The comparative effects of group prenatal care on psychosocial outcomes.

To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N = 124) or individual prenatal care (N = 124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89% completing the second survey (mean gestational age 32.7 weeks) and 84% completing the third survey (6 weeks' postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p < 0.05) in their use of prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p = 0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p = 0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p < 0.01) in prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p = 0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group prenatal care for all women.

Effects of Group Prenatal Care on Food Insecurity during Late Pregnancy and Early Postpartum.

OBJECTIVE: This study compared the effects of group to individual prenatal care in late pregnancy and early postpartum on (1) women's food security and (2) psychosocial outcomes among food-insecure women. METHODS AND RESULTS: We recruited 248 racially diverse, low-income, pregnant women receiving CenteringPregnancy™ group prenatal care (N = 124) or individual prenatal care (N = 124) to complete surveys in early pregnancy, late pregnancy, and early postpartum, with 84 % completing three surveys. Twenty-six percent of group and 31 % of individual care participants reported food insecurity in early pregnancy (p = 0.493). In multiple logistic regression models, women choosing group versus individual care were more likely to report food security in late pregnancy (0.85 vs. 0.66 average predicted probability, p < 0.001) and postpartum (0.89 vs. 0.78 average predicted probability, p = 0.049). Among initially food-insecure women, group participants were more likely to become food-secure in late pregnancy (0.67 vs. 0.35 individual care average predicted probability, p < 0.001) and postpartum (0.76 vs. 0.57 individual care average predicted probability, p = 0.052) in intention-to-treat models. Group participants were more likely to change perceptions on affording healthy foods and stretching food resources. Group compared to individual care participants with early pregnancy food insecurity demonstrated higher maternal-infant attachment scale scores (89.8 vs. 86.2 points for individual care, p = 0.032). CONCLUSIONS: Group prenatal care provides health education and the opportunity for women to share experiences and knowledge, which may improve food security through increasing confidence and skills in managing household food resources. Health sector interventions can complement food assistance programs in addressing food insecurity during pregnancy.

Group Prenatal Care Results in Medicaid Savings with Better Outcomes: A Propensity Score Analysis of CenteringPregnancy Participation in South Carolina.

Objectives This study was undertaken to determine the cost savings of prevention of adverse birth outcomes for Medicaid women participating in the CenteringPregnancy group prenatal care program at a pilot program in South Carolina. Methods A retrospective five-year cohort study of Medicaid women was assessed for differences in birth outcomes among women involved in CenteringPregnancy group prenatal care (n = 1262) and those receiving individual prenatal care (n = 5066). The study outcomes examined were premature birth and the related outcomes of low birthweight (LBW) and neonatal intensive care unit (NICU) visits. Because women were not assigned to the CenteringPregnancy group, a propensity score analysis ensured that the inference of the estimated difference in birth outcomes between the treatment groups was adjusted for nonrandom assignment based on age, race, Clinical Risk Group, and plan type. A series of generalized linear models were run to estimate the difference between the proportions of individuals with adverse birth outcomes, or the risk differences, for CenteringPregnancy group prenatal care participation. Estimated risk differences, the coefficient on the CenteringPregnancy group indicator variable from identity-link binomial variance generalized linear models, were then used to calculate potential cost savings due to participation in the CenteringPregnancy group. Results This study estimated that CenteringPregnancy participation reduced the risk of premature birth (36 %, P < 0.05). For every premature birth prevented, there was an average savings of $22,667 in health expenditures. Participation in CenteringPregnancy reduced the incidence of delivering an infant that was LBW (44 %, P < 0.05, $29,627). Additionally, infants of CenteringPregnancy participants had a reduced risk of a NICU stay (28 %, P < 0.05, $27,249). After considering the state investment of $1.7 million, there was an estimated return on investment of nearly $2.3 million. Conclusions Cost savings were achieved with better outcomes due to the participation in CenteringPregnancy among low-risk Medicaid beneficiaries.

Group prenatal care: has its time come?

Group prenatal care is an emerging trend in obstetrics, and for medically low-risk women has been shown to result in lower rates of preterm birth, higher rates of breastfeeding, and higher rates of participation in postpartum family planning. Significant cost savings to the health care system are seen when the lower rates of preterm birth and neonatal intensive care unit admissions are considered. More research is needed about patients' health outcomes as well as the economic and workforce implications to outpatient obstetric practices before widely transitioning prenatal care into group settings.

The impact of Centering Pregnancy Group Prenatal Care on postpartum family planning.

