Effect Of Group Prenatal Care Research Articles

Racial and Ethnic Disparities in the Effects of Group Prenatal Care On Identification of Intimate Partner Violence: Findings from a Randomized Controlled Trial of CenteringPregnancy

Abstract Purpose Intimate Partner Violence (IPV) during pregnancy can have serious consequences for maternal, infant, and child health. Importantly, the risk and consequences of IPV are greater for Black and Hispanic pregnant individuals than for White pregnant individuals. Thus, identification of IPV and referral to services during pregnancy is important, particularly for Black and Hispanic patients. Continuity of care and patient-centered care are thought to be essential for the identification of IPV in healthcare settings. Thus, we proposed that group prenatal care, which involves prenatal care providers delivering health, education, and support services to patients in a group setting, would create an atmosphere that is conducive to the identification of IPV. We specifically expected to see this effect among Black and Hispanic patients because group prenatal care has been hypothesized to increase the quality of the provider-patient relationship and reduce clinical bias against patients of color. Methods We conducted a secondary analysis of data from a randomized controlled trial of CenteringPregnancy (N = 523). Results We found that group prenatal care does have a significant, positive effect on IPV identification among prenatal care patients, but only for White women. Members of other racial and ethnic groups, who are at increased risk of experiencing IPV and its harmful consequences, do not receive this benefit. Conclusions Moving forward, researchers and practitioners should establish whether group prenatal care could be improved by intentionally incorporating a curriculum that directly addresses racial and ethnic disparities in quality of healthcare. Trial Registration Number and Date NCT02640638 (Prospectively registered 12/29/2015).

The Effect of Group Prenatal Care on the Empowerment of Pregnant Adolescents

Objectives: This study aimed to evaluate the effect of group prenatal care (GPNC) on the empowerment of pregnant adolescents. Methods: In this trial, 294 pregnant adolescents (aged 15–19 years) were randomly assigned into the GPNC (n = 147) and individual prenatal care (IPNC; n = 147) groups, where they received 5 sessions of GPNC (90–120 min) and IPNC, respectively, between the 16th and 40th weeks of pregnancy. The empowerment of participants in the two groups was measured using the Empowerment Scale for Pregnant Women. Data were analysed using various tests. Results: The mean total score of pregnant women’s empowerment in both groups after the intervention was 86.46 ± 4.95 and 81.89 ± 4.75, respectively (β = 6.11, 95% confidence interval: 4.89, 7.33; P <0.0001). Conclusion: GPNC can improve pregnant adolescent empowerment. The current study’s results can provide a foundation for implementing the GPNC model in Iran. Keywords: Adolescent Pregnancy; Empowerment; Centring Prenatal Care; Group Prenatal Care.

Randomized Controlled Trial on the Effect of Group Versus Individual Prenatal Care on Psychosocial Outcomes

ObjectiveTo assess the effect of group prenatal care (GPNC) compared with individual prenatal care (IPNC) on psychosocial outcomes in late pregnancy, including potential differences in outcomes by subgroups. DesignRandomized controlled trial. SettingAn academic medical center in the southeastern United States. ParticipantsA total of 2,348 women with low-risk pregnancies who entered prenatal care before 20 6/7 weeks gestation were randomized to GPNC (n = 1,175) or IPNC (n = 1,173) and stratified by self-reported race and ethnicity. MethodsWe surveyed participants during enrollment (M = 12.21 weeks gestation) and in late pregnancy (M = 32.51 weeks gestation). We used standard measures related to stress, anxiety, coping strategies, empowerment, depression symptoms, and stress management practices in an intent-to-treat regression analysis. To account for nonadherence to GPNC treatment, we used an instrumental variable approach. ResultsThe response rates were high, with 78.69% of participants in the GPNC group and 83.89% of participants in the IPNC group completing the surveys. We found similar patterns for both groups, including decrease in distress and increase in anxiety between surveys and comparable levels of pregnancy empowerment and stress management at the second survey. We identified greater use of coping strategies for participants in the GPNC group, particularly those who identified as Black or had low levels of partner support. ConclusionGroup prenatal care did not affect stress and anxiety in late pregnancy; however, the increased use of coping strategies may suggest a benefit of GPNC for some participants.

Rates of hypertensive disorders of pregnancy in group versus individual prenatal care: CRADLE secondary analysis

Little is known about the effect of group prenatal care (GPNC) on hypertensive disorders of pregnancy (HDP). Approximately 10% of pregnancies are complicated by a hypertensive disorder, with Black women being affected at higher rates. We hypothesized that women attending GPNC will have decreased rates of HDP compared to those attending traditional individual prenatal care (IPNC).

