Development of a Nationally Scalable Model of Group Prenatal Care to Improve Birth Outcomes: "Expect With Me"

May 27, 2020 updated by: Yale University

This study addresses the intractable challenges of adverse birth outcomes, including preterm delivery and low birthweight, by proposing the development, implementation and evaluation of a model of group prenatal care that could be scaled nationally. Group prenatal care models have been demonstrated through rigorous research to provide significantly improved birth outcomes with implications for maternal-child health and substantial cost savings. However, group prenatal care is currently available to only a small fraction of the more than four million women who give birth annually in the US. Through the development, implementation and evaluation of a new model of group prenatal care, we will create an outcomes-focused model of group prenatal care that will be scalable nationally with an eye toward improving US birth outcomes.

The long-term objective of the proposed study is to reduce the risk for adverse perinatal outcomes during and after pregnancy among women and families receiving prenatal care in health centers in 3 geographic locations serving vulnerable populations: Hidalgo County Texas, Nashville Tennessee, and Detroit Michigan. We will develop, disseminate, and evaluate a new and improved model of group prenatal care, "Expect with Me," based on our previous research on group models of prenatal care, which has already yielded favorable behavioral and biological results in two randomized controlled trials.

We hypothesize that, relative to women who receive standard individual prenatal care, the women who receive "Expect with Me" group prenatal care will be significantly more likely to:

  1. have better perinatal outcomes, including better health behaviors during pregnancy (e.g., nutrition, physical activity), better birth outcomes (e.g., decreased preterm labor, low birthweight, Neonatal Intensive Care Unit stays), and better postpartum indicators (e.g., increased breastfeeding);
  2. report greater change in risk-related behaviors and psychosocial characteristics that could be considered potential mechanisms for the program's effectiveness;
  3. have lower rates of sexually transmitted diseases and rapid repeat pregnancy one year postpartum;
  4. have lower healthcare costs through improved outcomes (e.g., appropriate care utilization, fewer complications, reduced NICU admissions/length of stays)

Comparisons based on propensity-score matched sample of women receiving standard individual prenatal care at the same clinical sites.

Study Overview

Detailed Description

This study addresses the intractable challenges of adverse birth outcomes, including preterm delivery and low birthweight, by proposing the development, implementation and evaluation of a model of group prenatal care that could be scaled nationally. Group prenatal care models have been demonstrated through rigorous research to provide significantly improved birth outcomes with implications for maternal-child health and substantial cost savings. However, group prenatal care is currently available to only a small fraction of the more than four million women who give birth annually in the US. Through the development, implementation and evaluation of a new model of group prenatal care, we will create an outcomes-focused model of group prenatal care that will be scalable nationally with an eye toward improving US birth outcomes.

Specific Aims:

The long-term objective of the proposed study is to reduce the risk for adverse perinatal outcomes during and after pregnancy among women and families receiving prenatal care in health centers in 3 geographic locations serving vulnerable populations: Hidalgo County Texas, Nashville Tennessee, and Detroit Michigan. We will develop, disseminate, and evaluate a new and improved model of group prenatal care, "Expect with Me," based on our previous research on group models of prenatal care, which has already yielded favorable behavioral and biological results in two randomized controlled trials. The overall objective of this project is to improve maternal health and reduce adverse birth outcomes. We will meet this objective by achieving three specific goals:

  1. Develop a new and improved model of group prenatal care, including curriculum, training materials, IT infrastructure and marketing materials to support broad adoption of group prenatal care, enhance consumer experience, monitor patient outcomes, and ensure national scalability.
  2. Implement group prenatal care in three communities at high risk for adverse perinatal outcomes (Hidalgo County TX, Nashville TN, Detroit MI), engaging and training providers in group facilitation and the established curriculum, engaging patients through improved in-reach and outreach strategies, and implementing IT infrastructure to improve uptake, patient experience, and sustainability through the monitoring of patient outcomes.
  3. Evaluate the effect of implementing group prenatal care through a rigorous process and outcome evaluation that identifies any barriers to national scalability and examines maternal health and birth outcomes and resultant cost implications.

