Maternal and Child Health Journal

, Volume 23, Issue 10, pp 1371–1381 | Cite as

Group Prenatal Care Attendance and Women’s Characteristics Associated with Low Attendance: Results from Centering and Racial Disparities (CRADLE Study)

  • Ellen Francis
  • Mary Beth Johnstone
  • Sarah Convington-Kolb
  • Brian Witrick
  • Sarah F. Griffin
  • Xiaoqian Sun
  • Amy Crockett
  • Liwei ChenEmail author



Group prenatal care (GPC), an alternative to individual prenatal care (IPC), is becoming more prevalent. This study aimed to describe the attendance and reasons of low attendance among pregnant women who were randomly assigned to receive GPC or IPC and explore the maternal characteristics associated with low-attendance.


This study was a descriptive study among Medically low risk pregnant women (N = 992) who were enrolled in an ongoing prospective study. Women were randomly assigned to receive CenteringPregnany GPC (N = 498) or IPC (N = 994) in a single clinical site The attendance frequency and reason for low-attendance (i.e. ≤ 5/10 sessions in GPC or ≤ 5 visits in IPC) were described separately in GPC and IPC. Multivariable logistic regressions were performed to explore the associations between maternal characteristics and low-attendance.


On average, women in GPC attended 5.32 (3.50) sessions, with only 6.67% attending all 10 sessions. Low-attendance rate was 34.25% in GPC and 10.09% in IPC. The primary reasons for low-attendance were scheduling barriers (23.19%) and not liking GPC (16.43%) in GPC but leaving the practice (34.04%) in IPC. In multivariable analysis, lower perceived family support (P = 0.01) was positively associated with low-attendance in GPC, while smoking in early pregnancy was negatively associated low-attendance (P = 0.02) in IPC.

Conclusions for Practice

Scheduling challenges and preference for non-group settings were the top reasons for low-attendance in GPC. Changes may need to be made to the current GPC model in order to add flexibility to accommodate women’s schedules and ensure adequate participation.

Trial registration

NCT02640638 Date Registered: 12/20/2015.


Prenatal care Group prenatal care Pregnant women Low-attendance 



We extend our gratitude to the study participants, research nurses, providers for their contributions.

Authors’ Contributions

EF: study conception and design, obtain data and statistical analysis, drafting the manuscript, major editing; MBJ: study conception and design, obtain data and analysis, drafting the manuscript, major editing; BW: obtain data and statistical analysis, editing; AC: major editing; SCK: major editing; SG: major editing; XS: major editing; LC: study conception and design, data obtain and statistical analysis, major editing; All authors: data collection. All authors read and approved the final manuscript.


This study is supported by National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH) through a 5-year Grant (R01HD082311). The funding body does not influence the design of the study and collection, analysis, and interpretation of data.

Compliance with Ethical Standards

Competing interests

The authors declare that we have no competing interests.

Supplementary material

10995_2019_2784_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 32 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ellen Francis
    • 1
  • Mary Beth Johnstone
    • 1
  • Sarah Convington-Kolb
    • 2
  • Brian Witrick
    • 1
  • Sarah F. Griffin
    • 1
  • Xiaoqian Sun
    • 3
  • Amy Crockett
    • 2
  • Liwei Chen
    • 4
    Email author
  1. 1.Department of Public Health SciencesClemson UniversityClemsonUSA
  2. 2.Department of Obstetrics and GynecologyGreenville Health SystemGreenvilleUSA
  3. 3.Department of Mathematical SciencesClemson UniversityClemsonUSA
  4. 4.Department of Epidemiology, Fielding School of Public HealthUniversity of California at Los AngelesLos AngelesUSA

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