The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

Heberlein, Emily; Smith, Jean; Willis, Carla; Hall, Wendasha Jenkins; Covington-Kolb, Sarah; Crockett, Amy

doi:10.1016/j.contraception.2020.02.010

Cited by 15 publications

(13 citation statements)

References 35 publications

(39 reference statements)

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“…Our primary analysis of between-group differences in outcomes of interest included all participants who completed the postpartum survey regardless of the number (dose) of prenatal care visits attended (ie, group prenatal care visits for participants in the GMPC group and in-person or virtual individual visits for those in the IMPC group). We conducted 3 secondary analyses stratified on varying levels of prenatal care use (dose-stratified analyses); we compared outcomes of GMPC vs IMPC participants who completed at least 1 prenatal care visit (DS1), 5 prenatal care visits (DS5), and 70% of prenatal care visits (DS70%) The 5-visit threshold was based on previous research defining this cutoff as a marker of adequate exposure to in-person group prenatal care . The 70% threshold was conducted to address variation in the number of virtual GMPC group sessions offered by KPNC clinics, which ranged from 7 to 10.…”

Section: Discussionmentioning

confidence: 99%

Group Multimodal Prenatal Care and Postpartum Outcomes

Avalos,

Oberman,

Gomez

et al. 2024

JAMA Netw Open

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ImportanceAn increasing body of evidence suggests equivalent if not improved postpartum outcomes of in-person group prenatal care compared with individual prenatal care. However, research is needed to evaluate outcomes of group multimodal prenatal care (GMPC), with groups delivered virtually in combination with individual in-person office appointments to collect vital signs and conduct other tests compared with individual multimodal prenatal care (IMPC) delivered through a combination of remotely delivered and in-person visits.ObjectiveTo compare postpartum outcomes between GMPC and IMPC.Design, Setting, and ParticipantsA frequency-matched longitudinal cohort study was conducted at Kaiser Permanente Northern California, an integrated health care delivery system. Participants included 424 individuals who were pregnant (212 GMPC and 212 frequency-matched IMPC controls (matched on gestational age, race and ethnicity, insurance status, and maternal age) receiving prenatal care between August 17, 2020, and April 1, 2021. Participants completed a baseline survey before 14 weeks’ gestation and a follow-up survey between 4 and 8 weeks post partum. Data analysis was performed from January 3, 2022, to March 4, 2024.ExposureGMPC vs IMPC.Main Outcome MeasuresValidated instruments were used to ascertain postpartum psychosocial outcomes (stress, depression, anxiety) and perceived quality of prenatal care. Self-reported outcomes included behavioral outcomes (breastfeeding initiation, use of long-acting reversible contraception), satisfaction with prenatal care, and preparation for self and baby care after delivery. Primary analyses included all study participants in the final cohort. Three secondary dose-stratified analyses included individuals who attended at least 1 visit, 5 visits, and 70% of visits. Log-binomial regression and linear regression analyses were conducted.ResultsThe final analytic cohort of 390 participants (95.6% follow-up rate of 408 singleton live births) was racially and ethnically diverse: 98 (25.1%) Asian/Pacific Islander, 88 (22.6%) Hispanic, 17 (4.4%) non-Hispanic Black, 161 (41.3%) non-Hispanic White, and 26 (6.7%) multiracial participants; median age was 32 (IQR, 30-35) years. In the primary analysis, after adjustment, GMPC was associated with a 21% decreased risk of perceived stress (adjusted risk ratio [ARR], 0.79; 95% CI, 0.67-0.94) compared with IMPC. Findings were consistent in the dose-stratified analyses. There were no significant differences between GMPC and IMPC for other psychosocial outcomes. While in the primary analyses there was no significant group differences in perceived quality of prenatal care (mean difference [MD], 0.01; 95% CI, −0.12 to 0.15) and feeling prepared to take care of baby at home (ARR, 1.09; 95% CI, 0.96-1.23), the dose-stratified analyses documented higher perceived quality of prenatal care (MD, 0.16; 95% CI, 0.01-0.31) and preparation for taking care of baby at home (ARR, 1.27; 95% CI, 1.13-1.43) for GMPC among those attending 70% of visits. No significant differences were noted in patient overall satisfaction with prenatal care and feeling prepared for taking care of themselves after delivery.ConclusionsIn this cohort study, equivalent and, in some cases, better outcomes were observed for GMPC compared with IMPC. Health care systems implementing multimodal models of care may consider incorporating virtual group prenatal care as a prenatal care option for patients.