Specific Study Hypotheses

We hypothesize that, relative to women who receive standard individual prenatal care, the women who receive "Expect with Me" group prenatal care will be significantly more likely to:

  1. have better perinatal outcomes, including better health behaviors during pregnancy (e.g., nutrition, physical activity), better birth outcomes (e.g., decreased preterm labor, low birthweight, Neonatal Intensive Care Unit stays), and better postpartum indicators (e.g., increased breastfeeding);
  2. report greater change in risk-related behaviors and psychosocial characteristics that could be considered potential mechanisms for the program's effectiveness;
  3. have lower rates of sexually transmitted diseases and rapid repeat pregnancy one year postpartum;
  4. have lower healthcare costs through improved outcomes (e.g., appropriate care utilization, fewer complications, reduced NICU admissions/length of stays)

Study Type

Interventional

Enrollment (Actual)

2402

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Michigan
      • Detroit, Michigan, United States, 48201
        • Wayne State University
    • Tennessee
      • Nashville, Tennessee, United States, 37232
        • Vanderbilt University Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • less than 24 weeks pregnant
  • able to attend groups conducted in English or Spanish
  • consent to share their data with the study

Exclusion Criteria:

  • severe medical problem requiring individual care only, as determined by the participating clinical practice

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Expect With Me group prenatal care
receiving prenatal care through an Expect With Me group
Expect With Me group prenatal care was designed based on: principles of group care; evidence from RCTs demonstrating improved birth outcomes; ACOG clinical guidelines; and research on patient and provider engagement through technology. Designed with national dissemination as a primary consideration, Expect With Me incorporates best evidence-based aspects of existing models of group care, with a novel IT platform to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. Expect With Me provides care to groups of 8-12 women of the same gestational age, implemented after initial individual assessment through delivery. Group visits are 90-120 minutes each, and follow a structured curriculum that incorporates standard content of prenatal care, and emphasizes critical health issues relevant to pregnancy, such as nutrition, physical activity, stress/mental health and sexual health.
Other Names:
  • group prenatal care
Active Comparator: Individual Care Only
Standard of Care- individual prenatal care
Standard of care- individual prenatal care
Other Names:
  • Individual Care Only

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Risk of preterm birth incidence
Time Frame: up to 37 weeks gestation
Incidence risk of delivery before 37 weeks gestation
up to 37 weeks gestation
Risk of low birth weight incidence
Time Frame: delivery
Incidence risk of infant weight at birth < 2500 grams
delivery
Risk of small for gestational age incidence
Time Frame: delivery
Incidence risk of infant weight below the 10th percentile for the gestational age at birth
delivery
Risk of neonatal intensive care unit (NICU) admission incidence
Time Frame: birth
Incidence risk of being admitted to the neonatal intensive care unit (NICU) at birth
birth

