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Does group prenatal care improve pregnancy outcomes?
Yes, it may decrease preterm births, especially among higher-risk women—minority women, women of low socioeconomic status, and adolescents (strength of recommendation [SOR]: B, 1 randomized, controlled trial [RCT] and 1 matched cohort study).
Evidence summary
The evidence supporting improved health outcomes resulting from group prenatal care is limited. We found 1 RCT,1 1 matched-cohort study,2 and several pilot studies with descriptive analysis.3-5 All data sets used a trademarked group prenatal care model, CenteringPregnancy. The TABLE summarizes the outcomes of group and individual prenatal care reported in the studies.
Fewer preterm births
One large, unblinded RCT investigated the effect of group prenatal care on a cohort of young, mostly minority women of low economic status. Women who received group prenatal care had fewer preterm births than those who received traditional care (number needed to treat [NNT]=25; P=.045).1
A single cohort study compared pregnant teenagers enrolled in the CenteringPregnancy program with 2 clinic convenience samples. The group care recipients had significantly lower preterm delivery rates (NNT=7; P<.02).3 The study design, and therefore the detected relationship of group care to pregnancy-associated outcomes, may be particularly subject to selection bias.
Birth weight data are inconsistent
The matched cohort study recorded higher birth weights among infants born to mothers in group prenatal care.2 Subset analysis of preterm infants born to mothers in group care showed average birth weights approximately 400 g higher than those in individual care (P<.05).2 The RCT, however, found no clinically or statistically significant differences in birth weights between intervention and control groups.1
TABLE
Pregnancy outcomes: Group vs individual prenatal care
| STUDY | STUDY DESIGN | OUTCOMES: GROUP VS INDIVIDUAL PRENATAL CARE | OR (95% CI) | NNT |
|---|---|---|---|---|
| Ickovics JR et al.1 | RCT N=1047 | Preterm births | 0.67 (0.44-0.98) | 25 |
| Preterm births in African American women | 0.59 (0.38-0.92) | 17 | ||
| Breastfeeding initiation | 1.73 (1.28-2.35) | 8 | ||
| Less-than-adequate prenatal care* | 0.68 (0.50-0.91) | 16 | ||
| RESULTS (P VALUE) | ||||
| Ickovics JR et al.2 | Matched cohort N=458 | Birth weight (g) | 3228 vs 3159 (P<.01) | — |
| Preterm birth weight (g) | 2398 vs 1990 (P<.05) | — | ||
| Grady MA et al.3 | Cohort study with clinic comparison N=124 (intervention) | Preterm births <37 wk (%) | 10.5 vs 25.7 (P<.02) | 7 |
| Low birth weight <2500 g (%) | 8.8 vs 22.9 (P<.02) | 7 | ||
| Breastfeeding at hospital discharge (%) | 46 vs 28 (P<.02) | 6 | ||
| Rising SS4 | Descriptive analysis N=111 | 3rd trimester emergency room visits (%) | 26 vs 74 (P=.001) | 2 |
| Baldwin KA5 | 2-group pre-/post-test design N=98 | Change in prenatal knowledge scores† | 0.98 vs 0.4 (P=.03) | — |
| CI, confidence interval; NN T, number needed to treat; OR, odds ratio. | ||||
| *Kotelchuck Adequacy of Prenatal Care Utilization Index, a validated scoring scale encompassing timing of initiation of care, number of visits, and quality and content of prenatal care. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and the proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994;84:1414-1420. | ||||
| †Patient Participation and Satisfaction questionnaire. Littlefield V, Adams B. Patient participation in alternative perinatal care: impact on satisfaction and health locus of control. Res Nurs Health. 1987;10:139-148. | ||||
Group care boosts breastfeeding, knowledge, and satisfaction
The RCT and the cohort study showed increased rates of breastfeeding initiation (NNT=8 and 6, respectively).1,3 The RCT demonstrated that patients in group care more often had adequate prenatal care (NNT=16).1 One cohort trial found that women enrolled in group prenatal care used the emergency department less during the third trimester (NNT=2, P=.001).4
Several studies have reported improved pregnancy knowledge and high levels of satisfaction with group prenatal care. The RCT showed increased knowledge and readiness for labor, and higher satisfaction compared with individual care (P<.001 for all outcomes).1 Lower-quality studies of group care support these findings.3-5
An innovative model that requires further study
Group prenatal care is a relatively new, innovative model of care, and limited data are available for review. The evidence from 1 RCT and 1 cohort study supports the protective effect of group prenatal care against preterm delivery for women at higher risk of adverse pregnancy outcomes.1,2 Trends toward improved health outcomes were found in lower-quality studies; the trends were large enough to have potential clinical significance. These preliminary findings should be evaluated as primary health outcomes in future research to define the optimal population for group care.
