Abstract
BackgroundGroup visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain.MethodsA keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I2 statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies.ResultsOne RCT, one secondary analysis of an RCT, one study with “random assignment”, and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97–1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79–1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis.ConclusionsGroup prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain.
Highlights
Since pregnancy is a time when women may be motivated to improve their health behaviors, it is often considered the optimal time to intervene on health behaviors such as eating habits and physical activity so that gestational weight gain goals are met and perinatalKominiarek et al BMC Pregnancy and Childbirth (2019) 19:18 gain counseling so as to avoid excessive gestational weight gain
Data synthesis The primary outcome was the occurrence of excessive gestational weight gain as determined by body mass index and the Institute of Medicine guidelines, but we evaluated the occurrence of adequate gestational weight gain
Given the low overall quality values, we separately evaluated studies in the top tertile quality scores based on the range and distribution of scores and found that excessive gestational weight gain was higher in group compared to traditional care [pooled rates 45% (1608/3207) vs. 39% (3631/8149), Relative risks (RR) 1.15, 95% confidence intervals (CI) 1.01–1.30] (Fig. 3)
Summary
Since pregnancy is a time when women may be motivated to improve their health behaviors, it is often considered the optimal time to intervene on health behaviors such as eating habits and physical activity so that gestational weight gain goals are met and perinatalKominiarek et al BMC Pregnancy and Childbirth (2019) 19:18 gain counseling so as to avoid excessive gestational weight gain. Group visits for weight management in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to usual care [9, 10]. Evidence suggests that compared to those receiving traditional individual prenatal care, women who receive group prenatal care have lower rates of preterm birth and cesarean delivery and higher rates of breastfeeding and knowledge and satisfaction with prenatal care. These findings have not been consistent and the mechanism for the possible improvement in outcomes is unknown [11,12,13,14]. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain
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