A review of prenatal group care literature: the need for a structured theoretical framework and systematic evaluation.

The purpose of this article is to systematically review the literature on group-based prenatal care related to patient participation, attendance, satisfaction, knowledge, pregnancy and birth outcomes, and program cost. MEDLINE, CINAHL, and PsycINFO sources were searched for English-language articles published any time prior to June 2010. Manual searches of bibliographies were conducted and experts were consulted to identify possible sources. Descriptive, cross-sectional, cohort, and randomized control studies that assessed group-based prenatal care were selected. Of the 15 articles reviewed, 11 studies met inclusion criteria for analysis of the study attributes and outcome data related to patient participation, attendance, satisfaction, knowledge, as well as breastfeeding, pregnancy and birth outcomes, and program cost. Results from the review show that group prenatal care may be associated with improved patient and birth outcomes including reduction in the number of preterm deliveries, higher patient participation and satisfaction, and increased initiation of breastfeeding. Prenatal group care research is limited by relatively few studies, most of which lack rigor. The current model of prenatal group care lacks a theoretical framework for describing and evaluating group processes as well as intermediary factors of prenatal and birth outcomes. Research on group care would benefit from additional randomized controlled trials that assess cost and sustainability and formally evaluate group process and intermediary factors thought to account for improved outcomes.