Recommendations
No published guidelines or textbook recommendations exist for group-based prenatal care. In other areas of medical care, including diabetes and low back pain, specialty societies such as the American Diabetes Association and systematic reviews have supported practice changes, including group visits, to improve care.6,7
1. Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and perinatal outcomes: a randomized, controlled trial. Obstet Gynecol. 2007;110:330-339.
2. Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics. Obstet Gynecol. 2003;102:1051-1057.
3. Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. J Midwifery Womens Health. 2004;49:412-420.
4. Rising SS. Centering pregnancy: an interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43:46-54.
5. Baldwin KA. Comparison of selected outcomes of centering pregnancy versus traditional prenatal care. J Midwifery Womens Health. 2006;51:266-272.
6. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):s13-s61.
7. Heymans MW, van Tulder MW, Esmail R, et al. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2005;30:2153-2163.
Yes, it may decrease preterm births, especially among higher-risk women—minority women, women of low socioeconomic status, and adolescents (strength of recommendation [SOR]: B, 1 randomized, controlled trial [RCT] and 1 matched cohort study).
Evidence summary
The evidence supporting improved health outcomes resulting from group prenatal care is limited. We found 1 RCT,1 1 matched-cohort study,2 and several pilot studies with descriptive analysis.3-5 All data sets used a trademarked group prenatal care model, CenteringPregnancy. The TABLE summarizes the outcomes of group and individual prenatal care reported in the studies.
Fewer preterm births
One large, unblinded RCT investigated the effect of group prenatal care on a cohort of young, mostly minority women of low economic status. Women who received group prenatal care had fewer preterm births than those who received traditional care (number needed to treat [NNT]=25; P=.045).1
A single cohort study compared pregnant teenagers enrolled in the CenteringPregnancy program with 2 clinic convenience samples. The group care recipients had significantly lower preterm delivery rates (NNT=7; P<.02).3 The study design, and therefore the detected relationship of group care to pregnancy-associated outcomes, may be particularly subject to selection bias.
Birth weight data are inconsistent
The matched cohort study recorded higher birth weights among infants born to mothers in group prenatal care.2 Subset analysis of preterm infants born to mothers in group care showed average birth weights approximately 400 g higher than those in individual care (P<.05).2 The RCT, however, found no clinically or statistically significant differences in birth weights between intervention and control groups.1
TABLE
Pregnancy outcomes: Group vs individual prenatal care
| STUDY | STUDY DESIGN | OUTCOMES: GROUP VS INDIVIDUAL PRENATAL CARE | OR (95% CI) | NNT |
|---|---|---|---|---|
| Ickovics JR et al.1 | RCT N=1047 | Preterm births | 0.67 (0.44-0.98) | 25 |
| Preterm births in African American women | 0.59 (0.38-0.92) | 17 | ||
| Breastfeeding initiation | 1.73 (1.28-2.35) | 8 | ||
| Less-than-adequate prenatal care* | 0.68 (0.50-0.91) | 16 | ||
| RESULTS (P VALUE) | ||||
| Ickovics JR et al.2 | Matched cohort N=458 | Birth weight (g) | 3228 vs 3159 (P<.01) | — |
| Preterm birth weight (g) | 2398 vs 1990 (P<.05) | — | ||
| Grady MA et al.3 | Cohort study with clinic comparison N=124 (intervention) | Preterm births <37 wk (%) | 10.5 vs 25.7 (P<.02) | 7 |
| Low birth weight <2500 g (%) | 8.8 vs 22.9 (P<.02) | 7 | ||
| Breastfeeding at hospital discharge (%) | 46 vs 28 (P<.02) | 6 | ||
| Rising SS4 | Descriptive analysis N=111 | 3rd trimester emergency room visits (%) | 26 vs 74 (P=.001) | 2 |
