Department of OB/GYN, Indiana University School of Medicine, 550 N. University Blvd, UH 2440, Indianapolis, IN, 46202, USA.
BMC Pregnancy Childbirth. 2017 Sep 29;17(1):329. doi: 10.1186/s12884-017-1522-2.
Group prenatal care (GPC) models have been gaining popularity in recent years. Studies of high-risk groups have shown improved outcomes. Our objective was to review and summarize outcomes for women in GPC for women with specific high-risk conditions.
A systematic literature review of Ovid, PubMed, and Google Scholar was performed to identify studies reporting the effects of group prenatal care in high-risk populations. Studies were included if they reported on pregnancy outcome results for women using GPC. We also contacted providers known to be utilizing GPC for specific high-risk women. Descriptive results were compiled and summarized by high-risk population.
We identified 37 reports for inclusion (8 randomized trials, 23 nonrandomized studies, 6 reports of group outcomes without controls). Preterm birth was found to be decreased among low-income and African American women. Attendance at prenatal visits was shown to increase among women in GPC in the following groups: Opioid Addiction, Adolescents, and Low-Income. Improved weight trajectories and compliance with the IOM's weight recommendations were found in adolescents. Increased rates of breastfeeding were found in adolescents and African Americans. Increased satisfaction with care was found in adolescents and African Americans. Pregnancy knowledge was increased among adolescents, as was uptake of LARC. Improved psychological outcomes were found among adolescents and low-income women. Studies in women with diabetes demonstrated that fewer women required treatment with medication when exposed to GPC, and for those requiring treatment with insulin, GPC individuals required less than half the dose. Among women with tobacco use, those who had continued to smoke after finding out they were pregnant were 5 times more likely to quit later in pregnancy if they were engaged in GPC.
Several groups of high-risk pregnant women may have benefits from engaging in group prenatal care. Because there is a paucity of high-quality, well-controlled studies, more trials in high-risk women are needed to determine whether it improves outcomes and costs of pregnancy-related care.
近年来，群体产前护理（GPC）模式越来越受欢迎。对高危人群的研究表明，该模式改善了结局。我们的目的是回顾和总结具有特定高危条件的妇女参加 GPC 的结局。
对 Ovid、PubMed 和 Google Scholar 进行系统文献检索，以确定报告群体产前护理对高危人群妊娠结局影响的研究。如果研究报告了使用 GPC 的妇女的妊娠结局结果，则纳入研究。我们还联系了已知为特定高危妇女使用 GPC 的提供者。按高危人群汇总和总结描述性结果。
我们确定了 37 份报告纳入（8 项随机试验、23 项非随机研究、6 份没有对照组的群体结局报告）。低收入和非裔美国妇女的早产率降低。GPC 中的以下人群产前检查的出席率增加：阿片类药物成瘾、青少年和低收入人群。青少年的体重轨迹和遵守 IOM 体重建议的情况得到改善。青少年和非裔美国人的母乳喂养率增加。青少年和非裔美国人对护理的满意度增加。青少年的妊娠知识增加，LARC 的采用增加。青少年和低收入妇女的心理结局得到改善。患有糖尿病的妇女的研究表明，与接受 GPC 相比，接受药物治疗的妇女减少，需要胰岛素治疗的妇女，GPC 个体所需的剂量不到一半。在吸烟的妇女中，如果她们在发现怀孕后继续吸烟，那么如果她们参加 GPC，她们在怀孕后期戒烟的可能性是不参加 GPC 的 5 倍。
有几种高危孕妇群体可能从参加群体产前护理中获益。由于高质量、对照良好的研究较少，需要在高危妇女中进行更多的试验，以确定它是否改善妊娠相关护理的结局和成本。
