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

Abstract

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.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1522-2) contains supplementary material, which is available to authorized users.

Women‐centered care: Implementation of CenteringPregnancy® in The Netherlands

“…37 These results are encouraging for the further introduction and implementation of the CP model, especially since other models of care seem to be less effective than anticipated in reaching marginalized groups. 29 We evaluated a cross section of low obstetric risk pregnant women starting care in community-based midwifery practices, which could be the reason that we did not find significantly improved differences in neonatal outcomes. 28,40 Our results on neonatal outcomes, however, are less striking.…”

“…29 To carry out subgroup analyses comparing marginalized women to nonmarginalized women, a specific "disadvantaged pregnancy" variable was defined when one or more risk factors were present: BMI >25, smoking at first prenatal appointment, single or living apart from partner, teenager (<20 years), non-Dutch background, or living in a disadvantaged area as defined by postal code. 29 To carry out subgroup analyses comparing marginalized women to nonmarginalized women, a specific "disadvantaged pregnancy" variable was defined when one or more risk factors were present: BMI >25, smoking at first prenatal appointment, single or living apart from partner, teenager (<20 years), non-Dutch background, or living in a disadvantaged area as defined by postal code.…”

“…14,16,18 In addition, a general call for Dutch maternity care reform has emerged from dissatisfied consumer groups demanding a more woman-centered approach. [29][30][31][32] Studies from the United States show that marginalized women receiving CP care are more likely to stop smoking, have better pregnancy outcomes, and are better prepared for birth and parenting. 26,27 Groups are facilitated by a midwife or obstetrician together with a co-facilitator such as a colleague or a practice assistant.…”

“…25 CenteringPregnancy (CP) is an innovative model of prenatal care in which the traditional individual (provider-to-user) prenatal visits are replaced by 10 two-hour group sessions consisting of eight to twelve women with similar gestational ages. 28,29 Within this climate of change in Dutch maternity care, in 2011 midwives received funding to initiate a primary care innovation project that addressed the need for a more client-centered model of prenatal care in The Netherlands. Offering pregnant women medical prenatal checkups, health education, and peer support, this model empowers women to improve their general health and pregnancy outcomes and to make decisions with respect to their pregnancy and birth process.…”

Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices

“…15,[17][18][19] Some studies indicate the model may have particular promise for women with higher-risk conditions. 20 Given that group prenatal care has potential benefits and does not appear to have unintended negative effects, many prenatal care practices want to implement the model. Implementation, however, can be challenging as it requires practitioners and other clinic staff to rethink how care is provided and adjust practices accordingly.…”