Group Prenatal Care and Perinatal Outcomes

Abstract

OBJECTIVE-To determine whether group prenatal care improves pregnancy outcomes, psychosocial function, and patient satisfaction and to examine potential cost differences.METHODS-A multisite randomized controlled trial was conducted at two university-affiliated hospital prenatal clinics. Pregnant women aged 14−25 years (n=1,047) were randomly assigned to either standard or group care. Women with medical conditions requiring individualized care were excluded from randomization. Group participants received care in a group setting with women having the same expected delivery month. Timing and content of visits followed obstetric guidelines from week 18 through delivery. Each 2-hour prenatal care session included physical assessment, education and skills building, and support through facilitated group discussion. Structured interviews were conducted at study entry, during the third trimester, and postpartum.RESULTS-Mean age of participants was 20.4 years; 80% were African American. Using intentto-treat analyses, women assigned to group care were significantly less likely to have preterm births compared with those in standard care: 9.8% compared with 13.8%, with no differences in age, parity, education, or income between study conditions. This is equivalent to a risk reduction of 33% (odds ratio 0.67, 95% confidence interval 0.44−0.99, P=.045), or 40 per 1,000 births. Effects were strengthened for African-American women: 10.0% compared with 15.8% (odds ratio 0.59, 95% confidence interval 0.38−0.92, P=.02). Women in group sessions were less likely to have suboptimal prenatal care (P<.01), had significantly better prenatal knowledge (P<.001), felt more ready for labor and delivery (P<.001), and had greater satisfaction with care (P<.001). Breastfeeding initiation was higher in group care: 66.5% compared with 54.6%, P<.001. There were no differences in birth weight nor in costs associated with prenatal care or delivery. There have been prior randomized controlled trials on augmented prenatal care to reduce preterm birth. 4-10 Hobel et al 4 reported a 19% reduction in preterm birth among high-risk patients in county clinics randomized to an enhanced program that included education and increased visits. Klerman et al 5 reported significantly increased patient satisfaction and knowledge. Although rates of preterm delivery, cesarean delivery, and length of stay in the neonatal intensive care unit decreased, there was no statistically significant difference. Results of other randomized controlled trials of augmented care are equivocal, 6-10 except among certain subgroups: primiparous mothers 7 and high-risk African-American women. 8,10 Lu et al 11 suggest that preterm birth prevention will require a reconceptualization of prenatal care as part of a broader strategic approach. CONCLUSION-GroupGroup prenatal care (CenteringPregnancy, Cheshire, CT) has been implemented in over 100 clinical practices in the United States and abroad since 1995. 12-13 It provides an integrated approach to prenatal care in a group setting, i...

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