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
breastfeeding
Time Frame: 6 and 12 months postpartum
initiation and duration of breastfeeding
6 and 12 months postpartum
nutrition
Time Frame: 2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum
nutritional choices, food security, and use of mindful eating practices
2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum
physical activity
Time Frame: 2nd and 3rd trimester and 6 and 12 months postpartum
level of physical activity in a typical week
2nd and 3rd trimester and 6 and 12 months postpartum
readiness for labor and delivery
Time Frame: measured at 2nd and third trimester
readiness for labor and delivery
measured at 2nd and third trimester
readiness for taking care of baby
Time Frame: 2nd and 3rd trimester of pregnancy
readiness for taking care of baby
2nd and 3rd trimester of pregnancy
social support
Time Frame: 2nd and 3rd trimester and 6 and 12 months postpartum
multidimensional scale of perceived social support subscale
2nd and 3rd trimester and 6 and 12 months postpartum
condom use self-efficacy
Time Frame: 2nd and 3rd trimester and 6 and 12 months postpartum
condom use self efficacy scale
2nd and 3rd trimester and 6 and 12 months postpartum
substance use
Time Frame: 2nd and 3rd trimester and 6 and 12 months postpartum
use of cigarettes, alcohol, and drugs
2nd and 3rd trimester and 6 and 12 months postpartum
care satisfaction
Time Frame: 3rd trimester
satisfaction with Expect With Me group prenatal care and use of program components
3rd trimester
adherence to medical recommendations
Time Frame: 6 & 12 months postpartum
adherence to medical recommendations (e.g., 6-week postpartum check, pediatric visits, vaccinations, infant feeding)
6 & 12 months postpartum
postpartum body mass index
Time Frame: measured at 6 and 12 months postpartum
individual's body weight divided by the square of their height (kg/m2)
measured at 6 and 12 months postpartum
maternal weight gain
Time Frame: measured at 2nd and 3rd trimester and birth
weight gain as compared to medical recommendations
measured at 2nd and 3rd trimester and birth
mode of delivery
Time Frame: delivery
mode of delivery (e.g., cesarean, vaginal)
delivery
sexual risk: condom use
Time Frame: measured at 2nd and 3rd trimester and 6 and 12 months postpartum
condom use percent (0-100%)
measured at 2nd and 3rd trimester and 6 and 12 months postpartum
sexual risk: contraceptive use (LARC)
Time Frame: measured at 2nd and 3rd trimester and 6 and 12 months postpartum
use of other contraceptives to prevent pregnancy (no/yes)
measured at 2nd and 3rd trimester and 6 and 12 months postpartum
sexual risk: number of sexual partners
Time Frame: measured at 2nd and 3rd trimester and 6 and 12 months postpartum
number of partners
measured at 2nd and 3rd trimester and 6 and 12 months postpartum
sexual risk: sexually transmitted infection
Time Frame: measured at 2nd and 3rd trimester and 6 and 12 months postpartum
sexually transmitted infection (no/yes, during pregnancy or incident postpartum)
measured at 2nd and 3rd trimester and 6 and 12 months postpartum

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
nurse visitation
Time Frame: 2nd and 3rd trimester of pregnancy
participation in a nurse visitation program
2nd and 3rd trimester of pregnancy
sexual debut
Time Frame: 2nd trimester pregnancy
age at first intercourse
2nd trimester pregnancy
living situation
Time Frame: 2nd and 3rd trimester and 6 and 12 months postpartum
where and with whom they live with and the stability of their housing
2nd and 3rd trimester and 6 and 12 months postpartum
transfer of motivation
Time Frame: 2nd and3rd trimester and 6 and 12 months postpartum
relation of motivation for self and baby's health
2nd and3rd trimester and 6 and 12 months postpartum
confidence in parenting skills
Time Frame: 6 and 12 months postpartum
confidence in parenting skills
6 and 12 months postpartum
intimate partner violence
Time Frame: measured at 2nd and 3rd trimester and 6 and 12 months postpartum
perpetration and victimization of violence by an intimate partner
measured at 2nd and 3rd trimester and 6 and 12 months postpartum
perceived stress
Time Frame: 2nd and 3rd trimester and 6 and 12 months postpartum
stress level as reported by patient
2nd and 3rd trimester and 6 and 12 months postpartum
depressive symptomatology
Time Frame: 2nd and 3rd trimester of pregnancy
patient endorsement of depressive symptoms
2nd and 3rd trimester of pregnancy
perceived discrimination
Time Frame: 2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum
patient experiences of discrimination
2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum
resilience
Time Frame: 2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum
shift and persist scale
2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Collaborators

Investigators

  • Principal Investigator: Jeannette R Ickovics, Ph.D., Yale School of Public Health
  • Study Director: Jessica B Lewis, PhD, MFT, Yale School of Public Health

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2014

Primary Completion (Actual)

December 1, 2016

Study Completion (Actual)

December 1, 2017

Study Registration Dates

First Submitted

June 18, 2014

First Submitted That Met QC Criteria

June 19, 2014

First Posted (Estimate)

June 20, 2014

Study Record Updates

Last Update Posted (Actual)

May 29, 2020

Last Update Submitted That Met QC Criteria

May 27, 2020

Last Verified

May 1, 2020

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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