Department of Obstetrics and Gynecology, Divisions of Women's Reproductive Healthcare and Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University School of Medicine, St Louis, MO.
Am J Obstet Gynecol. 2017 Jun;216(6):552-556. doi: 10.1016/j.ajog.2017.02.006. Epub 2017 Feb 9.
Patients participating in group prenatal care gather together with women of similar gestational ages and 2 providers who cofacilitate an educational session after a brief medical assessment. The model was first described in the 1990s by a midwife for low-risk patients and is now practiced by midwives and physicians for both low-risk patients and some high-risk patients, such as those with diabetes. The majority of literature on group prenatal care uses CenteringPregnancy, the most popular model. The first randomized controlled trial of CenteringPregnancy showed that it reduced the risk of preterm birth in low-risk women. However, recent meta-analyses have shown similar rates of preterm birth, low birthweight, and neonatal intensive care unit admission between women participating in group prenatal care and individual prenatal care. There may be subgroups, such as African Americans, who benefit from this type of prenatal care with significantly lower rates of preterm birth. Group prenatal care seems to result in increased patient satisfaction and knowledge and use of postpartum family planning as well as improved weight gain parameters. The literature is inconclusive regarding breast-feeding, stress, depression, and positive health behaviors, although it is theorized that group prenatal care positively affects these outcomes. It is unclear whether group prenatal care results in cost savings, although it may in large-volume practices if each group consists of approximately 8-10 women. Group prenatal care requires a significant paradigm shift. It can be difficult to implement and sustain. More randomized trials are needed to ascertain the true benefits of the model, best practices for implementation, and subgroups who may benefit most from this innovative way to provide prenatal care. In short, group prenatal care is an innovative and promising model with comparable pregnancy outcomes to individual prenatal care in the general population and improved outcomes in some demographic groups.
参与群体产前护理的患者与具有相似妊娠年龄的女性聚集在一起，由 2 名共同促进教育课程的提供者在简短的医疗评估后进行。该模式最初由一名助产士于 20 世纪 90 年代描述，用于低风险患者，现在由助产士和医生用于低风险患者和一些高风险患者，例如患有糖尿病的患者。大多数关于群体产前护理的文献都使用 CenteringPregnancy，这是最受欢迎的模式。CenteringPregnancy 的首次随机对照试验表明，它降低了低风险女性早产的风险。然而，最近的荟萃分析表明，在参与群体产前护理和个体产前护理的女性之间，早产、低出生体重和新生儿重症监护病房入院的发生率相似。可能存在亚组，例如非裔美国人，他们从这种类型的产前护理中受益，早产率显著降低。群体产前护理似乎导致患者满意度和产后计划生育知识的提高和使用增加，以及体重增加参数的改善。关于母乳喂养、压力、抑郁和积极的健康行为，文献尚无定论，尽管有人认为群体产前护理对这些结果有积极影响。虽然在大容量实践中，如果每个小组由大约 8-10 名女性组成，群体产前护理可能会节省成本，但目前尚不清楚群体产前护理是否会节省成本。群体产前护理需要重大的范式转变。它可能难以实施和维持。需要更多的随机试验来确定该模式的真正益处、实施的最佳实践以及可能从这种创新的产前护理方式中受益最多的亚组。简而言之，群体产前护理是一种创新且有前途的模式，与普通人群中的个体产前护理相比，其妊娠结局相当，并且在某些人群中改善了结局。
