Group Prenatal Care and Perinatal Outcomes: A Randomized Controlled Trial

Abstract

Group prenatal care is an integrated approach based on management in a group setting, including family members, as well as peer support and education. This multisite randomized controlled trial was designed to show whether group care can reduce adverse perinatal outcomes. The study population included 1047 parturients 14 to 25 years of age, about 80% of them African Americans. Two university-affiliated hospital prenatal clinics took part in the study. Each 2-hour prenatal care session included physical assessment, education, skills building, and support from facilitated group discussions. Structured interviews were carried out at baseline, during the third trimester, and following childbirth. Intent-to-treat analyses indicated that women assigned to group care were significantly less likely than those given standard care to have preterm births (9.8% vs. 13.8%), with no differences between the 2 study conditions in age, parity, educational level, or income. The calculated risk reduction was 33%, with an odds ratio (OR) of 0.67 at a 95% confidence interval (CI) of 0.44–0.99. Treatment effects were especially strong when only African-American women were analyzed (OR, 0.59; 95% CI, 0.38–0.92). Women in group care were less likely than those given standard care to have suboptimal prenatal care, and more likely to gain prenatal knowledge, to feel ready for labor and delivery, and to be satisfied with their care. In addition more women in group care initiated breast feeding (66.5% vs. 54.6%). No group differences were found in birth weight or in the cost of prenatal care or delivery. In this study, group prenatal care improved perinatal outcomes while not increasing the cost of care.