The Effects of CenteringPregnancy Group Prenatal Care on Gestational Age, Birth Weight, and Fetal Demise

Abstract

We examined the effects of CenteringPregnancy group prenatal care versus individually delivered prenatal care on gestational age, birth weight, and fetal demise. We conducted a retrospective chart review and used propensity score matching to form a sample of 6,155 women receiving prenatal care delivered in a group or individual format at five sites in Tennessee. Compared to the matched group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had longer weeks of gestation (b = .35, 95 % CI [.29, .41]), higher birth weight in grams (b = 28.6, 95 % CI [4.8, 52.3]), lower odds of very low birth weight (OR = .21, 95 % CI [.06, .70]), and lower odds of fetal demise (OR = .12, 95 % CI [.02, .92]). Results indicated no evidence of differences in the odds of preterm birth or low birth weight for participants in group versus individual prenatal care. CenteringPregnancy group prenatal care had statistically and clinically significant beneficial effects on very low birth weight and fetal demise outcomes relative to traditional individually delivered prenatal care. Group prenatal care had statistically significant beneficial effects on gestational age and birth weight, although the effects were relatively small in clinical magnitude.

Perceptions of Barriers and Facilitators During Implementation of a Complex Model of Group Prenatal Care in Six Urban Sites

“…Prenatal physical examinations also take place in the group space, with visual privacy (Novick, 2004;Rising, 1998). CenteringPregnancy produces perinatal outcomes and experiences of care comparable with-or superior toindividual care (Ickovics et al, 2003(Ickovics et al, , 2007(Ickovics et al, , 2009Kennedy et al, 2011;Picklesimer, Billings, Hale, Blackhurst, & Convington-Kolb, 2012;Tanner-Smith, Steinka-Fry, & Lipsey, 2013). Women receiving CenteringPregnancy care are less likely to experience preterm birth and fetal demise, while being more likely to experience longer gestations, higher birth weights, breastfeeding, and improved psychosocial outcomes (Ickovics et al, 2003(Ickovics et al, , 2007(Ickovics et al, , 2011Kennedy et al, 2011;Picklesimer et al, 2012;Tanner-Smith et al, 2013).…”

“…CenteringPregnancy produces perinatal outcomes and experiences of care comparable with-or superior toindividual care (Ickovics et al, 2003(Ickovics et al, , 2007(Ickovics et al, , 2009Kennedy et al, 2011;Picklesimer, Billings, Hale, Blackhurst, & Convington-Kolb, 2012;Tanner-Smith, Steinka-Fry, & Lipsey, 2013). Women receiving CenteringPregnancy care are less likely to experience preterm birth and fetal demise, while being more likely to experience longer gestations, higher birth weights, breastfeeding, and improved psychosocial outcomes (Ickovics et al, 2003(Ickovics et al, , 2007(Ickovics et al, , 2011Kennedy et al, 2011;Picklesimer et al, 2012;Tanner-Smith et al, 2013). In a large randomized controlled trial (RCT) conducted in two urban sites by members of our research team, CenteringPregnancy demonstrated a 33% reduction of likelihood of preterm birth, greater likelihood of improved utilization of care and breastfeeding initiation, reductions in sexually transmitted infections, improved psychological and social outcomes, and increased satisfaction with care (Ickovics et al, 2007;Kershaw, Magriples, Westdahl, Rising, & Ickovics, 2009).…”

Group Prenatal Care Compared With Traditional Prenatal Care

“…Compared with individual care, group prenatal care has been associated with a reduction in preterm birth, increased birth weight in preterm infants, increased initiation of breastfeeding, increased utilization of postpartum family planning services, reduction in emergency visits in the third trimester, and varying degrees of improved satisfaction and increased knowledge. (6–8) However, some studies have reported no differences in pregnancy outcomes between CenteringPregnancy and routine care. (9–11) The most recent Cochrane review included only four RCTs and found no differences in prenatal outcomes between traditional care and group care.…”

`It makes sense and it works': Maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)

“…Group antenatal care (gANC) has been successfully implemented in a number of countries, including Australia (Teate et al, 2011), the United States (Ickovics et al, 2007), and Iran (Jafari et al, 2010). It associated with higher attendance rates and improved health outcomes for women and babies such as reduced incidences of pre-term birth, low birth-weight and caesarean birth (Carter et al, 2017;Catling et al, 2015;Ickovics et al, 2007;Jafari et al, 2010;Tanner-Smith et al, 2014). As part of the Research for Equitable Antenatal Care and Health (REACH) Pregnancy Programme, which aims to improve access to, and experiences of, antenatal care for women from marginalised and disadvantaged groups, we aimed to test the feasibility of implementing a gANC model prior to conducting a pilot and full randomised controlled trial comparing gANC with standard one to one antenatal care.…”