| Baldwin KA5 | 2-group pre-/post-test design N=98 | Change in prenatal knowledge scores† | 0.98 vs 0.4 (P=.03) | — |
| CI, confidence interval; NN T, number needed to treat; OR, odds ratio. | ||||
| *Kotelchuck Adequacy of Prenatal Care Utilization Index, a validated scoring scale encompassing timing of initiation of care, number of visits, and quality and content of prenatal care. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and the proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994;84:1414-1420. | ||||
| †Patient Participation and Satisfaction questionnaire. Littlefield V, Adams B. Patient participation in alternative perinatal care: impact on satisfaction and health locus of control. Res Nurs Health. 1987;10:139-148. | ||||
Group care boosts breastfeeding, knowledge, and satisfaction
The RCT and the cohort study showed increased rates of breastfeeding initiation (NNT=8 and 6, respectively).1,3 The RCT demonstrated that patients in group care more often had adequate prenatal care (NNT=16).1 One cohort trial found that women enrolled in group prenatal care used the emergency department less during the third trimester (NNT=2, P=.001).4
Several studies have reported improved pregnancy knowledge and high levels of satisfaction with group prenatal care. The RCT showed increased knowledge and readiness for labor, and higher satisfaction compared with individual care (P<.001 for all outcomes).1 Lower-quality studies of group care support these findings.3-5
An innovative model that requires further study
Group prenatal care is a relatively new, innovative model of care, and limited data are available for review. The evidence from 1 RCT and 1 cohort study supports the protective effect of group prenatal care against preterm delivery for women at higher risk of adverse pregnancy outcomes.1,2 Trends toward improved health outcomes were found in lower-quality studies; the trends were large enough to have potential clinical significance. These preliminary findings should be evaluated as primary health outcomes in future research to define the optimal population for group care.
Recommendations
No published guidelines or textbook recommendations exist for group-based prenatal care. In other areas of medical care, including diabetes and low back pain, specialty societies such as the American Diabetes Association and systematic reviews have supported practice changes, including group visits, to improve care.6,7
Yes, it may decrease preterm births, especially among higher-risk women—minority women, women of low socioeconomic status, and adolescents (strength of recommendation [SOR]: B, 1 randomized, controlled trial [RCT] and 1 matched cohort study).
Evidence summary
The evidence supporting improved health outcomes resulting from group prenatal care is limited. We found 1 RCT,1 1 matched-cohort study,2 and several pilot studies with descriptive analysis.3-5 All data sets used a trademarked group prenatal care model, CenteringPregnancy. The TABLE summarizes the outcomes of group and individual prenatal care reported in the studies.
Fewer preterm births
One large, unblinded RCT investigated the effect of group prenatal care on a cohort of young, mostly minority women of low economic status. Women who received group prenatal care had fewer preterm births than those who received traditional care (number needed to treat [NNT]=25; P=.045).1
A single cohort study compared pregnant teenagers enrolled in the CenteringPregnancy program with 2 clinic convenience samples. The group care recipients had significantly lower preterm delivery rates (NNT=7; P<.02).3 The study design, and therefore the detected relationship of group care to pregnancy-associated outcomes, may be particularly subject to selection bias.
