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.

Trial registration: ClinicalTrials.gov NCT00271960.

Conflict of interest statement

Declaration of interest: Claire M. Westdahl conducts occasional training facilitation workshops for the Centering Healthcare Institute. No commercial entity has agreed to direct any benefits to any organisation with which she is affiliated. Sharon Schindler Rising is the Executive Director of the non-profit entity, Centering Healthcare Institute that promotes the CenteringPregnancy model of care nationally and internationally. There are no other known conflicts of interest.

Figures

Figure 1

Changes in self-esteem from second (time 1) to third (time 2) trimester of pregnancy for IC and CP+ groups.

Figure 2

Changes in stress from second (time 1) to third (time 2) trimester of pregnancy for IC and CP+ groups.

Figure 3

Changes in social conflict from second trimester (time 1) to 12 months postpartum (time 4) for IC and CP+ groups.

Figure 4

Changes in depression from time 1 to time 4 for IC and CP+ groups.