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.
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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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    • "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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