Effect of Group Prenatal Care on Contraceptive Use at Twelve Weeks Postpartum [5H

INTRODUCTION: We compared the prevalence of contraceptive use by 12 weeks postpartum among women who participated in group prenatal care (GPC) vs. traditional prenatal care (TPC) and investigated differences in contraceptive method choice by type of prenatal care. METHODS: We performed a retrospective review of patients who received GPC or TPC and followed up within 12 weeks of delivery, between January 1 and December 31, 2017, at our institution, after receiving IRB approval. Postpartum contraceptive methods were analyzed by effectiveness (Tier 1, long-acting reversible contraception and sterilization; Tier 2, hormonal methods; Tier 3, barrier and fertility awareness methods, withdrawal, spermicide; and no method) using Chi-square and multivariate logistic regression. RESULTS: 122 participants in GPC and 121 in TPC were included. The prevalence of any contraceptive use by 12 weeks postpartum was 70.5% and 68.6% for GPC and TPC, respectively (P=.75). After controlling for demographic and clinical factors, there was no difference in Tier 1 versus other contraceptive use (aOR 0.92, 95% CI 0.81-1.07, P=.31). Participants in GPC were significantly more likely to select Tier 2 contraceptive methods (aOR 1.19, 95% CI 1.03-1.36, P=.02), and attendance at each additional GPC visit increased the odds of selecting a Tier 2 method (aOR 1.02, 95% CI 1.00-1.04, P=.03). CONCLUSION: There was no difference in the prevalence of contraceptive use at 12 weeks postpartum among women who received group compared to traditional prenatal care in this study. Participation in GPC was associated with increased use of Tier 2 contraceptive methods in a dose-dependent fashion, regardless of sociodemographics.

The Effects of Group Prenatal Care on Infant Birthweight and Maternal Well-Being: A Randomized Controlled Trial.

Group prenatal care models have been in use in the USA for over 20 years and have shown benefits in reducing rates of preterm birth and low birth weight infants in high-risk civilian populations. Group prenatal care has been widely implemented at military treatment facilities, despite a lack of high-quality evidence for improved perinatal outcomes in this population. In this randomized, controlled trial, 129 patients at a military treatment facility received either traditional one-on-one prenatal care or group prenatal care using the CenteringPregnancy model. CenteringPregnancy care was administered by certified nurse midwives and family medicine residents and faculty. The primary outcomes were infant birthweight appropriateness for gestational age, maternal anxiety (as measured by the State-Trait Anxiety Inventory) and depression (as measured by the Center for Epidemiologic Studies-Depression scale), and patient satisfaction (as measured by the Short-Form Patient Satisfaction Questionnaire). Infant birthweights were compared using Chi-square tests for the categorical variables of small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age. Maternal mood and satisfaction scores were evaluated before, during, and after the intervention and analyzed using rank sum tests. Additional demographic and outcome data were collected directly from participants and extracted from patient records. Patients receiving group care were more likely to deliver an infant that was appropriate for gestational age, with an incidence ratio of 1.12 [CI = 1.01-1.25, p = 0.04]. Depression and anxiety levels remained similar between groups throughout the study. Satisfaction was similar between groups, though patients receiving group care reported higher satisfaction with the accessibility and convenience of their care at the study's end [p = 0.048]. There were no differences between groups in preterm births, maternal or neonatal morbidity, mode of delivery, maternal weight gain, or breastfeeding rates. Military parturients receiving group prenatal care in the CenteringPregnancy model were less likely to deliver an small for gestational age or large for gestational age newborn and were more likely to be satisfied with their access to care. Group prenatal care is well received by patients and may positively influence neonatal metabolic status.

The effect of group prenatal care for women with diabetes on social support and depressive symptoms: a pilot randomized trial

Objective: To measure the impact of group prenatal care (GPC) on diabetes-specific peer support and depressive symptoms in women with pregnancies complicated by diabetes.Materials and methods: This is a planned secondary analysis of a two-center pilot randomized controlled trial conducted at Denver health (DH) and Washington University in St. Louis (WU) including Spanish (DH) or English (WU) speaking women with type 2 or gestational diabetes. Women were randomized to diabetes GPC or individual prenatal care (IPC) in the resident diabetes clinic. Participants completed an Edinburgh Postnatal Depression Scale (EPDS) at randomization, at 38-week gestation and at 6–12 weeks postpartum. The diabetes support scale (DSS), which includes 12 questions answered on a Likert scale, was administered at 38 weeks. Analysis was by intention to treat (clincaltrials.gov#NCT02444325).Results: A total of 84 women were consented and randomized. Six withdrew consent (two from each cohort) or were lost to follow-up (two from IPC), and three did not complete the 38-week assessment (two from GPC and one from IPC), resulting in primary outcome data available for 75 women: 38 in GPC and 37 in IPC. More women randomized to GPC reported composite positive peer support on the DSS (52.5 versus 26.3%; p < .02). There were no differences in EPDS scores, depression (EPDS >10), or rates of improved EPDS score from baseline to 38 weeks.Conclusion: GPC for women with diabetes is associated with improved diabetes-specific peer social support with no significant impact on depressive symptoms.Clinical trial registration: Clincaltrials.gov NCT02444