Birth weight data are inconsistent
The matched cohort study recorded higher birth weights among infants born to mothers in group prenatal care.2 Subset analysis of preterm infants born to mothers in group care showed average birth weights approximately 400 g higher than those in individual care (P<.05).2 The RCT, however, found no clinically or statistically significant differences in birth weights between intervention and control groups.1
TABLE
Pregnancy outcomes: Group vs individual prenatal care
| STUDY | STUDY DESIGN | OUTCOMES: GROUP VS INDIVIDUAL PRENATAL CARE | OR (95% CI) | NNT |
|---|---|---|---|---|
| Ickovics JR et al.1 | RCT N=1047 | Preterm births | 0.67 (0.44-0.98) | 25 |
| Preterm births in African American women | 0.59 (0.38-0.92) | 17 | ||
| Breastfeeding initiation | 1.73 (1.28-2.35) | 8 | ||
| Less-than-adequate prenatal care* | 0.68 (0.50-0.91) | 16 | ||
| RESULTS (P VALUE) | ||||
| Ickovics JR et al.2 | Matched cohort N=458 | Birth weight (g) | 3228 vs 3159 (P<.01) | — |
| Preterm birth weight (g) | 2398 vs 1990 (P<.05) | — | ||
| Grady MA et al.3 | Cohort study with clinic comparison N=124 (intervention) | Preterm births <37 wk (%) | 10.5 vs 25.7 (P<.02) | 7 |
| Low birth weight <2500 g (%) | 8.8 vs 22.9 (P<.02) | 7 | ||
| Breastfeeding at hospital discharge (%) | 46 vs 28 (P<.02) | 6 | ||
| Rising SS4 | Descriptive analysis N=111 | 3rd trimester emergency room visits (%) | 26 vs 74 (P=.001) | 2 |
| Baldwin KA5 | 2-group pre-/post-test design N=98 | Change in prenatal knowledge scores† | 0.98 vs 0.4 (P=.03) | — |
| CI, confidence interval; NN T, number needed to treat; OR, odds ratio. | ||||
| *Kotelchuck Adequacy of Prenatal Care Utilization Index, a validated scoring scale encompassing timing of initiation of care, number of visits, and quality and content of prenatal care. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and the proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994;84:1414-1420. | ||||
| †Patient Participation and Satisfaction questionnaire. Littlefield V, Adams B. Patient participation in alternative perinatal care: impact on satisfaction and health locus of control. Res Nurs Health. 1987;10:139-148. | ||||
Group care boosts breastfeeding, knowledge, and satisfaction
The RCT and the cohort study showed increased rates of breastfeeding initiation (NNT=8 and 6, respectively).1,3 The RCT demonstrated that patients in group care more often had adequate prenatal care (NNT=16).1 One cohort trial found that women enrolled in group prenatal care used the emergency department less during the third trimester (NNT=2, P=.001).4
Several studies have reported improved pregnancy knowledge and high levels of satisfaction with group prenatal care. The RCT showed increased knowledge and readiness for labor, and higher satisfaction compared with individual care (P<.001 for all outcomes).1 Lower-quality studies of group care support these findings.3-5
An innovative model that requires further study
Group prenatal care is a relatively new, innovative model of care, and limited data are available for review. The evidence from 1 RCT and 1 cohort study supports the protective effect of group prenatal care against preterm delivery for women at higher risk of adverse pregnancy outcomes.1,2 Trends toward improved health outcomes were found in lower-quality studies; the trends were large enough to have potential clinical significance. These preliminary findings should be evaluated as primary health outcomes in future research to define the optimal population for group care.
Recommendations
No published guidelines or textbook recommendations exist for group-based prenatal care. In other areas of medical care, including diabetes and low back pain, specialty societies such as the American Diabetes Association and systematic reviews have supported practice changes, including group visits, to improve care.6,7
1. Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and perinatal outcomes: a randomized, controlled trial. Obstet Gynecol. 2007;110:330-339.
2. Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics. Obstet Gynecol. 2003;102:1051-1057.
3. Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. J Midwifery Womens Health. 2004;49:412-420.
4. Rising SS. Centering pregnancy: an interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43:46-54.
5. Baldwin KA. Comparison of selected outcomes of centering pregnancy versus traditional prenatal care. J Midwifery Womens Health. 2006;51:266-272.
6. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):s13-s61.
7. Heymans MW, van Tulder MW, Esmail R, et al. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2005;30:2153-2163.
1. Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and perinatal outcomes: a randomized, controlled trial. Obstet Gynecol. 2007;110:330-339.
2. Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics. Obstet Gynecol. 2003;102:1051-1057.
3. Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. J Midwifery Womens Health. 2004;49:412-420.
4. Rising SS. Centering pregnancy: an interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43:46-54.
5. Baldwin KA. Comparison of selected outcomes of centering pregnancy versus traditional prenatal care. J Midwifery Womens Health. 2006;51:266-272.
6. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):s13-s61.
7. Heymans MW, van Tulder MW, Esmail R, et al. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2005;30:2153-2163.
Evidence-based answers from the Family Physicians Inquiries Network