SC Connecticut News

In the effort to reduce longstanding maternal health disparities, group prenatal care programs could be an effective tool, according to researchers from Yale School of Medicine (YSM) and Yale School of Public Health. Based on their earlier studies, the researchers described many possible benefits of group prenatal care programs in a perspective article published June 8 in the New England Journal of Medicine as part of the journal’s call for papers discussing health interventions to reduce inequities.

Jeannette Ickovics, PhD, Herman Professor of Social and Behavioral Sciences at Yale School of Public Health, and Jessica Lewis, PhD, research scientist at Yale School of Medicine, responded to the call by discussing their group prenatal care program “Expect With Me,” which they founded in 2014. They emphasized the urgency of addressing 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], and so when we were developing Expect With Me and studying group models, we were finding that we could actually mitigate those disparities in group prenatal care,” says Lewis.

The Expect With Me model consists of 10 two-hour group sessions with eight to 12 participants who are due in the same month. Led by an obstetrician or a midwife, sessions focus on nutrition, physical activity, mental health, and sexual health, in addition to standard prenatal content. Facilitated group discussions allow patients to interact, garner social support, and normalize their pregnancy symptoms by sharing their experiences with one another.

“We hear that on the delivery floor you can tell who’s been through group prenatal care and who hasn’t because they are more informed; they speak up about what’s going on; [and] they’re more empowered to ask for what they want,” says Lewis.

Lewis and her team tested Expect With Me with 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 risks of delivering premature infants, delivering low birth weight infants, and having an infant admitted to the neonatal intensive care unit. Their study was published in 2021 in the journal Preventive Medicine.

While studying earlier models of group prenatal care, Lewis and her team found that while group care reduced these risks overall, the effect was even greater for Black women. These differences were a major consideration when testing Expect With Me: participants in the study were 60% Black and 15% Latina.

“Knowing that there are these differences in outcomes especially for Black women,” Lewis says. “We were really targeting clinics that would give us that kind of diversity so that we could look at how effective it is among especially higher-risk populations.”

While standard individual prenatal care occurs along the same timeline and covers much of the same core content as group care, patients tend to meet with their providers for only about 10-15 minutes at a time and may see a different provider each visit. Group care sessions last two hours each time with consistent providers throughout. Lewis believes this consistency is key to its success.

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

Another key component is technology integration. Expect With Me incorporates an IT platform allowing patients to track weight and blood pressure online while communicating with providers and accessing educational materials. Patients using this website regularly had significantly lower risk of delivering low birth weight infants than those who did not use it.

Implementation challenges include up-front investments in training as well as logistical issues around scheduling space. However, Lewis believes these can be addressed through IT platform tools like scheduling features. Ultimately she asserts that reducing perinatal and maternal health inequities should outweigh implementation challenges.

“We hear that on the delivery floor you can tell who’s been through group prenatal care because they are more informed; they speak up about what’s going on; [and] they’re more empowered,” says Lewis. “This is a model with potential to help reduce disparities.”