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Section: Discussionmentioning

confidence: 99%

Group Multimodal Prenatal Care and Postpartum Outcomes

Avalos,

Oberman,

Gomez

et al. 2024

JAMA Netw Open

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“…All practices offer both CenteringPregnancy group prenatal care and individual prenatal care for patients who chose not to participate in group prenatal care or who are not eligible due to medical comorbidities, pregnancy complications, or late entry to prenatal care. Twenty-one of the 24 practices had data available for this study; previous research found that SCCPEP’s group prenatal care was associated with decreased rates of preterm birth and low birth weight births and increased rates of postpartum visit attendance (Crockett et al, 2019; Heberlein et al, 2020).…”

Section: Methodsmentioning

confidence: 99%

“…Women participating in the CenteringPregnancy model demonstrate increased participation in preventive health services during and after pregnancy, suggesting that the group model may increase health literacy or patient engagement (DeCesare et al, 2017; Grady & Bloom, 2004; Hale et al, 2014; Heberlein et al, 2020; Kennedy et al, 2009; Picklesimer et al, 2012; Roussos-Ross et al, 2020; Schellinger et al, 2017). Research investigating associations between group prenatal care participation and ER utilization is limited.…”

Section: Introductionmentioning

confidence: 99%

Group Prenatal Care and Emergency Room Utilization

et al. 2021

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Pregnancy-related complaints are a significant driver of emergency room (ER) utilization among women. Because of additional time for patient education and provider relationships, group prenatal care may reduce ER visits among pregnant women by helping them identify appropriate care settings, improving understanding of common pregnancy discomforts, and reducing risky health behaviors. We conducted a retrospective cohort study, utilizing Medicaid claims and birth certificate data from a statewide expansion of group care, to compare ER utilization between pregnant women participating in group prenatal care and individual prenatal care. Using propensity score matching methods, we found that group care was associated with a significant reduction in the likelihood of having any ER utilization (–5.9% among women receiving any group care and –6.0% among women attending at least five group care sessions). These findings suggest that group care may reduce ER utilization among pregnant women and encourage appropriate health care utilization during pregnancy.

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“…Strategies to enhance psychosocial health have been shown to reduce anxiety, empower individuals, and result in better glycemic control among individuals with GD, but they are not aimed to reduce GD risk. Group prenatal care (GPNC) is an innovative model of medical care to improve clinical outcomes and health behaviors and to reduce racial disparities . CenteringPregnancy (Centering Healthcare Institute, Boston, Massachusetts) is the most widely implemented GPNC model and includes a curriculum specifically targeting elements of healthy lifestyle and behaviors (eg, nutrition, exercise, goal setting, and self-care) and psychosocial improvement (eg, stress management, empowerment, and peer and family support) .…”

Section: Introductionmentioning

confidence: 99%

Group vs Individual Prenatal Care and Gestational Diabetes Outcomes

Chen,

Crockett,

Britt

et al. 2023

JAMA Netw Open

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ImportanceThe impact of group-based prenatal care (GPNC) model in the US on the risk of gestational diabetes (GD) and related adverse obstetric outcomes is unknown.ObjectiveTo determine the effects of the GPNC model on risk of GD, its progression, and related adverse obstetric outcomes.Design, Setting, and ParticipantsThis is a single-site, parallel-group, randomized clinical trial conducted between February 2016 and March 2020 at a large health care system in Greenville, South Carolina. Participants were individuals aged 14 to 45 years with pregnancies earlier than 21 weeks’ gestational age; follow-up continued to 8 weeks post partum. This study used an intention-to-treat analysis, and data were analyzed from March 2021 to July 2022.InterventionsEligible participants were randomized to receive either CenteringPregnancy, a widely used GPNC model, with 10 group-based sessions or traditional individual prenatal care (IPNC).Main Outcomes and MeasuresThe primary outcome was the incidence of GD diagnosed between 24 and 30 weeks of gestation. The secondary outcomes included progression to A2 GD (ie, GD treated with medications) and GD-related adverse obstetric outcomes (ie, preeclampsia, cesarean delivery, and large for gestational age). Log binomial models were performed to estimate risk differences (RDs), 95% CIs, and P values between GPNC and IPNC groups, adjusting for all baseline covariates.ResultsOf all 2348 participants (mean [SD] age, 25.1 [5.4] years; 952 Black participants [40.5%]; 502 Hispanic participants [21.4%]; 863 White participants [36.8%]), 1176 participants were randomized to the GPNC group and 1174 were randomized to the IPNC group. Among all participants, 2144 (91.3%) completed a GD screening (1072 participants [91.3%] in GPNC vs 1071 [91.2%] in IPNC). Overall, 157 participants (6.7%) developed GD, and there was no difference in GD incidence between the GPNC (83 participants [7.1%]) and IPNC (74 participants [6.3%]) groups, with an adjusted RD of 0.7% (95% CI, −1.2% to 2.7%). Among participants with GD, GPNC did not reduce the risk of progression to A2 GD (adjusted RD, −6.1%; 95% CI, −21.3% to 9.1%), preeclampsia (adjusted RD, −7.9%; 95% CI, −17.8% to 1.9%), cesarean delivery (adjusted RD, −8.2%; 95% CI, −12.2% to 13.9%), and large for gestational age (adjusted RD, −1.2%; 95% CI, −6.1% to 3.8%) compared with IPNC.Conclusions and RelevanceIn this secondary analysis of a randomized clinical trial among medically low-risk pregnant individuals, the risk of GD was similar between participants who received GPNC intervention and traditional IPNC, indicating that GPNC may be a feasible treatment option for some patients.Trial RegistrationClinicalTrials.gov Identifier: NCT02640638

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The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use

Cited by 15 publications

References 35 publications

Group Multimodal Prenatal Care and Postpartum Outcomes

Group Multimodal Prenatal Care and Postpartum Outcomes

Group Prenatal Care and Emergency Room Utilization

Group vs Individual Prenatal Care and Gestational Diabetes Outcomes

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