Group Prenatal Care and Emergency Room Utilization

Pregnancy-related complaints are a significant driver of emergency room (ER) utilization among women. Because of additional time for patient education and provider relationships, group prenatal care may reduce ER visits among pregnant women by helping them identify appropriate care settings, improving understanding of common pregnancy discomforts, and reducing risky health behaviors. We conducted a retrospective cohort study, utilizing Medicaid claims and birth certificate data from a statewide expansion of group care, to compare ER utilization between pregnant women participating in group prenatal care and individual prenatal care. Using propensity score matching methods, we found that group care was associated with a significant reduction in the likelihood of having any ER utilization (–5.9% among women receiving any group care and –6.0% among women attending at least five group care sessions). These findings suggest that group care may reduce ER utilization among pregnant women and encourage appropriate health care utilization during pregnancy.

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Pilot Randomized Controlled Trial of Diabetes Group Prenatal Care

American Journal of Perinatology ◽

10.1055/s-0040-1714209 ◽

2020 ◽

Author(s):

Ebony B. Carter ◽

Kate Barbier ◽

Pamela K. Hill ◽

Alison G. Cahill ◽

Graham A. Colditz ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Prenatal Care ◽

Controlled Trial ◽

Self Care ◽

Group Care ◽

Group Prenatal Care ◽

Diabetes Group ◽

Randomized Controlled ◽

Individual Care ◽

Pilot Randomized Controlled Trial

Objective This study aimed to determine the feasibility and effectiveness of Diabetes Group Prenatal Care to increase patient engagement in diabetes self-care activities. Study Design A pilot randomized controlled trial was conducted at two sites. Inclusion criteria were English or Spanish speaking, type 2 or gestational diabetes, 22 to 34 weeks of gestational age at first study visit, ability to attend group care at specified times, and willingness to be randomized. Exclusion criteria included type 1 diabetes, multiple gestation, major fetal anomaly, serious medical comorbidity, and serious psychiatric illness. Women were randomized to Diabetes Group Prenatal Care or individual prenatal care. The primary outcome was completion of diabetes self-care activities, including diet, exercise, blood sugar testing, and medication adherence. Secondary outcomes included antenatal care characteristics, and maternal, neonatal, and diabetes management outcomes. Analysis followed the intention-to-treat principle. Results Of 159 eligible women, 84 (53%) consented to participate in the study and were randomized to group (n = 42) or individual (n = 42) prenatal care. Demographic characteristics were similar between study arms. Completion of diabetes self-care activities was similar overall, but women in group care ate the recommended amount of fruits and vegetables on more days per week (5.1 days/week ± 2.0 standard deviation [SD] in group care vs. 3.4 days ± 2.6 SD in individual care; p < 0.01) and gained less weight per week during the study period (0.2 lbs/week [interquartile range: 0–0.7] vs. 0.5 lbs/week [interquartile range: 0.2–0.9]; p = 0.03) than women in individual care. Women with gestational diabetes randomized to group care were 3.5 times more likely to have postpartum glucose tolerance testing than those in individual care (70 vs. 21%; relative risk: 3.5; 95% confidence interval: 1.4–8.8). Other maternal, neonatal, and pregnancy outcomes were similar between study arms. Conclusion Diabetes group care is feasible and shows promise for decreasing gestational weight gain, improving diet, and increasing postpartum diabetes testing among women with pregnancies complicated by diabetes. Key Points

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Enhancing Accessibility of Physical Activity During Pregnancy: A Pilot Study on Women’s Experiences With Integrating Yoga Into Group Prenatal Care

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392819834886 ◽

2019 ◽

Vol 6 ◽

pp. 233339281983488

Author(s):

Patricia Kinser ◽

Nancy Jallo ◽

Leroy Thacker ◽

Christine Aubry ◽

Saba Masho

Keyword(s):