Group Prenatal Visits: Maternal and Neonatal Health Outcomes.

Most studies evaluating the effect of group prenatal care on maternal and neonatal health outcomes assess the CenteringPregnancy model, which follows a set structure and educational curriculum. Group prenatal visits (GPVs) bring together pregnant patients for visits that include education and a health evaluation. GPVs represent a more flexible method of delivering group prenatal care, compared with CenteringPregnancy. Our study sought to determine whether GPV participation affects maternal and neonatal health outcomes. The Myers Park Obstetrics and Gynecology Clinic is located in Charlotte, North Carolina, and serves a racially, ethnically, and socioeconomically diverse population. GPVs were offered at the clinic between July 2014 and July 2015. Retrospective data were collected for women who obtained prenatal care, either GPV or individual care, during that period. Demographic, birth, and postpartum data were extracted from the electronic health record. GPV participants were categorized by the percent of prenatal visits that were GPVs (limited GPV: <30% of visits as GPV; moderate GPV: ≥30% of visits as GPV). Logistic regression models were created to assess the effect of GPV participation on low birth weight, preterm birth, cesarean birth, and postpartum visit attendance. There were 355 study participants (GPV n = 78, individual care n = 277). Among GPV participants, 52.6% were classified as limited GPV, and 47.4% were classified as moderate GPV. The adjusted analysis showed limited-GPV patients had lower odds of postpartum visit attendance, compared with individual-care patients (odds ratio, 0.48; 95% CI, 0.24-0.94). Neither the unadjusted nor adjusted models demonstrated a statistically significant association between GPV participation and low birth weight, preterm birth, or cesarean birth. GPVs for prenatal care can be implemented without negative effects on maternal or neonatal health. However, fidelity to a more comprehensive model of group prenatal care may be necessary to achieve health outcome improvements.

A systematic overview of the literature regarding group prenatal care for high-risk pregnant women

BackgroundGroup prenatal care (GPC) models have been gaining popularity in recent years. Studies of high-risk groups have shown improved outcomes. Our objective was to review and summarize outcomes for women in GPC for women with specific high-risk conditions.MethodsA systematic literature review of Ovid, PubMed, and Google Scholar was performed to identify studies reporting the effects of group prenatal care in high-risk populations. Studies were included if they reported on pregnancy outcome results for women using GPC. We also contacted providers known to be utilizing GPC for specific high-risk women. Descriptive results were compiled and summarized by high-risk population.ResultsWe identified 37 reports for inclusion (8 randomized trials, 23 nonrandomized studies, 6 reports of group outcomes without controls). Preterm birth was found to be decreased among low-income and African American women. Attendance at prenatal visits was shown to increase among women in GPC in the following groups: Opioid Addiction, Adolescents, and Low-Income. Improved weight trajectories and compliance with the IOM’s weight recommendations were found in adolescents. Increased rates of breastfeeding were found in adolescents and African Americans. Increased satisfaction with care was found in adolescents and African Americans. Pregnancy knowledge was increased among adolescents, as was uptake of LARC. Improved psychological outcomes were found among adolescents and low-income women. Studies in women with diabetes demonstrated that fewer women required treatment with medication when exposed to GPC, and for those requiring treatment with insulin, GPC individuals required less than half the dose. Among women with tobacco use, those who had continued to smoke after finding out they were pregnant were 5 times more likely to quit later in pregnancy if they were engaged in GPC.ConclusionsSeveral groups of high-risk pregnant women may have benefits from engaging in group prenatal care. Because there is a paucity of high-quality, well-controlled studies, more trials in high-risk women are needed to determine whether it improves outcomes and costs of pregnancy-related care.