OBJECTIVE: The objective of the study was to evaluate the impact of group prenatal care (GPNC) on postpartum family-planning utilization. STUDY DESIGN: A retrospective cohort of women continuously enrolled in Medicaid for 12 months (n = 3637) was used to examine differences in postpartum family-planning service utilization among women participating in GPNC (n = 570) and those receiving individual prenatal care (IPNC; n = 3067). Propensity scoring methods were used to derive a matched cohort for additional analysis of selected outcomes. RESULTS: Utilization of postpartum family-planning services was higher among women participating in GPNC than among women receiving IPNC at 4 points in time: 3 (7.72% vs 5.15%, P < .05), 6 (22.98% vs 15.10%, P < .05), 9 (27.02% vs 18.42%, P < .05), and 12 (29.30% vs 20.38%, P < .05) months postpartum. Postpartum family-planning visits were highest among non-Hispanic black women at each interval, peaking with 31.84% by 12 months postpartum. After propensity score matching, positive associations between GPNC and postpartum family-planning service utilization remained consistent by 6 (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.05-1.92), 9 (OR, 1.43; 95% CI, 1.08-1.90), and 12 (OR, 1.44; 95% CI, 1.10-1.90) months postpartum. CONCLUSION: These findings demonstrate the potential that GPNC has to positively influence women's health outcomes after pregnancy and to improve the utilization rate of preventive health services. Utilization of postpartum family-planning services was highest among non-Hispanic black women, further supporting evidence of the impact of GPNC in reducing health disparities. However, despite continuous Medicaid enrollment, postpartum utilization of family-planning services remained low among all women, regardless of the type of prenatal care they received.

The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population.

OBJECTIVE: The purpose of this study was to evaluate the impact of group prenatal care on rates of preterm birth. STUDY DESIGN: We conducted a retrospective cohort study of 316 women in group prenatal care that was compared with 3767 women in traditional prenatal care. Women self-selected participation in group care. RESULTS: Risk factors for preterm birth were similar for group prenatal care vs traditional prenatal care: smoking (16.9% vs 20%; P = .17), sexually transmitted diseases (15.8% vs 13.7%; P = .29), and previous preterm birth (3.2% vs 5.4%; P = .08). Preterm delivery (<37 weeks' gestation) was lower in group care than traditional care (7.9% vs 12.7%; P = .01), as was delivery at <32 weeks' gestation (1.3% vs 3.1%; P = .03). Adjusted odds ratio for preterm birth for participants in group care was 0.53 (95% confidence interval, 0.34-0.81). The racial disparity in preterm birth for black women, relative to white and Hispanic women, was diminished for the women in group care. CONCLUSION: Among low-risk women, participation in group care improves the rate of preterm birth compared with traditional care, especially among black women. Randomized studies are needed to eliminate selection bias.

Racial differences in C-reactive protein levels during normal pregnancy.

OBJECTIVE: The purpose of this study was to characterize serum C-reactive protein (CRP) levels in a diverse population of healthy pregnant women with the use of a high sensitivity assay. STUDY DESIGN: We conducted a cross-sectional analysis of a cohort of 775 pregnant women. CRP was measured on serum specimens that were drawn at < 26 weeks of gestation with highly sensitive enzyme-linked immunosorbent assay kits. RESULTS: Median CRP was 4.8 mg/L (interquartile range, 0.63-15.7). Black women had higher median CRP values than did white women (7.68 vs 2.59 mg/L; P < .001). Black women demonstrated higher levels of CRP, even after the data were controlled for known confounding factors such as smoking and maternal weight. CONCLUSION: Pregnancy is an inflammatory stressor. The cause of racial differences is unclear but may be important for understanding racial disparities in the incidence of inflammatory disorders such as preterm labor and preeclampsia.

Determinants of the middle cerebral artery peak systolic velocity in the human fetus.

OBJECTIVE: The purpose of this study was to identify physiologic determinants of the peak systolic blood flow velocity (PSV) of the middle cerebral artery (MCA) in the human fetus. STUDY DESIGN: MCA PSV was measured with pulsed wave Doppler ultrasound in human fetuses who underwent cordocentesis. Hemoglobin, hematocrit, and blood gas values were analyzed from umbilical venous blood, and the data were normalized for gestational age. Total oxygen content of fetal venous blood was calculated from oxygen saturation, hemoglobin value, and pO2. Correlation and logistic regression analyses were performed to identify primary physiologic determinants of MCA PSV. RESULTS: In 136 fetuses who underwent cordocentesis (predominantly for alloimmune disease), hematocrit, hemoglobin, and blood oxygen content correlated significantly with the MCA PSV (P < .01). Logistic regression modeling demonstrated that fetal hemoglobin content (odds ratio, 7.1; 95% CI, 3.71-13.7) and pCO2, but not pO2 or fetal blood oxygen content, accounted for increases in MCA PSV. CONCLUSION: Under physiologic circumstances, fetal hemoglobin, and not fetal oxygenation, primarily determines the middle cerebral artery peak systolic velocity.

