BackgroundGroup prenatal care (GC) models are receiving increasing attention as a means of preventing preterm birth; yet, there is limited data on whether group care improves perinatal outcomes in in women who deliver at term.ObjectiveThe purpose of this study was to evaluate our institutional experience with GC over the last decade and test the hypothesis that GC, compared to traditional individual care (TC), improves perinatal outcomes in women who deliver at term.Study DesignWe performed a retrospective cohort study of women delivering at term who participated in GC compared to TC. A group of 207 GC patients who delivered at term from 2004–2014 were matched in a 1:2 ratio to 414 patients with term singleton pregnancies who delivered at our institution during the same period by delivery year, maternal age, race, and insurance status. The primary outcome was low birthweight < 2500g. Secondary outcomes included early term birth (37.0–38 6/7 weeks), 5 minute APGAR score <7, special care nursery admission, neonatal intensive care unit (NICU) admission, neonatal demise, cesarean section, and number of prenatal visits. Outcomes were compared between the two groups using univariable statistics.ResultsBaseline characteristics were similar between the two matched groups. GC was associated with a significant reduction in low birthweight infants compared to TC (11.1% vs. 19.6%; RR 0.57; 95% confidence interval [CI] 0.37–0.87). Patients in GC were significantly less likely than controls to require cesarean delivery, have low 5 min APGAR scores and need higher level neonatal care (NICU: 1.5% vs. 6.5%; RR 0.22; 95% CI 0.07–0.72). There were no significant differences in rates of early term birth and neonatal demise.ConclusionLow-risk women participating in GC and delivering at term had a lower risk of low birthweight and other adverse perinatal outcomes compared to women in TC. This suggests GC is a promising alternative to individual prenatal care to improve perinatal outcomes in addition to preterm birth.
Objective This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities.
Study Design A pilot randomized controlled trial was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of gestational age at first study visit, ability to attend group care at specified times, and willingness to be randomized. Exclusion criteria included type 1 diabetes, multiple gestation, major fetal anomaly, serious medical comorbidity, and serious psychiatric illness. Women were randomized to Diabetes Group Prenatal Care or individual prenatal care. The primary outcome was completion of diabetes self-care activities, including diet, exercise, blood sugar testing, and medication adherence. Secondary outcomes included antenatal care characteristics, and maternal, neonatal, and diabetes management outcomes. Analysis followed the intention-to-treat principle.
Results Of 159 eligible women, 84 (53%) consented to participate in the study and were randomized to group (n = 42) or individual (n = 42) prenatal care. Demographic characteristics were similar between study arms. Completion of diabetes self-care activities was similar overall, but women in group care ate the recommended amount of fruits and vegetables on more days per week (5.1 days/week ± 2.0 standard deviation [SD] in group care vs. 3.4 days ± 2.6 SD in individual care; p < 0.01) and gained less weight per week during the study period (0.2 lbs/week [interquartile range: 0–0.7] vs. 0.5 lbs/week [interquartile range: 0.2–0.9]; p = 0.03) than women in individual care. Women with gestational diabetes randomized to group care were 3.5 times more likely to have postpartum glucose tolerance testing than those in individual care (70 vs. 21%; relative risk: 3.5; 95% confidence interval: 1.4–8.8). Other maternal, neonatal, and pregnancy outcomes were similar between study arms.
Conclusion Diabetes group care is feasible and shows promise for decreasing gestational weight gain, improving diet, and increasing postpartum diabetes testing among women with pregnancies complicated by diabetes.
Key Points
(Abstracted from Am J Perinatol 2020; doi: 10.1055/s-0040-1714209)
Approximately 10% of pregnant women have type 2 diabetes or gestational diabetes mellitus (GDM), increasing the risk of poor perinatal outcomes such as macrosomia, shoulder dystocia, preeclampsia, or cesarean delivery. One potential strategy to help manage these conditions in this patient population is group prenatal care.
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