Dataset Information

The impact of group prenatal care on pregnancy and postpartum weight trajectories.

ABSTRACT: The objective of the study was to investigate whether group prenatal care (Centering Pregnancy Plus [CP+]) has an impact on pregnancy weight gain and postpartum weight loss trajectories and to determine whether prenatal depression and distress might moderate these trajectories.This was a secondary analysis of a cluster-randomized trial of CP+ in 14 Community Health Centers and hospitals in New York City. Participants were pregnant women aged 14-21 years (n = 984). Medical record review and 4 structured interviews were conducted: in the second and third trimesters and 6 and 12 months postpartum. Longitudinal mixed modeling was utilized to evaluate the weight change trajectories in the control and intervention groups. Prenatal distress and depression were also assessed to examine their impact on weight change.There were no significant differences between the intervention and control groups in baseline demographics. Thirty-five percent of the participants were overweight or obese, and more than 50% had excessive weight gain by Institute of Medicine standards. CP+ was associated with improved weight trajectories compared with controls (P < .0001): women at clinical sites randomized to group prenatal care gained less weight during pregnancy and lost more weight postpartum. This effect was sustained among women who were categorized as obese based on prepregnancy body mass index (P < .01). Prenatal depression and distress were significantly associated with higher antepartum weight gain and postpartum weight retention. Women with the highest levels of depression and prenatal distress exhibited the greatest positive impact of group prenatal care on weight trajectories during pregnancy and through 12 months postpartum.Group prenatal care has a significant impact on weight gain trajectories in pregnancy and postpartum. The intervention also appeared to mitigate the effects of depression and prenatal distress on antepartum weight gain and postpartum weight retention. Targeted efforts are needed during and after pregnancy to improve weight gain trajectories and overall health.

SUBMITTER: Magriples U

PROVIDER: S-EPMC4910388 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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The impact of group prenatal care on pregnancy and postpartum weight trajectories.

Magriples Urania U Boynton Marcella H MH Kershaw Trace S TS Lewis Jessica J Rising Sharon Schindler SS Tobin Jonathan N JN Epel Elissa E Ickovics Jeannette R JR

American journal of obstetrics and gynecology 20150709 5

<h4>Objective</h4>The objective of the study was to investigate whether group prenatal care (Centering Pregnancy Plus [CP+]) has an impact on pregnancy weight gain and postpartum weight loss trajectories and to determine whether prenatal depression and distress might moderate these trajectories.<h4>Study design</h4>This was a secondary analysis of a cluster-randomized trial of CP+ in 14 Community Health Centers and hospitals in New York City. Participants were pregnant women aged 14-21 years (n ...[more]

PMID: 26164694

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Project description:BackgroundGroup visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain.MethodsA keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I2 statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies.ResultsOne RCT, one secondary analysis of an RCT, one study with "random assignment", and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97-1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79-1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis.ConclusionsGroup prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain.

Project description:ObjectiveTo describe patients' preferences for prenatal and postpartum care delivery.MethodsWe conducted a cross-sectional survey of postpartum patients admitted for childbirth and recovery at an academic institution. We assessed patient preferences for prenatal and postpartum care delivery, including visit number, between-visit contact (eg, phone and electronic medical record portal communication), acceptability of remote monitoring (eg, weight, blood pressure, fetal heart tones), and alternative care models (eg, telemedicine and home visits). We compared preferences for prenatal care visit number to current American College of Obstetricians and Gynecologists' recommendations (12-14 prenatal visits).ResultsOf the 332 women eligible for the study, 300 (90%) completed the survey. Women desired a median number of 10 prenatal visits (interquartile range 9-12), with most desiring fewer visits than currently recommended (fewer than 12: 63% [n=189]; 12-14: 22% [n=65]; more than 14: 15% [n=46]). Women who had private insurance or were white were more likely to prefer fewer prenatal visits. The majority of patients desired contact with their care team between visits (84%). Most patients reported comfort with home monitoring skills, including measuring weight (91%), blood pressure (82%), and fetal heart tones (68%). Patients reported that they would be most likely to use individual care models (94%), followed by pregnancy medical homes (72%) and home visits (69%). The majority of patients desired at least two postpartum visits (91%), with the first visit within 3 weeks after discharge (81%).ConclusionCurrent prenatal and postpartum care delivery does not match patients' preferences for visit number or between-visit contact, and patients are open to alternative models of prenatal care, including remote monitoring. Future prenatal care redesign will need to consider diverse patients' preferences and flexible models of care that are tailored to work with patients in the context of their lives and communities.

Dataset Information

The impact of group prenatal care on pregnancy and postpartum weight trajectories.

Publications

The impact of group prenatal care on pregnancy and postpartum weight trajectories.

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