Group Multimodal Prenatal Care and Postpartum Outcomes

Key Points Question Is group prenatal care delivered virtually with individual in-person office visits associated with better postpartum psychosocial, behavioral, and perceived quality of prenatal care outcomes, satisfaction with prenatal care, and preparation for self and baby care compared with individual prenatal care delivered with a combination of remote and in-person visits? Findings In this cohort study of 390 participants who were pregnant, group care was associated with equivalent, and in some cases better, outcomes compared with individual care. Meaning The findings of this study suggest that health care systems implementing multimodal models of care should consider incorporating virtual group prenatal care as an option for individuals who are pregnant.


Identification and recruitment of GMPC participants
Potential GMPC participants were identified from the EHRs using the unique Centering procedure code for a future appointment and sent recruitment emails.Of the 551 GMPC participants identified, 212 enrolled, 9 (2%) were ineligible, 49 (8%) refused, and 281 (51%) were unable to contact.Reasons for ineligibility included: did not speak English (n=6), residing outside the KPNC service area (n=2), and disenrollment from GMPC (n=1).Reasons for refusal included: no interest (n=14), lack of time (n=1), stress (n=1), and non-completion or partial completion of the baseline survey after agreeing at the recruitment call (n=33).
Of the 212 GMPC participants who enrolled in the study, 5 experienced a pregnancy loss (2%) resulting in 207 participants with a live birth.Of these 207, 198 (96%) completed the follow-up survey (including 3 partial completes), 8 (4%) were lost to follow-up and 1 (<1%) refused the follow-up survey (Figure 1).

Identification and recruitment of IMPC participants
A total of 2,955 IMPC controls were identified from clinics that did not offer GMPC through frequency matching based on gestational age, race/ethnicity, Medicaid enrollment, and maternal age for the 212 enrolled Centering participants.Up to 15 frequency-matched controls were identified for each GMPC participant and sent a recruitment email.The first individual for each GMPC participant who responded that they were interested in the study received a follow-up phone call to assess eligibility.Potential controls were asked if they would have participated in GMPC if it was available at their clinic and offered to them.Those who responded "yes" were recruited.The recruiter also followed up with individuals who were sent an email until a control was enrolled for each GMPC participant.If more controls were needed, up to 15 more were © 2024 Avalos LA et al.JAMA Network Open.
identified from the EHRs.The recruitment emails included consent information embedded in the body and the link to the survey.
Of the 2,955 IMPC controls identified, 212 enrolled in the study, 91 (2%) refused, 275 were unable to contact (9%), and 14 (<1%) were ineligible.A match had been found prior to needing to assess eligibility for 2,187 individuals and prior to 174 responding that they were interested in the study.
Of the 212 enrolled IMPC participants 10 (4.7%) experienced a pregnancy loss resulting in 202 individuals with a live birth.One multiple gestation pregnancy identified after study enrollment was excluded from the analysis, resulting in 201 participants with a singleton live birth.Of these 201 participants, 192 (95.0%) completed a postpartum follow-up survey (including 3 partial completes), 7 (3.5%) were lost to follow-up, and 2 (1%) refused the follow-up survey (Figure 1).

eTable 1. CenteringPregnancy Topics*
This list represents a general list of topics covered during CenteringPregnancy, but the list is not exhaustive.

Associations Between GMPC and Postpartum Behavioral (Breastfeeding and LARC Intention)
Note: Bold values denote statistical significance at the p < 0.05 level; ITT: Intent to Treat; PC: Per Compliance; cRR: Crude Risk Ratio; aRR: Adjusted Risk Ratio; CI: Confidence Interval Note: Bold values denote statistical significance at the p < 0.05 level 1 Adjusted for race/ethnicity, age at pregnancy onset, annual household income level, parity, gestational age at baseline survey completion. 2 Any self-reported breastfeeding since birth 3 Self-reported intention to use a LARC (Long-Acting Reversible Contraceptive) method in the postpartum period

eAppendix. The Quality of Prenatal Care Questionnaire Subscales
The results of the tests were explained to me in a way that I could understand.My prenatal care provider(s) gave straightforward answers to my questions.My prenatal care providers gave me enough information to make decisions for myself.My prenatal care provider kept my information confidential.I fully understood the reasons for blood work and other tests my prenatal care provider(s) ordered for me.Anticipatory Guidance (11 items) My prenatal care provider(s) gave me options for my birth experience.I was given enough information to meet the needs about breastfeeding.My prenatal care provider(s) prepared me for my birth experience.My prenatal care provider(s) spent time talking with me about my expectations for labor and delivery.I was given enough information about the safety of moderate exercise during pregnancy.I received adequate information about my diet during pregnancy.My prenatal care provider(s) was interested in how my pregnancy was affecting my life.I was linked to programs in the community that were helpful to me.I received adequate information about alcohol use during pregnancy.I was given adequate information about depression during pregnancy.My prenatal care provider(s) took time to ask about things that were important to me Sufficient Time (5 items) I had as much time with my prenatal care provider(s) as I needed.My prenatal care provider(s) was rushed.My prenatal care provider(s) always had time to answer my questions.My prenatal care provider(s) made time for me to talk.My prenatal care provider(s) took time to listen.Approachability (4 items) My prenatal care provider(s) was abrupt with me.I was rushed during my prenatal care visits.My prenatal care provider(s) made me feel like I was wasting their time.I was afraid to ask my prenatal care provider(s) questions.