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Group Prenatal Care and Preterm Birth Weight: Results From a Matched Cohort Study at Public Clinics

From the Departments of Epidemiology and Public Health and Obstetrics and Gynecology, and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine; Yale University School of Nursing, New Haven, Connecticut; Department of Gynecology and Obstetrics, Emory University and Grady Hospital System, Atlanta, Georgia; and Centering Pregnancy and Parenting Association, Cheshire, Connecticut.

Address reprint requests to: Jeannette R. Ickovics, Yale University, Department of Epidemiology and Public Health, 60 College Street, Suite 415, PO Box 208034, New Haven, CT 06520-8034; E-mail: jeannette.ickovics{at}Yale.edu.

OBJECTIVE: To examine the impact of group versus individual prenatal care on birth weight and gestational age.

METHODS: This prospective, matched cohort study included pregnant women (N = 458) entering prenatal care at 24 or less weeks’ gestation; one half received group prenatal care with women of the same gestational age. Women were matched by clinic, age, race, parity, and infant birth date. Women were predominantly black and Hispanic of low socioeconomic status, served by one of three public clinics in Atlanta, Georgia or New Haven, Connecticut.

RESULTS: Birth weight was greater for infants of women in group versus individual prenatal care (P < .01). Among those born preterm, infants of group patients were significantly larger than infants of individual-care patients (mean, 2398 versus 1990 g, P < .05). Although not statistically significant, infants of group patients were less likely than those of individual-care patients to be low birth weight (less than 2500 g; 16 versus 23 infants); very low birth weight (less than 1500 g; three versus six infants); early preterm (less than 33 weeks; two versus seven infants); or to experience neonatal loss (none versus three infants). There were no differences in number of prenatal visits or other risk characteristics (patient age, race, prior preterm birth).

CONCLUSIONS: Group prenatal care results in higher birth weight, especially for infants delivered preterm. Group prenatal care provides a structural innovation, permitting more time for provider–patient interaction and therefore the opportunity to address clinical as well as psychological, social, and behavioral factors to promote healthy pregnancy. Results have implications for design of sustainable prenatal services that might contribute to reduction of racial disparities in adverse perinatal outcomes.