with mothers during the study and assessed the following functional outcomes: return to school, return to work, enrollment in a substance abuse treatment program, and becoming pregnant. In addition, data on study children were collected from Child Protective Services to assess referrals because of suspected abuse and/or neglect.

Results  Data were collected on 213 mother-infant dyads, including 108 who received GWCC and 105 who received IWCC. At the conclusion of the study period, similar proportions of GWCC and IWCC mothers scored in the high-risk range on the Sense of Competence subscale, Social Isolation subscale, and the Social Support Questionnaire (P=.57, .32, and .59, respectively). For more than 50% of the mothers, scores on the Sense of Competence and Social Isolation subscales deteriorated during the study period from the not-high-risk range to the high-risk range, regardless of assignment to GWCC or IWCC. No differences were noted between GWCC and IWCC mothers for any functional outcome. During the study period, 8.8% of children receiving GWCC were referred to Child Protective Services vs 8.3% of those receiving IWCC (P=.85).

Conclusion  The format of well-child care may not be an important determinant of outcomes among high-risk mothers.

From the Department of Pediatrics, Division of General Pediatrics, University of Washington (Drs Taylor and Kemper), and the Department of Family Medicine, Swedish Medical Center (Dr Kemper), Seattle.

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