October 31, 2013 — Summary of "The Impact of Centering Pregnancy Group Prenatal Care on Postpartum Family Planning," Hale et al., American Journal of Obstetrics & Gynecology, October 2013.
Some studies have suggested that women who participate in group prenatal care (GPNC) experience lower rates of preterm birth, as well improved infant birth weight, breastfeeding rates, patient satisfaction, and readiness for childbirth and parenting, according to Nathan Hale of the University of South Carolina's Arnold School of Public Health and colleagues. However, no studies have specifically examined how participation in GPNC affects a woman's use of postpartum health services, such as family planning services.
The researchers hypothesized that targeted discussions on certain topics and peer support through GPNC could help "reinforce important messages related to postpartum family-planning utilization ... that would not be present for women receiving" conventional individual prenatal care (IPNC). For this study, they analyzed Medicaid data to compare how GPNC or IPNC participation affected utilization of family planning services for one year after delivery.
The researchers used data from the Office of Research and Statistics of the South Carolina Budget and Control Board to identify a retrospective cohort of women who had a single live birth at Greenville Memorial Hospital between March 2009 and March 2012. Women in the cohort received care through a Greenville Health System obstetric practice and were allowed to choose either GPNC or IPNC.
According the study, the practice uses the Centering Pregnancy model of GPNC, which includes a curriculum delivered in 10, two-hour group sessions over six months. In each session, a group of eight to 12 pregnant women who are due to deliver in the same month receive a physical assessment from a health care provider, complete lessons from the curriculum and build relationships with other participants.
The researchers restricted their analysis to women who were enrolled in Medicaid for 12 months after delivery and attended GPNC (n=570) or IPNC (n=3,067). They noted that GPNC is only offered to women with low-risk pregnancies who seek care early in gestation. Those who began prenatal care after the first 16 weeks of pregnancy or had signs of pregestational diabetes or hypertension were excluded.
The researchers tracked visits to GPNC and IPNC at postpartum months three, six, nine or 12 using Medicaid billing records. They then used propensity scoring methods to derive a matched group of participants for additional analysis of certain outcomes.
Overall, utilization of postpartum family planning services was significantly higher among women participating in GPNC than among women receiving IPNC at months three, six, nine and 12. By 12 months, the proportion of GPNC participants who had used a family-planning service was 29.3%, compared with 20.38% among IPNC participants.
Non-Hispanic black women had the highest postpartum family planning utilization at each of the four intervals, reaching 31.84% by 12 months postpartum.
In addition, the researchers identified "notable differences in the characteristics of the study population" among GPNC and IPNC participants. For example, 64.9% of pregnancies among GPNC participants were first births, compared with 42.78% of participants in IPNC. Further, women in GPNC were more likely to be black, younger and have less education than those in IPNC. However, women in IPNC were more likely to smoke (25.2%) and develop gestational diabetes (6.59%), compared with those in GPNC (19.7% and 2.11%, respectively).
After propensity score matching, positive associations between GPNC and postpartum family-planning service utilization remained consistent at months six, nine and 12.
The researchers wrote that their "main finding is that continuously insured women enrolled in Medicaid who participate in [GPNC] are more likely to access family-planning services by 3, 6, 9 and 12 months postpartum," compared with a comparable group of women who received IPNC.
The "findings suggest that GPNC promotes improved pregnancy outcomes by affecting maternal health behaviors and improves health literacy by establishing a continuum of care for women extending from pregnancy through the postpartum period," the researchers added. Further, the findings "suggest that GPNC does exert some influence on transitioning to postpartum family planning services, particularly in non-Hispanic black women," they wrote.
Although the reasons for the findings are not known, the researchers noted that "continued reinforcement of key messages with facilitated group discussion and peer support are important features of GPNC that are not routinely present in IPNC." They called for "[l]arger prospective, randomized trials ... to confirm the favorable effects of GPNC on selected health and health service outcomes and provide additional insight on the specific mechanisms underpinning observed results," as well as studies "examin[ing] the content of GPNC visits and address[ing] long-term outcomes, such as the duration of the interconceptional interval and the outcome of subsequent pregnancies."