title: The comparative effects of group prenatal care on psychosocial outcomes.
abstract: To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N = 124) or individual prenatal care (N = 124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89% completing the second survey (mean gestational age 32.7 weeks) and 84% completing the third survey (6 weeks' postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p < 0.05) in their use of prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p = 0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p = 0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p < 0.01) in prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p = 0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group prenatal care for all women.
authors.affiliation: Department of Public Health Sciences, College of Health, Education, and Human Development, Clemson University, Clemson, SC, 29634, USA. heberleine@gmail.com.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Heberlein
authors.affiliation: Greenville Health System, Department of Obstetrics and Gynecology, 890 W. Faris Road, Greenville, SC, 29605, USA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Picklesimer
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Billings
authors.affiliation: Greenville Health System, Department of Obstetrics and Gynecology, 890 W. Faris Road, Greenville, SC, 29605, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Covington-Kolb
authors.affiliation: College of Social Work, University of South Carolina, 902 Sumter St., Columbia, SC, 29208, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Farber
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006126:Group Processes; D006801:Humans; D007223:Infant; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology; D011446:Prospective Studies; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: CenteringPregnancy; Group prenatal care; Pregnancy-related distress; Prenatal care; Prenatal coping; Psychosocial outcomes