Advertisement

Maternal and Child Health Journal

, Volume 23, Issue 10, pp 1424–1433 | Cite as

Effects of a Multi-site Expansion of Group Prenatal Care on Birth Outcomes

  • Amy H. Crockett
  • Emily C. HeberleinEmail author
  • Jessica C. Smith
  • Pelin Ozluk
  • Sarah Covington-Kolb
  • Carla Willis
Article
  • 115 Downloads

Abstract

Objectives Perinatal Quality Collaboratives across the United States are initiating projects to improve health and healthcare for women and infants. We compared an evidence-based group prenatal care model to usual individual prenatal care on birth outcomes in a multi-site expansion of group prenatal care supported by a state-wide multidisciplinary Perinatal Quality Collaborative. Methods We analyzed 15,330 pregnant women aged 14–48 across 13 healthcare practices in South Carolina (2013–2017) using a preferential-within cluster matching propensity score method and logistic regression. Outcomes were extracted from birth certificate data. We compared outcomes for (a) women at the intent-to-treat level and (b) for women participating in at least five group prenatal care visits to women with less than five group visits with at least five prenatal visits total. Results In the intent-to-treat analyses, women who received group prenatal care were significantly less likely to have preterm births (absolute risk difference − 3.2%, 95% CI − 5.3 to − 1.0%), low birth weight births (absolute risk difference − 3.7%, 95% CI − 5.5 to − 1.8%) and NICU admissions (absolute risk difference − 4.0%, 95% CI − 5.6 to − 2.3%). In the as-treated analyses, women had greater improvements compared to intent-to-treat analyses in preterm birth and low birth weight outcomes. Conclusions for Practice CenteringPregnancy group prenatal care is effective across a range of real-world clinical practices for decreasing the risk of preterm birth and low birth weight. This is a feasible approach for other Perinatal Quality Collaboratives to attempt in their ongoing efforts at improving maternal and infant health outcomes.

Keywords

Birth outcomes CenteringPregnancy Group prenatal care Low birthweight Preterm birth 

Notes

Funding

South Carolina Department of Health and Human Services funded this study. The sponsor has not been involved in study design, data analysis, or writing of this article.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

10995_2019_2795_MOESM1_ESM.pdf (566 kb)
Supplementary material 1 (PDF 566 kb)

