Carter E B, Barbier K, Sarabia R, Macones G A, Cahill A G, Tuuli M G
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA.
Barnes Jewish Hospital, Department of Ambulatory Services, St Louis, MO, USA.
J Perinatol. 2017 Jul;37(7):769-771. doi: 10.1038/jp.2017.33. Epub 2017 Mar 30.
Group prenatal care (GC) models are receiving increasing attention as a means of preventing preterm birth; yet, there are limited data on whether group care improves perinatal outcomes in women who deliver at term. The purpose of this study was to evaluate our institutional experience with GC over the past decade and test the hypothesis that GC, compared with traditional individual care (TC), improves perinatal outcomes in women who deliver at term.
We performed a retrospective cohort study of women delivering at term who participated in GC compared with TC. A group of 207 GC patients who delivered at term from 2004 to 2014 were matched in a 1:2 ratio to 414 patients with term singleton pregnancies who delivered at our institution during the same period by delivery year, maternal age, race and insurance status. The primary outcome was low birth weight (<2500 g). Secondary outcomes included early term birth (37.0 to 38 6/7 weeks), 5 min APGAR score <7, special care nursery admission, neonatal intensive care unit (NICU) admission, neonatal demise, cesarean section and number of prenatal visits. Outcomes were compared between the two groups using univariable statistics.
Baseline characteristics were similar between the two matched groups. GC was associated with a significant reduction in low birth weight infants compared with TC (11.1% vs 19.6%; relative risk (RR) 0.57; 95% confidence interval (CI) 0.37 to 0.87). Patients in GC were significantly less likely than controls to require cesarean delivery, have low 5 min APGAR scores and need higher-level neonatal care (NICU: 1.5% vs 6.5%; RR 0.22; 95% CI 0.07 to 0.72). There were no significant differences in rates of early term birth and neonatal demise.
Low-risk women participating in GC and delivering at term had a lower risk of low birth weight and other adverse perinatal outcomes compared with women in TC. This suggests GC is a promising alternative to individual prenatal care to improve perinatal outcomes in addition to preterm birth.
作为预防早产的一种手段，群体产前护理（GC）模式正受到越来越多的关注；然而，关于群体护理能否改善足月分娩女性的围产期结局的数据有限。本研究的目的是评估我们机构在过去十年中GC的经验，并检验与传统个体护理（TC）相比，GC能改善足月分娩女性围产期结局的假设。
我们对参与GC与TC的足月分娩女性进行了一项回顾性队列研究。将2004年至2014年期间足月分娩的207例GC患者按1:2的比例与同期在我们机构足月单胎妊娠分娩的414例患者进行匹配，匹配因素包括分娩年份、产妇年龄、种族和保险状况。主要结局是低出生体重（<2500g）。次要结局包括早期足月分娩（37.0至38 6/7周）、5分钟阿氏评分<7、入住特殊护理病房、入住新生儿重症监护病房（NICU）、新生儿死亡、剖宫产及产前检查次数。使用单变量统计方法比较两组的结局。
两个匹配组的基线特征相似。与TC相比，GC与低出生体重儿显著减少相关（11.1%对19.6%；相对风险（RR）0.57；95%置信区间（CI）0.37至0.87）。GC组患者剖宫产、5分钟阿氏评分低及需要更高水平新生儿护理的可能性显著低于对照组（NICU：1.5%对6.5%；RR 0.22；95%CI 0.07至0.72）。早期足月分娩率和新生儿死亡率无显著差异。
与TC组女性相比，参与GC并足月分娩的低风险女性低出生体重及其他不良围产期结局的风险更低。这表明，除预防早产外，GC是改善围产期结局的一种有前景的个体产前护理替代方案。