Group Prenatal Care and Its Effects on Triage Visits [12E

INTRODUCTION: Group prenatal care has a positive impact on patients and their pregnancy. We investigated effects of group prenatal care on number of patient initiated triage visits, gestational age at delivery, breastfeeding initiation rates, and attendance at postpartum visit. METHODS: Pregnant women receiving traditional prenatal care at a private obstetric clinic, traditional prenatal care at a resident clinic, and group prenatal care were compared through single-site, retrospective chart review. Multiple gestations, prenatal care beginning after 20 weeks gestation, and patients without documented delivery were excluded. The number of triage visits, gestational age at delivery, breastfeeding initiation, and postpartum visit attendance was collected through chart review. We used Zero-inflated Poisson regression to analyze triage visits and Chi-square analysis to analyze gestational age at delivery, feeding methods, and postpartum appointment attendance. RESULTS: Group prenatal care patients had increased patient initiated triage visits (p=0.0187). There was no difference between private patients compared to group prenatal care patients or when comparing private patients to resident patients. Group care patients had higher breastfeeding initiation (70%) than private (63%) and resident patients (57%), (P=0.3777). Postpartum visit attendance was higher in group care (95%) than in private (84%) and resident patients (81%) (P=0.1240). There were no differences in gestational age at delivery (P=0.122). CONCLUSION: Group prenatal care patients present more often to triage for evaluation than those receiving routine prenatal care, possibly due to increased education and symptom awareness in this patient group. Although not statistically significant, group prenatal care patients have slightly higher breastfeeding initiation rates, and postpartum appointment attendance.

Effects of Group Prenatal Care on Connection to Site of Care [27D

INTRODUCTION: Centering Pregnancy, a form of group prenatal care, provides greater contact time and continuity of care with providers. We sought to determine if this approach impacts factors that serve as measures of affiliation with prenatal care site and prenatal care providers. METHODS: Retrospective case-control study at a single institution between 2012-2015. Individuals in group care were matched to controls in traditional care by gestational age at enrollment. Inclusion criteria included: greater than 17 years old and initiation of care at less than 16 weeks. Exclusion criteria included transfer to high-risk providers and miscarriage at less than 16 weeks gestation. Prenatal care, delivery, and postpartum information were collected on all participants. Outcomes of interest included: number of scheduled visits attended, institution at which delivery occurred, and attendance at postpartum visit. RESULTS: A total of 226 patients were included (124 cases and 101 controls). The gestational age at enrollment (9w5d v 10w3d) and gestational age at delivery (39w3d v 39w3d) did not differ between the groups. There was no significant difference between the percentages of prenatal care visits attended (80% vs 83.3%). Centering patients were significantly more likely to deliver at their home institution than controls (95.3% v 79.2%, p = 0.001). In addition, a significantly greater number of patients in group prenatal care attended a postpartum visit (81.1% v 68.3%, p = 0.03). CONCLUSION: Group prenatal care was associated with greater connection with home institution leading to increased number of individuals delivering at the home institution and attending a postpartum visit.

Group Prenatal Care Compared With Traditional Prenatal Care: A Systematic Review and Meta-analysis.

To estimate the effect of group prenatal care on perinatal outcomes compared with traditional prenatal care. We searched MEDLINE through PubMed, EMBASE, Scopus, Cumulative Index of Nursing and Allied Health literature, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. We searched electronic databases for randomized controlled trials and observational studies comparing group care with traditional prenatal care. The primary outcome was preterm birth. Secondary outcomes were low birth weight, neonatal intensive care unit admission, and breastfeeding initiation. Heterogeneity was assessed using the Q test and I statistic. Pooled relative risks (RRs) and weighted mean differences were calculated using random-effects models. Four randomized controlled trials and 10 observational studies met inclusion criteria. The rate of preterm birth was not significantly different with group care compared with traditional care (11 studies: pooled rates 7.9% compared with 9.3%, pooled RR 0.87, 95% confidence interval [CI] 0.70-1.09). Group care was associated with a decreased rate of low birth weight overall (nine studies: pooled rate 7.5% group care compared with 9.5% traditional care; pooled RR 0.81, 95% CI 0.69-0.96), but not among randomized controlled trials (four studies: 7.9% group care compared with 8.7% traditional care, pooled RR 0.92, 95% CI 0.73-1.16). There were no significant differences in neonatal intensive care unit admission or breastfeeding initiation. Available data suggest that women who participate in group care have similar rates of preterm birth, neonatal intensive care unit admission, and breastfeeding.

Effects of Group Prenatal Care on Food Insecurity during Late Pregnancy and Early Postpartum.

