The Impact of Group Prenatal Care on Interpregnancy Interval

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points

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.

Birth outcomes for medically high-risk pregnancies: comparing group to individual prenatal care

Objective(s): Group prenatal care models were initially designed for women with medically low risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birthweight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group vs. individual prenatal care. Study Design: This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI >45). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (1 or more groups) or minimum threshold (≥ 5 groups). Results: Participation in group prenatal care at either treatment exposure level was associated with a lower risk of NICU admissions (10.2% group vs 13.8% individual care, OR 0.708, p<0.001). Participating in the minimum threshold of groups (≥5 sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR 0.569, p<0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR 0.483, p<0.001). No differences in birthweight were observed. Conclusion: This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birthweight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups.

“When I think of mental healthcare, I think of no care.” Mental Health Services as a Vital Component of Prenatal Care for Black Women

Purpose Black people give birth joyously despite disproportionate rates of adverse perinatal outcomes. Given that group prenatal care shows promise in mitigating these inequities, we sought to solicit the opinions of Black peripartum women on how group prenatal care could be tailored to fit their specific needs. In this study, we describe attitudes about a proposed Black group prenatal care in a single focus group of 11 Black women who receive maternal health services from Black Infant Health (BIH, a state and federal funded state-wide program for Black pregnant people with the goal to improve infant and maternal health). These data were used to design a race-conscious group prenatal care curriculum specifically for Black women at UCSF. Description This study was an analysis of focus group data generated as part of a larger project focused on community involvement in Black maternal health. English speaking pregnant or recently postpartum women age 18 or older who receive services from BIH were recruited to participated in the focus group analyzed in this study. All facilitators of the focus group were Black women in order to facilitate candid conversation about racism in prenatal care. Assessment The need for mental health care was common thread underlying all conversations about prenatal health improvements desired by our focus groups. Participants expressed the centrality of mental health access during our discussion of other themes (e.g.: ease of access, inclusion of partners, special classes for teen moms) by discussing them in terms of their relationship to mental health. Our participants’ clear expression of the centrality of mental health care to their prenatal health guided our decision to focus on mental health as a necessary pillar of any group prenatal care intervention designed to mitigate perinatal healthcare disparities in this paper. Three themes related to mental health integration into group prenatal care emerged from thematic analysis of the transcripts. Participants expressed insufficient access and advocacy, and provider distrust. Conclusion Evidence exists supporting group prenatal care as a tool for mitigation of perinatal health disparities among Black women. There is also a large body of data describing the disproportionate burden of mental health needs among Black women. The rich data we present here from Black women on their desire for the integration of these two needs fits well into the parallel conversation occurring in the literature. To our knowledge, this is the first study investigating desires of Black women regarding group prenatal care designed specifically for them. They expressed a strong desire for more access to mental health care providers who are racially conscious and aware of white supremacy, and nuanced opinions on the role of racial concordance in health equity.

Risks of Adverse Neonatal Outcomes in Early Adolescent Pregnancy Using Group Prenatal Care as a Strategy for Public Health Policies: A Retrospective Cohort Study in Brazil

Background: Adolescent pregnancy is a public health concern and many studies have evaluated neonatal outcomes, but few have compared younger adolescents with older using adequate prenatal care.Objective: To compare the risks of adverse neonatal outcomes in younger pregnant adolescents who are properly followed through group prenatal care (GPC) delivered by specialized public services.Methods: This retrospective cohort study followed pregnant adolescents (aged 10–17 years) who received GPC from specialized public services in Brazil from 2009 to 2014. Data were obtained from medical records and through interviews with a multidisciplinary team that treated the patients. The neonatal outcomes (low birth weight, prematurity, Apgar scores with 1 and 5 min, and neonatal death) of newborns of adolescents aged 10–13 years were compared to those of adolescents aged 14–15 years and 16–17 years. Incidence was calculated with 95% confidence intervals (CIs) and compared over time using a chi-squared test to observe trends. Poisson Multivariate logistic regression was used to adjust for confounding variables. The results are presented as adjusted relative risks or adjusted mean differences.Results: Of the 1,112 adolescents who were monitored, 758 were included in this study. The overall incidence of adverse neonatal outcomes (low birth weight and prematurity) was measured as 10.2% (95% CI: 9.7–11.5). Apgar scores collected at 1 and 5 min were found to be normal, and no instance of fetal death occurred. The incidence of low birth weight was 16.1% for the 10–13 age group, 8.7% for the 14–15 age group and 12.1% for the 16–17 age group. The incidence of preterm was measured at 12, 8.5, and 12.6% for adolescents who were 10–13, 14–15, and 16–17 years of age, respectively. Neither low birth weight nor prematurity levels significantly differed among the groups (p &gt; 0.05). The infants born to mothers aged 10–13 years presented significantly (p &lt; 0.05) lower Apgar scores than other age groups, but the scores were within the normal range.Conclusions: Our findings showed lower incidence of neonatal adverse outcomes and no risk difference of neonatal outcomes in younger pregnancy adolescents. It potentially suggests that GPC model to care pregnant adolescents is more important than the age of pregnant adolescent, however further research is needed.