Group Prenatal Care and Perinatal Outcomes

School of Public Health, Yale University, 60 College Street, New Haven, CT 06520-8034, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 08/2007; 110(2 Pt 1):330-9. DOI: 10.1097/01.AOG.0000275284.24298.23
Source: PubMed


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 intent- to-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

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    • "Interpersonal (mesosystems) level Ickovics et al. 75 (2007) Mixed methods: multisite RCT, structured interview at enrollment, 3rd trimester, and postpartum; New Haven, CT and Atlanta, GA n = 1,047, 80% AA 20 hours of peer group prenatal care with women of the same delivery month at an urban hospital clinic "
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    ABSTRACT: Abstract The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.
    Breastfeeding Medicine 11/2014; 10(1). DOI:10.1089/bfm.2014.0023 · 1.25 Impact Factor
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    • "Another prospective, matched cohort evaluation of CP that included 458 pregnant women who began prenatal care at 24 or less weeks of gestation reported that CP resulted in significantly higher birth weight infants [21]. In a large randomized controlled trial, which focused on 14–25-year old pregnant women (n = 1,047), the risk for preterm birth was significantly reduced by 33% for women in group care, with the effects strengthened for African-American women, whose risk was reduced by 41% [22]. In a recent cohort study (n = 4,083), significant reductions in racial disparities were also found [23]. "
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    ABSTRACT: Background: Centering Pregnancy (CP) is an effective method of delivering prenatal care, yet providers have been slow to adopt the CP model. Our main hypothesis is that a site's adoption of CP is contingent upon knowledge of the CP, characteristics health care personnel, anticipated patient impact, and system readiness. Methods: Using a matched, pretest-posttest, observational design, 223 people completed pretest and posttest surveys. Our analysis included the effect of the seminar on the groups' knowledge of CP essential elements, barriers to prenatal care, and perceived value of CP to the patients and to the system of care. Results: Before the CP Seminar only 34% of respondents were aware of the model, while knowledge significantly after the Seminar. The three greatest improvements were in understanding that the group is conducted in a circle, the health assessment occurs in the group space, and a facilitative leadership style is used. Child care, transportation, and language issues were the top three barriers. The greatest improvements reported for patients included improvements in timeliness, patient-centeredness and efficiency, although readiness for adoption was influenced by costs, resources, and expertise. Discussion: Readiness to adopt CP will require support for the start-up and sustainability of this model.
    The Scientific World Journal 02/2014; 2014:285386. DOI:10.1155/2014/285386 · 1.73 Impact Factor
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    • "One-on-one lifestyle interventions such as the Diabetes Prevention Program are costly and did not target pregnant women [17]. However, group interventions have been found to be both acceptable and effective in promoting positive pregnancy behaviors [18,19]. Studies of women with GDM have found self-efficacy to be one of the few modifiable predictors of physical activity [20-22]. "
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    ABSTRACT: Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina. Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3 months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22--36 weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22--36 weeks pregnant) to 10 months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10 months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10 months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10 months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting. Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations.Trial registrationNCT01809431.
    BMC Pregnancy and Childbirth 10/2013; 13(1):184. DOI:10.1186/1471-2393-13-184 · 2.19 Impact Factor
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