Group multimodal prenatal care (GMPC) leads to improved outcomes compared to individual multimodal prenatal care (IMPC), according to a recent study in JAMA Network Open.1
Takeaways
- Group multimodal prenatal care (GMPC) reduces perceived stress by 21% compared to individual multimodal prenatal care (IMPC).
- There is no significant difference between GMPC and IMPC in terms of depression, anxiety, and social support.
- Participants in GMPC experienced increased sleep duration compared to those in IMPC.
- Both GMPC and IMPC showed no significant difference in breastfeeding initiation, LARC intention, and overall satisfaction with prenatal care.
- Researchers suggest health care centers consider offering virtual group prenatal care as it often matches or surpasses the benefits of individual care.
Data suggesting equivalent or improved perinatal psychological and behavioral outcomes from in-person group prenatal care vs in-person individual care has grown over time. Groups sessions provide engaging curriculum in a supportive environment to encourage relationship building and improved social support.
Additionally, group prenatal care has been associated with improved management of gestational diabetes (GD).2 One study reported reduced progression to A2 GD among patients receiving group care vs individualized care.
Following the onset of the COVID-19 pandemic, prenatal care experienced significant changes, shifting to a multimodal care.1 However, there is little data evaluating outcomes following virtual group prenatal care.
Investigators conducted a cohort study to determine whether GMPC can lead to improved postpartum outcomes vs IMPC. Outcomes evaluated included psychological, behavioral, perceived quality of prenatal care, patient satisfaction with prenatal care, and preparation for self and baby after delivery.
Kaiser Permanente Northern California (KPNC) service centers participated in the analysis. Individual prenatal care from KPNC is based on recommendations from the American College of Obstetrics and Gynecology.
These guidelines suggest 9 individual visits lasting 15 minutes spread throughout pregnancy. Visits increase in frequency as delivery approaches, and a final 15-minute visit occurs at 4 to 10 weeks postpartum. From March 2020 onward, 4 of the prenatal care visits were offered as remote visits.
Group prenatal care from KPNC before March 2020 included in-person CenteringPregnancy (Centering Healthcare Institute) group care. Following March 2020, this method was adapted into a virtual format.
Remote CenteringPregnancy included 7 to 10 virtual webinars with 8 to 12 pregnant individuals and their partners lasting for 60 to 90 minutes. Around the same time, participants also attended 10- to 15-minute individual in-person office visits where clinicians obtained vital signs, weight, and additional tests.
Individuals receiving prenatal care at KPNC between August 17, 2020, and April 1, 2021, were included in the analysis. Those receiving GMPC were matched with controls based on gestational age, race and ethnicity, insurance status, and maternal age.
Eligibility criteria included being English-speaking, aged 18 to 45 years, and with a singleton pregnancy in the first or early second trimester. High-risk pregnancies were excluded from the analysis.
A postpartum survey was used to determine outcomes. Depression was assessed on an 8-item scale, with scores from 10 to 24 indicating clinically significant depressive symptoms.
Anxiety was assessed on a 7-point scale, with scores from 10 to 21 indicating clinically significant anxiety symptoms and scores of 14 or greater indicating moderate to severe perceived stressed. A 19-point score was used to assess sleep quality, with higher scores indicating poorer sleep. Higher social support scores indicated improved support.
Breastfeeding initiation and long-acting reversible contraception (LARC) intention were defined as behavioral outcomes. Additional outcomes included perceived quality of care, prenatal care satisfaction, and preparation for self and baby care.
There were 207 GMPC participants included in the analysis, 198 of whom completed the follow-up survey. For IMPC individuals, these numbers were 201 and 192, respectively. The median age of participants was 32 years and the median gestational age at study entry was 13 weeks. Most baseline characteristics were similar between groups.
A median 68.4% of virtual group visits were attended by the GMPC group and attending least 70% of sessions was reported by 50%, at least 5 by 58.1%, and at least 1 by 89.4%. In the IMPC group, a median 7 prenatal visits were reported, with 14.3% being virtual. Attending at least 1, 5, and 70% of visits was reported by 97.9%, 93.8%, and 85.4%, respectively.
The risk of perceived stress was decreased by 21% among GMPC participants vs IMPC participants. Other psychosocial outcomes, including depression, anxiety, sleep quality, and social support did not differ between groups.
Breastfeeding, LARC intention, perceived quality of prenatal care, patient satisfaction with prenatal care, and feeling prepared for taking care of themselves and their baby also did not significantly differ between GMPC and IMPC participants. However, sleep duration was increased following GMPC vs IMPC after adjustment.
These results indicated GMPC is often equivalent and sometimes superior to IMPC for postpartum outcomes. Investigators recommended health care centers consider virtual group prenatal care as an option for patients.
References
- Avalos LA, Oberman N, Gomez L, et al. Group multimodal prenatal care and postpartum outcomes. JAMA Netw Open. 2024;7(5):e2412280. doi:10.1001/jamanetworkopen.2024.12280
- Krewson C. Group prenatal care effective for managing gestational diabetes. Contemporary OB/GYN. August 31, 2023. Accessed June 6, 2024. https://www.contemporaryobgyn.net/view/group-prenatal-care-effective-for-managing-gestational-diabetes.