Physical Activity ◽

Pilot Study ◽

Prenatal Care ◽

Pregnant Women ◽

Lived Experience ◽

Self Efficacy ◽

The United States ◽

Group Prenatal Care ◽

Hospital System ◽

Over Time

Introduction: Health guidelines suggest that pregnant women should participate in daily physical activity, yet rarely do they meet these guidelines. Means to enhance accessibility of physical activity for pregnant women are required, and yoga has been suggested as a possible method to enhance women’s sense of confidence and competence with physical activity. In this pilot study, our primary aim is to evaluate pregnant women’s perceptions about their lived experience of an intervention which integrates a low-intensity form of physical activity, yoga, into prenatal care; our secondary aim is to evaluate changes in participants’ self-efficacy for physical activity and time spent in physical activity over time. Methods: Held in an outpatient obstetrics department of an urban hospital system in the United States, this pilot study enrolled 16 pregnant women to participate in the intervention throughout their pregnancy. We explored participants’ lived experience of the intervention using qualitative methods (phenomenology). Means, variances, and covariances were calculated for the 2 measures (self-efficacy and time spent in physical activity) over the intervention period. Results: Qualitative findings from focus groups suggest that it is acceptable for prenatal yoga to be integrated into group prenatal care classes and women reported increased confidence with physical activity during pregnancy. Participants did not consider the intervention to fit within the traditional definition of exercise. Women reported increased amounts of time spent in physical activity from baseline to the end of pregnancy, but there were no statistically significant changes in self-efficacy over time. Discussion: The integration of gentle physical activity into the group prenatal care model warrants further attention for potential benefits with regard to maternal physical and mental wellness.

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Prenatal Care Utilization Level of Pregnant Women Living inThree Different Neighborhoods of Izmir's Bornova District

TAF Preventive Medicine Bulletin ◽

10.5455/pmb.1-1428673248 ◽

2015 ◽

Vol 14 (5) ◽

pp. 370 ◽

Cited By ~ 2

Author(s):

Ummahan Yucel ◽

Meltem Ciceklioglu ◽

Zeliha Ocek ◽

Safak Taner

Keyword(s):

Prenatal Care ◽

Pregnant Women ◽

Care Utilization ◽

Prenatal Care Utilization

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Prenatal care utilization and expenditure among pregnant women

Health Policy and Management ◽

10.4332/kjhpa.2009.19.4.053 ◽

2009 ◽

Vol 19 (4) ◽

pp. 53-65 ◽

Cited By ~ 5

Author(s):

Kyung-Ha Kim ◽

Rah-Il Hwang ◽

Ji-Won Yoon ◽

Jin-Soo Kim

Keyword(s):

Prenatal Care ◽

Pregnant Women ◽

Care Utilization ◽

Prenatal Care Utilization

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Correction: Group prenatal care experiences among pregnant women in a Bangladeshi community

PLoS ONE ◽

10.1371/journal.pone.0220816 ◽

2019 ◽

Vol 14 (7) ◽

pp. e0220816

Author(s):

Marufa Sultana ◽

Nausad Ali ◽

Raisul Akram ◽

Tania Jahir ◽

Rashidul Alam Mahumud ◽

...

Keyword(s):

Prenatal Care ◽

Pregnant Women ◽

Group Prenatal Care

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Factors Associated with Antenatal Influenza Vaccination in a Medically Underserved Population

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2020/5803926 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Jenna C. Adams ◽

Hope H. Biswas ◽

Sheree L. Boulet ◽

Kamini Doraivelu ◽

Michele K. Saums ◽

...

Keyword(s):

Prenatal Care ◽

Influenza Vaccination ◽

Pregnant Women ◽

Vaccination Rate ◽

Medically Underserved ◽

Care Utilization ◽

Vaccination Rates ◽

Medically Underserved Population ◽

Prenatal Care Adequacy ◽

Inadequate Prenatal Care

Influenza infection in pregnant women is associated with increased risk of morbidity and mortality. Despite recommendations for all women to receive the seasonal influenza vaccine during pregnancy, vaccination rates among pregnant women in the U.S. have remained around 50%. The objective of this study was to evaluate clinical and demographic factors associated with antenatal influenza vaccination in a medically underserved population of women. We conducted a retrospective cohort study at Grady Memorial Hospital, a large safety-net hospital in Atlanta, Georgia, from July 1, 2016, to June 30, 2018. Demographic and clinical characteristics were abstracted from the electronic medical record. The Kotelchuck index was used to assess prenatal care adequacy. Relative risks and 95% confidence intervals for associations between receipt of influenza vaccine and prenatal care adequacy, demographic characteristics, and clinical characteristics were calculated using multivariable log-binominal models. Among 3723 pregnant women with deliveries, women were primarily non-Hispanic black (68.4%) and had Medicaid as their primary insurance type (87.9%). The overall vaccination rate was 49.8% (1853/3723). Inadequate prenatal care adequacy was associated with a lower antenatal influenza vaccination rate (43.5%), while intermediate and higher levels of prenatal care adequacy were associated with higher vaccination rates (66.9–68.3%). Hispanic ethnicity, non-Hispanic other race/ethnicity, interpreter use for a language other than Spanish, and preexisting diabetes mellitus were associated with higher vaccination coverage in multivariable analyses. Among medically underserved pregnant women, inadequate prenatal care utilization was associated with a lower rate of antenatal influenza vaccination. Socially disadvantaged women may face individual and structural barriers when accessing prenatal care, suggesting that evidenced-based, tailored approaches may be needed to improve prenatal care utilization and antenatal influenza vaccination rates.

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