Qualitative Comparison of Women's Perspectives on the Functions and Benefits of Group and Individual Prenatal Care.

INTRODUCTION: Women's definitions and experiences of the functions and benefits of their routine prenatal care are largely absent from research and public discourse on prenatal care outcomes. This qualitative study aimed to develop a framework of women's prenatal care experiences by comparing the experiences of women in individual and group prenatal care. METHODS: We conducted serial qualitative interviews with racially diverse low-income women receiving individual prenatal care (n = 14) or group prenatal care (n = 15) through pregnancy and the early postpartum period. We completed 42 second-trimester, 48 third-trimester, and 44 postpartum interviews. Using grounded theory, the semistructured interviews were coded for themes, and the themes were integrated into an explanatory framework of prenatal care functions and benefits. RESULTS: Individual and group participants described similar benefits in 3 prenatal care functions: confirming health, preventing and monitoring medical complications, and building supportive provider relationships. For the fourth function, educating and preparing, group care participants experienced more benefits and different benefits. The benefits for group participants were enhanced by the supportive group environment. Group participants described greater positive influences on stress, confidence, knowledge, motivation, informed decision making, and health care engagement. DISCUSSION: Whereas pregnant women want to maximize their probability of having a healthy newborn, other prenatal care outcomes are also important: reducing pregnancy-related stress; developing confidence and knowledge for improving health; preparing for labor, birth, and newborn care; and having supportive relationships. Group prenatal care may be more effective in attaining these outcomes. Achieving these outcomes is increasingly relevant in health care systems prioritizing woman-centered care and improved birth outcomes. How to achieve them should be part of policy development and research.

The impact of gestational age on the sonographic detection of aneuploidy.

OBJECTIVE: The purpose of this study was to identify the influence of gestational age on the detection of sonographic markers of aneuploidy. STUDY DESIGN: Using a retrospective chart review, cases of trisomy 13, 18, and 21 with fetal ultrasounds between 14 1/7 and 36 4/7 weeks' gestation were identified. Sonographic markers were subdivided into major abnormalities and "soft" sonographic markers: nuchal thickening > or = 5 mm, humerus or femur length <10th percentile, intracardiac echogenic focus, echogenic bowel, pyelectasis > or = 4 mm, and choroid plexus cysts. Markers were stratified by karyotype and gestational age. RESULTS: Fifteen fetuses with trisomy 13, 32 with trisomy 18, and 49 with trisomy 21 were identified. There was no difference in the prevalence of ultrasound markers by gestational age (P = .40). Soft markers were more common in the second trimester of pregnancy (P = .006) with a trend toward increased prevalence of major anomalies with advancing gestation (P = .22). CONCLUSION: Although sonographic markers change with gestational age, these markers are present throughout gestation and can provide clinically useful information to guide patient counseling.

Case report: malignant peritoneal mesothelioma in two siblings.

BACKGROUND: Mesothelioma is a rare tumor, linked with occupational asbestos exposure. This association has been used to explain clustering of cases within families. Newer evidence, however, supports a possible genetic predisposition for this tumor. CASE: Our patient's brother was diagnosed with advanced stage malignant peritoneal mesothelioma in August 1995 at age of 42, he underwent tumor-reductive surgery followed by chemotherapy. He underwent a repeat cytoreductive surgery in September 1996 and further chemotherapy. He died of disease in December 1996. Our patient underwent cytoreductive surgery in May 1999 at age of 49 for advanced stage malignant peritoneal mesothelioma with suboptimal debulking. She received multiple chemotherapy regimens, including most recently experimental targeted agents, for slow progressing disease. She is presently alive with clinical disease 6 years from diagnosis. CONCLUSION: This is the first report of two siblings of different gender with malignant peritoneal mesothelioma and only average environmental asbestos exposure. It is highly likely that the family described in this case report has some form of inherited susceptibility to malignancy cancer gene, HLA type, or tumor suppressor gene mutation.