Group Prenatal Care Improves Pregnancy Outcomes at No Additional Cost
New Haven, Conn. — Group prenatal care can improve pregnancy outcomes in the area of reducing preterm births and increasing breastfeeding initiation, psychosocial function, and patient satisfaction, without incurring any additional costs over standard care, according to a study published in the August issue of Obstetrics & Gynecology.
The lead author is Jeannette Ickovics, professor at Yale School of Medicine’s Department of Epidemiology & Public Health (EPH), with co-authors from Yale, Emory University, and the Centering Pregnancy and Parenting Association in Cheshire. Ickovics is head of EPH’s Social and Behavioral Science Program, deputy director of the Yale Center for Clinical Investigation, and director of CARE: Community Alliance for Research and Engagement.
The U.S., the researchers said, ranks at the bottom among developed nations for infant mortality. Preterm birth accounts for 35 percent of all U.S. healthcare spending for infants. In addition, there is a twofold higher rate of preterm birth and low birth weight among African-American women.
“Preterm birth has been an intractable problem, with few interventions having any impact,” Ickovics said. “The goal of this project was to determine whether an innovative model of group prenatal care could improve birth outcomes as well as other psychosocial outcomes for at-risk young women in our community.”
The multi-site randomized controlled trial was at two university-affiliated hospital prenatal clinics at Yale-New Haven Hospital and Emory University Hospital. Pregnant women aged 14-25 were randomly assigned to group or standard individual care. The average age of participants was 20.4 years and 80 percent of the women were African American.
Group participants actively participated in their prenatal care in a setting with other women having the same expected delivery month. Led by a credentialed prenatal provider (obstetrician and/or midwife), Centering Pregnancy, an integrative prenatal care model, combined three primary components: assessment, educations/skills building, and support. The women received “one stop prenatal care” and became empowered through education and skills building related to having a healthy pregnancy, childbirth preparation, and postpartum/parenting. They were also provided opportunities for community building with other pregnant women.
Traditional care participants received one-on-one exam room visits with care provided by a credentialed prenatal provider. The educational component of care in the traditional setting was provider-dependent and based on time available and/or responses to patients’ questions. There were few opportunities for the participants to interact socially with other pregnant women.
The authors concluded that the women randomized to group prenatal care had clinical and psychological advantages to those receiving individual care. The study documented a 33 percent reduction in the odds of preterm birth. Other birth and psychosocial outcomes were as good or better in group care versus traditional prenatal care. Women in group prenatal care were more likely to receive adequate prenatal care and reported greater satisfaction with that care. They also had more prenatal care knowledge, felt more prepared for labor and delivery, and were more likely to initiate breastfeeding. Basic billing from hospital records available from Yale-New Haven Hospital indicated no significant difference in raw costs of prenatal care or delivery care costs.
“These study results affirm our belief that group care is superior to individual care in supporting women to have healthy pregnancy outcomes,” said Sharon Schindler Rising, founder and executive director. “Every woman deserves to have these benefits. It is the mission of the Centering Pregnancy and Parenting Association that the Centering Pregnancy model of care will become the standard for prenatal care delivery.”
Ickovics concluded, “Based on the results of our study, group prenatal care may be one potential approach toward addressing much needed changes in the healthcare system. Pregnancy is an important ‘window of opportunity’ to have a positive impact on the health of women and their families.”
EPH provides leadership to protect and improve the health of the public. Through innovative research, policy analysis, and education that draw upon multi-disciplinary scholarship from across the graduate and professional programs at Yale, the department serves local, national, and international communities with its knowledge and expertise.
Founded by Charles-Edward Amory Winslow in 1915, the Yale program http://publichealth.yale.edu is one of the oldest in the country. It has played a pivotal role in defining and addressing public health issues and training leaders in public health research, education, and practice.
The study was supported by a grant from the National Institutes of Health.
Co-authors included Trace Kershaw, Claire Westdahl, Urania Magripes, M.D., Zohar Massey, and Heather Reynolds.
Obstetrics & Gynecology 110 (2): 330-339 (August 2007)