{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:52:09Z","timestamp":1782489129054,"version":"3.54.5"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong evidence base for improving perinatal outcomes, but less than half of eligible women enroll.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess whether WIC enrollment is improved with direct digital referrals from prenatal care to WIC and\/or a registered dietitian nutritionist (RDN) compared with usual care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this 4-arm randomized clinical trial, pregnant participants were enrolled in 2024 and followed up for 6 months in a large integrated health system in Pennsylvania. Pregnant participants who met WIC income eligibility were recruited, and 1539 potential participants were identified through the electronic health record (EHR) and sent recruitment materials. Data were analyzed from April 29, 2024, to June 11, 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Four models were compared, and individuals in all models received usual prenatal care. Model 1 provided patients with WIC written information. Model 2 provided patients with a direct digital referral to WIC. Model 3 provided WIC written information plus a digital referral to an RDN for telehealth counseling (1 session monthly for 6 months). Model 4 provided a combination digital referral to WIC and RDN. WIC and RDNs contacted participants after receiving referrals to arrange care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was measure of the difference in WIC enrollment via participant survey at 6-month follow-up.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 514 pregnant participants who completed screening, 140 were ineligible and 134 were not interested. Of 240 eligible, consenting participants (mean [SD] age, 29.2 [6.1] years; mean [SD] gestational age, 17.8 [11.1] weeks), 202 had outcome data. Randomization to digital WIC referral models increased enrollment (models 2 and 4: 78% [80 of 103]) vs no digital referral (models 1 and 3: 65% [64 of 99]) (\n P<\/jats:italic>\n \u2009=\u2009.04). Randomization to RDN (models 3 and 4: 78% [76 of 97]) also increased enrollment vs no RDN (models 1 and 2: 65% [68 of 105]) (\n P<\/jats:italic>\n \u2009=\u2009.03). Compared with model 1 where WIC enrollment was 54% (27 of 50), enrollment was significantly higher in other models (model 2: 75% [41 of 55]; model 3: 76% [37 of 49]; model 4: 81% [39 of 48]; all\n P<\/jats:italic>\n \u2009=\u2009.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of pregnant individuals, both digital WIC referral and RDN referral improved WIC enrollment, offering scalable strategies to improve perinatal health.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT06311799<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.20138","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:30:54Z","timestamp":1782487854000},"page":"e2620138","source":"Crossref","is-referenced-by-count":0,"title":["Direct Digital Referrals From Prenatal Care and WIC Enrollment Among Pregnant Individuals"],"prefix":"10.1001","volume":"9","author":[{"given":"Lisa","family":"Bailey-Davis","sequence":"first","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Department of Population Health Sciences, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Dhanya","family":"Mackeen","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirstie M.","family":"Herb Neff","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Department of Population Health Sciences, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Geisinger Medical Center, Danville, Pennsylvania"},{"name":"Center for Obesity and Metabolic Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Brandt","sequence":"additional","affiliation":[{"name":"Center for Kidney Health Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Ditchey","sequence":"additional","affiliation":[{"name":"Geisinger Health Plan, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawnee","family":"Lutcher","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle A.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Matrey","sequence":"additional","affiliation":[{"name":"Geisinger Health Plan, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Seiler","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Cook","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Center for Obesity and Metabolic Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Welch","sequence":"additional","affiliation":[{"name":"Geisinger Health Plan, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Craig","family":"Wood","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Center for Obesity and Metabolic Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyndell","family":"Wright","sequence":"additional","affiliation":[{"name":"Center for Women\u2019s and Children\u2019s Research, Geisinger College of Health Sciences, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Geisinger College of Health Sciences, Danville, Pennsylvania"},{"name":"Geisinger Medical Center, Danville, Pennsylvania"},{"name":"Center for Kidney Health Research, Geisinger College of Health Sciences, Danville, 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Health"},{"issue":"1","key":"zoi260561r16","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1186\/s12913-022-08002-5","article-title":"Outcomes from a hybrid implementation-effectiveness study of the living well during pregnancy tele-coaching program for women at high risk of excessive gestational weight gain.","volume":"22","author":"de Jersey","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"10","key":"zoi260561r17","doi-asserted-by":"publisher","DOI":"10.2196\/20720","article-title":"Association between usage of an app to redeem prescribed food benefits and redemption behaviors among the Special Supplemental Nutrition Program for Women, Infants, and Children participants: cross-sectional study.","volume":"8","author":"Zhang","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"zoi260561r18","doi-asserted-by":"publisher","first-page":"3393","DOI":"10.1186\/s12889-024-20509-6","article-title":"Comparing models that integrate obstetric care 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C, Bryant? A, Munkacsy? K, Farson Gray? K. National- and State-level estimates of WIC eligibility and WIC program reach in 2021. U.S. Department of Agriculture Food and Nutrition Service, November 2023. 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