References

  1. American College of Obstetricians & Gynecologists. (n.d.). Alliance for innovation on maternal health. https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/What-is-AIM. Accessed May 30, 2018.
  2. Arpino, B., & Cannas, M. (2016). Propensity score matching with clustered data. An application to the estimation of the impact of caesarean section on the APGAR score. Statistics in Medicine, 35(12), 2074–2091.CrossRefGoogle Scholar
  3. Bryson, A., Dorsett, R., & Purdon, S. (2002). The use of propensity score matching in the evaluation of active labour market policies. London: Department for Work and Pensions.Google Scholar
  4. Carter, E. B., Temming, L. A., Akin, J., Fowler, S., Macones, G. A., Colditz, G. A., et al. (2016). Group prenatal care compared with traditional prenatal care: A systematic review and meta-analysis. Obstetrics and Gynecology, 128(3), 551–561.CrossRefGoogle Scholar
  5. Centers for Disease Control & Prevention. (2018). Perinatal quality collaboratives. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm. Accessed May 30, 2018.
  6. Crockett, A., Heberlein, E. C., Glasscock, L., Covington-Kolb, S., Shea, K., & Khan, I. A. (2017). Investing in CenteringPregnancy™ group prenatal care reduces newborn hospitalization costs. Women’s Health Issues, 27(1), 60–66.CrossRefGoogle Scholar
  7. Cunningham, S. D., Grilo, S., Lewis, J. B., Novick, G., Rising, S. S., Tobin, J. N., et al. (2017). Group prenatal care attendance: Determinants and relationship with care satisfaction. Maternal and Child Health Journal, 21(4), 770–776.CrossRefGoogle Scholar
  8. Cunningham, S. D., Lewis, J. B., Shebl, F. M., Boyd, L. M., Robinson, M. A., Grilo, S. A., et al. (2018). Group prenatal care reduces risk of preterm birth and low birth weight: A matched cohort study. Journal of Women’s Health.  https://doi.org/10.1089/jwh.2017.6817.Google Scholar
  9. Gareau, S., Lòpez-De Fede, A., Loudermilk, B. L., Cummings, T. H., Hardin, J. W., Picklesimer, A. H., et al. (2016). Group prenatal care results in Medicaid savings with better outcomes: A propensity score analysis of CenteringPregnancy participation in South Carolina. Maternal and Child Health Journal, 20(7), 1384–1393.CrossRefGoogle Scholar
  10. Gupta, M., Donovan, E. F., & Henderson, Z. (2017). State-based perinatal quality collaboratives: Pursuing improvements in perinatal health outcomes for all mothers and newborns. Paper presented at the Seminars in perinatology.Google Scholar
  11. Hale, N., Picklesimer, A. H., Billings, D. L., & Covington-Kolb, S. (2014). The impact of CenteringPregnancy group prenatal care on postpartum family planning. American Journal of Obstetrics and Gynecology, 210(1), 50.e51–50.e57.  https://doi.org/10.1016/j.ajog.2013.09.001.CrossRefGoogle Scholar
  12. Hassan, S., Romero, R., Vidyadhari, D., Fusey, S., Baxter, J., Khandelwal, M., et al. (2011). Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: A multicenter, randomized, double- blind, placebo- controlled trial. Ultrasound in Obstetrics and Gynecology, 38(1), 18–31.CrossRefGoogle Scholar
  13. Heckman, J. J., Ichimura, H., & Todd, P. (1998). Matching as an econometric evaluation estimator. The Review of Economic Studies, 65(2), 261–294.CrossRefGoogle Scholar
  14. Henderson, Z. T., Suchdev, D. B., Abe, K., Johnston, E. O., & Callaghan, W. M. (2014). Perinatal quality collaboratives: Improving care for mothers and infants. Journal of Women’s Health, 23(5), 368–372.CrossRefGoogle Scholar
  15. Ickovics, J. R., Earnshaw, V., Lewis, J. B., Kershaw, T. S., Magriples, U., Stasko, E., et al. (2016). Cluster randomized controlled trial of group prenatal care: Perinatal outcomes among adolescents in New York City health centers. American Journal of Public Health, 106(2), 359–365.CrossRefGoogle Scholar
  16. Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., et al. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics and Gynecology, 110(2), 330–339.CrossRefGoogle Scholar
  17. Meis, P. J., Klebanoff, M., Thom, E., Dombrowski, M. P., Sibai, B., Moawad, A. H., et al. (2003). Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. New England Journal of Medicine, 348(24), 2379–2385.CrossRefGoogle Scholar
  18. Picklesimer, A. H., Billings, D., Hale, N., Blackhurst, D., & Covington-Kolb, S. (2012). The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. American Journal of Obstetrics and Gynecology, 206(5), 415.e411–415.e417.  https://doi.org/10.1016/j.ajog.2012.01.040.CrossRefGoogle Scholar
  19. Rising, S. S., Kennedy, H. P., & Klima, C. S. (2004). Redesigning prenatal care through CenteringPregnancy. Journal of Midwifery & Women’s Health, 49(5), 398–404.CrossRefGoogle Scholar
  20. Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.CrossRefGoogle Scholar
  21. Rosenbaum, P. R., & Rubin, D. B. (1985). Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. The American Statistician, 39(1), 33–38.Google Scholar
  22. Rubin, D. B. (2007). The design versus the analysis of observational studies for causal effects: Parallels with the design of randomized trials. Statistics in Medicine, 26(1), 20–36.CrossRefGoogle Scholar
  23. Schneider, P. D., Sabol, B. A., King, P. A. L., Caughey, A. B., & Borders, A. E. (2017). The hard work of improving outcomes for mothers and babies: Obstetric and perinatal quality improvement initiatives make a difference at the hospital, state, and national levels. Clinics in Perinatology, 44(3), 511–528.CrossRefGoogle Scholar
  24. South Carolina Department of Health and Human Services. (2016). The Birth Outcomes Initiative. https://www.scdhhs.gov/organizations/south-carolina-birth-outcomes-initiative. Accessed August 15, 2018.
  25. South Carolina Community Assessment Network (SCAN). (2016). http://scangis.dhec.sc.gov/scan/bdp/tables/birthtable.aspx. Accessed December 15, 2017
  26. Tanner-Smith, E. E., Steinka-Fry, K. T., & Gesell, S. B. (2014a). Comparative effectiveness of group and individual prenatal care on gestational weight gain. Maternal and Child Health Journal, 18, 1711–1720.  https://doi.org/10.1007/s10995-013-1413-8.CrossRefGoogle Scholar
  27. Tanner-Smith, E., Steinka-Fry, K., & Lipsey, M. (2012). A multi-site evaluation of the CenteringPregnancy programs in Tennessee: Final report prepared for the Tennessee Department of Health. Nashville, TN: Peabody Research Institute, Vanderbilt University.Google Scholar
  28. Tanner-Smith, E. E., Steinka-Fry, K. T., & Lipsey, M. W. (2014b). The effects of CenteringPregnancy group prenatal care on gestational age, birth weight, and fetal demise. Maternal and Child Health Journal, 18(4), 801–809.CrossRefGoogle Scholar
  29. Urban Institute. (2018). Strong start for mothers and newborns evaluation: Year 5 project synthesis. Washington, DC: Urban Institute. https://downloads.cms.gov/files/cmmi/strongstart-prenatal-finalevalrpt-v1.pdf. Accessed January 25, 2019.

Copyright information

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

Authors and Affiliations

  • Amy H. Crockett
    • 1
  • Emily C. Heberlein
    • 2
    Email author
  • Jessica C. Smith
    • 2
  • Pelin Ozluk
    • 3
  • Sarah Covington-Kolb
    • 4
  • Carla Willis
    • 2
  1. 1.Prisma Health UpstateUniversity of South Carolina School of Medicine GreenvilleGreenvilleUSA
  2. 2.Georgia Health Policy Center, Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaUSA
  3. 3.Department of Economics, Andrew Young School of Policy StudiesGeorgia State UniversityAtlantaUSA
  4. 4.Prisma Health UpstateGreenvilleUSA

Personalised recommendations