Group prenatal care shows promise in reducing disparities in maternal health

In the fight to reduce long-standing disparities in maternal health, group prenatal care programs could be an effective tool, say researchers from the Yale School of Medicine (YSM) and the Yale School of Public Health.

Based on their previous studies, the researchers described many potential benefits of group prenatal care programs perspective article which was published on June 8 in the New England Journal of Medicine as part of the journal’s call for articles discussing health interventions to reduce inequality.

Jeannette Ickovics, Ph.D., Herman Professor of Social and Behavioral Sciences at the Yale School of Public Health, and Jessica Lewis, Ph.D., research scientist at the Yale School of Medicine, responded to the call by discussing their group prenatal care program “Expect With Me,” which they founded in 2014, proclaimed the urgency of the profound and life-threatening racial disparities that persist in perinatal and maternal health.

“Maternal morbidity and mortality for black women are very different [from that of other racial groups]When we developed Expect With Me and studied group models, we found that we could actually reduce those disparities in prenatal group care,” says Lewis.

Prenatal care benefits for groups

The Expect With Me model consists of 10 two-hour group sessions with eight to twelve participants expected in the same month. Led by a midwife or midwife, the sessions focus on nutrition, physical activity, mental health and sexual health, in addition to standard prenatal content. Facilitated group discussions allow patients to communicate, gain social support, and normalize their pregnancy symptoms by sharing their experiences with each other.

Lewis and her team tested Expect With Me in more than 2,400 participants between 2014 and 2018. They found that compared to the standard model of individual prenatal care, participants in group care had significantly lower risk of delivering premature babies and low birth weight . infants and admitting a child to the neonatal intensive care unit. Their studies was published in the magazine in 2021 Preventive medicine.

Studying previous models of prenatal group care, Lewis and her team found that while group care reduced the risk of these outcomes overall, the effect was even greater for black women. These differences were an important consideration when testing Expect With Me: the study participants were 60% Black and 15% Latina.

“Knowing that there are disparities in outcomes, especially for black women,” says Lewis, “we actually identified clinics that would offer us that kind of diversity so we could see how effective it is among higher-risk populations in particular. “

Consistency, steadfastness and technology

Although standard individual prenatal care occurs along the same timeline and includes much of the same core content as group care, patients tend to meet with their providers for only about 10 to 15 minutes at a time and may see a different provider at each visit. Group care, on the other hand, lasts two hours and each session is led by the same caregivers. Lewis believes that this consistency and long session times are key components to the success of group care.

“It gives healthcare providers the opportunity to really hear about the issues patients are struggling with and get to know their patients. It also gives patients the opportunity to hear not only the answers to their own questions, but also questions [from others] that they didn’t think to ask, or maybe they felt too embarrassed to ask,” says Lewis.

Another important part of the program is the technology. Expect With Me differs from other prenatal care programs by integrating an IT platform that allows patients to use a website to track their weight and blood pressure, communicate with healthcare providers and other group members, and access a variety of educational materials.

In fact, Lewis and her team found that Expect With Me patients who used the website regularly had a significantly lower risk of giving birth to a low birth weight child than those who did not use the website.

Implementation will be one of the biggest challenges for prenatal group care. In addition to upfront investments in training, there can also be logistical issues surrounding planning and space. However, this is something that Lewis believes Expect With Me can solve through the IT platform’s scheduling tool.

Ultimately, she says, the success of the program and the urgency of finding solutions to reduce inequities in perinatal and maternal health should outweigh the challenges in its implementation.

“We hear that on the delivery floor you can tell who has had prenatal group care and who has not, because they are better informed, they talk about what is going on, [and] they have more power to ask for what they want,” says Lewis. “This is a model that has a lot of potential to help reduce inequality.”