Volume 5, No. 9, October 2007
Abstract of the Month
Group Prenatal Care Improves Pregnancy Outcomes at No Additional Cost
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<.01), had significantly better prenatal knowledge (P<.001), felt more ready for labor and delivery (P<.001), and had greater satisfaction with care (P<.001). Breastfeeding initiation was higher in group care: 66.5% compared with 54.6%, P<.001. There were no differences in birth weight nor in costs associated with prenatal care or delivery.
CONCLUSION: Group prenatal care resulted in equal or improved perinatal outcomes at no added cost. LEVEL OF EVIDENCE: I
Ickovics JR, et al Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol. 2007 Aug;110(2 Pt 1):330-9
National MCH Coordinator Editorial comment:
CenteringPregnancy in the Indian Health system
I want to acknowledge the 30 participants who attended the CenteringPregnancy group prenatal care training held August 13 and 14th in Albuquerque. The training provided the fundamentals and the experience of this new model of care. The August 15 to 17 Native Women's Health and Maternity Care Conference, "Improve the System, Improve the Outcome" provided a 1 hour workshop experience on CenteringPregnancy lead by IHS facilities engaged in group prenatal care. Expect an article from the sites already involved in Centering shortly in an upcoming CCC Corner.
The web site is complete with information on research, trainings, background materials and conferences on Centering. http://www.centeringpregnancy.org/
A model of Centering Parenting is underway, encouraged by prenatal clients and their families across the US.
For site specific activities and training questions please contact me judith.thierry@ihs.gov or Joel Rosen joel.rosen@ihs.gov
You can subscribe to an IHS centering pregnancy list serve past this link into your browser: http://www.ihs.gov/cio/listserver/index.cfm?module=list&option=list&num=80&startrow=1
Contents Summary ‹ Previous | Next › From Your Colleagues
OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
