Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia.
Department of Obstetrics and Gynecology, Prisma Health Upstate, Greenville, South Carolina.
Am J Perinatol. 2024 Mar;41(4):414-421. doi: 10.1055/a-1682-2704. Epub 2021 Oct 28.
Group prenatal care models were initially designed for women with medically low-risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birth weight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group versus individual prenatal care.
This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI > 45 kg/m). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (one or more groups) or minimum threshold (five or more groups).
Participation in group prenatal care at either treatment exposure level was associated with a lower risk of neonatal intensive care unit (NICU) admissions (10.2 group vs. 13.8% individual care, odds ratio [OR] = 0.708, < 0.001). Participating in the minimum threshold of groups (five or more sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR = 0.569, < 0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR = 0.483, < 0.001). No differences in birth weight were observed.
This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birth weight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups.
· This study compares outcomes for women who receive group versus individual prenatal care. · The study population was limited to women with diabetes, hypertension, and/or high BMI.. · Group participants did not have higher rates of preterm birth, low birth weight, or NICU admissions..
群体产前护理模式最初是为有低医疗风险妊娠的女性设计的，早期的结果数据主要集中在这些患者群体上。需要了解参加群体产前护理的有高医疗风险妊娠的女性的妊娠结局数据，以指导临床实践。本研究比较了接受群体产前护理和个体产前护理的有不良妊娠结局医疗风险的女性的早产率、低出生体重和新生儿重症监护病房（NICU）入院率。
这项回顾性队列研究使用生命统计数据比较了参与全州群体产前护理扩展项目的 21 个产科实践的女性的妊娠结局。本文的研究人群包括患有孕前或孕中高血压、孕前或孕中糖尿病和高体重指数（BMI＞45kg/m）的女性。使用倾向评分对患者进行匹配，并使用逻辑回归比较结果。对于接受群体护理的女性，根据群体就诊次数的两种治疗暴露水平评估：任何暴露（一次或多次就诊）或最低阈值（五次或更多就诊）。
在任何治疗暴露水平下，参加群体产前护理与较低的 NICU 入院风险相关（群体护理为 10.2%，个体护理为 13.8%，比值比[OR]＝0.708， ＜0.001）。参加五次或更多群体就诊的最低阈值与早产风险降低相关（群体护理为 11.4%，个体护理为 18.4%，OR＝0.569， ＜0.001）和 NICU 入院风险降低相关（群体护理为 8.4%，个体护理为 15.9%，OR＝0.483， ＜0.001）。未观察到出生体重的差异。
本研究初步表明，在有或患有妊娠期间常见医疗状况的女性中，如果她们参加群体产前护理，其早产、低出生体重或 NICU 入院的风险并不会增加。那些常规将这些患者排除在群体参与之外的医疗机构应重新考虑增加群体的包容性。
·本研究比较了接受群体产前护理和个体产前护理的女性的结局。·研究人群仅限于患有糖尿病、高血压和/或高 BMI 的女性。·群体参与者的早产率、低出生体重率和 NICU 入院率没有更高。