This study compared the effects of group to individual prenatal care in late pregnancy and early postpartum on (1) women's food security and (2) psychosocial outcomes among food-insecure women. We recruited 248 racially diverse, low-income, pregnant women receiving CenteringPregnancy™ group prenatal care (N = 124) or individual prenatal care (N = 124) to complete surveys in early pregnancy, late pregnancy, and early postpartum, with 84 % completing three surveys. Twenty-six percent of group and 31 % of individual care participants reported food insecurity in early pregnancy (p = 0.493). In multiple logistic regression models, women choosing group versus individual care were more likely to report food security in late pregnancy (0.85 vs. 0.66 average predicted probability, p < 0.001) and postpartum (0.89 vs. 0.78 average predicted probability, p = 0.049). Among initially food-insecure women, group participants were more likely to become food-secure in late pregnancy (0.67 vs. 0.35 individual care average predicted probability, p < 0.001) and postpartum (0.76 vs. 0.57 individual care average predicted probability, p = 0.052) in intention-to-treat models. Group participants were more likely to change perceptions on affording healthy foods and stretching food resources. Group compared to individual care participants with early pregnancy food insecurity demonstrated higher maternal-infant attachment scale scores (89.8 vs. 86.2 points for individual care, p = 0.032). Group prenatal care provides health education and the opportunity for women to share experiences and knowledge, which may improve food security through increasing confidence and skills in managing household food resources. Health sector interventions can complement food assistance programs in addressing food insecurity during pregnancy.

Effects of Group Prenatal Care on Food Insecurity

The 2013 Lancet Nutrition Series highlighted the importance of nutrition-sensitive interventions across multiple sectors, including the health sector. This study compared the effects of group to individual prenatal care on women's food security. We recruited 248 racially diverse, low-income, pregnant women receiving group (N=124) or individual prenatal care (N=124) to complete surveys in early and late pregnancy and early postpartum, with 84% completing three surveys. Multiple logistic regression models compared changes in food security by prenatal care model. Among women initially food insecure, group participants were more likely to become food secure in late pregnancy (0.64 compared to 0.36 average predicted probability, p<0.001). Initially food-insecure women who remained in group care through pregnancy were more likely to become food secure postpartum (0.77 compared to 0.59 average predicted probability, p=0.045). Among women initially food secure, group participants were more likely to maintain food security in late pregnancy (0.92 compared to 0.76 average predicted probability, p<0.001). Group participants were more likely to change perceptions on affording healthy foods and stretching food resources. Group prenatal care provides health education and the opportunity for women to share experiences and knowledge, which may improve confidence and skills in managing household food resources. Health sector interventions can complement food assistance programs in addressing food insecurity among pregnant women. Funded by AHRQ and the USDA RIDGE Program.

Group Prenatal Care Versus Individual Prenatal Care: A Systematic Review and Meta-Analyses

ObjectiveTo compare the effects of group prenatal care (GPC) and individual prenatal care (IPC) on perinatal health outcomes, including our primary outcomes of preterm birth (PTB < 37 weeks) and low birth weight (< 2500 g). Data SourcesWe searched Medline, Embase, CINAHL, and the references of selected articles. Study SelectionTwo reviewers independently performed each step of the systematic review. Of the 4178 non-duplicate titles and abstracts identified, 77 were selected for full-text review. An additional eight full-text articles were selected from reference lists. Overall, 85 full-text articles were reviewed. Studies included assessed maternal or infant health outcomes. Data Extraction and Data SynthesisTwo reviewers independently extracted data from eligible full-text articles. Statistical analyses were completed using Review Manager, version 5.0 (Copenhagen: The Nordic Cochrane Centre, Cochrane Collaboration, 2011), whereby dichotomous variables and continuous outcomes were analyzed using relative risk and mean difference, respectively. The random effects model was employed to pool data. Where available, adjusted data were used to assess the independent effect of GPC. Eight studies of mostly low quality (three randomized controlled trials and five cohort studies) were included, involving 3242 women, most at high risk. Women randomized to GPC had lower rates of PTB (RR 0.71; 95% CI 0.52 to 0.96), no difference in rates of LBW (RR 0.91; 95% CI 0.65 to 1.27) or IUGR (RR 0.85; 95% CI 0.61 to 1.19), fewer Caesarean sections (RR 0.80; 95% CI 0.67 to 0.93), and slightly higher rates of breastfeeding (RR 1.08; 95%CI 1.02 to 1.14). ConclusionStudies comparing GPC with IPC are mostly of low quality and in high-risk groups, although two randomized studies, one a secondary analysis, showed improvement in some outcomes, including rates of PTB in women participating in GPC. In order to determine generalizability, more high-quality studies of GPC are needed.

Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial

Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14–25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This ‘bundled’ intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.