title: Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial.
abstract: Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14-25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This 'bundled' intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.
authors.affiliation: Yale School of Public Health and Yale Center for Interdisciplinary Research on AIDS, New Haven, CT 06520-8034, USA. jeannette.ickovics@yale.edu
authors.forename: Jeannette R
authors.initials: JR
authors.lastname: Ickovics
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reed
authors.forename: Urania
authors.initials: U
authors.lastname: Magriples
authors.forename: Claire
authors.initials: C
authors.lastname: Westdahl
authors.forename: Sharon
authors.initials: S
authors.lastname: Schindler Rising
authors.forename: Trace S
authors.initials: TS
authors.lastname: Kershaw
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006126:Group Processes; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D015397:Program Evaluation / Q000379:methods; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis; D014584:User-Computer Interface; D055815:Young Adult