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Effects of Group Prenatal Care on Psychosocial Risk in Pregnancy: Results from a Randomised Controlled Trial

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Group prenatal care was helpful in increasing self-esteem while decreasing social conflict and depression among at-risk women.

[popup title="Sample, Hypothesis, Variables Measured, Study Design" format="Default hover" text='

Sample

  • N: 1,047
  • Subject Ages: Mothers 14–25 years
  • Location: United States, two public hospitals: one in New Haven, Connecticut, the other in Atlanta, Georgia
  • SES: Not available
  • Eligibility: Teen and young pregnant women
  • Additional:  
    • 80% African American, 13% Latina, 6% White, 1% mixed or other race/ethnicity
    • 38% had completed high school (or graduate equivalent degree), 36% were still in high school, 26% had dropped out
    • 32% were currently employed; the remainder received public assistance (22%) or economic support from the baby’s father (25%) or family members (16%)
    • All patients had public (e.g. Medicaid) or hospital assistance for complete prenatal care coverage
    • 48% were nulliparous

Hypotheses

  1. CenteringPregnancy Plus (CP+), a bundled intervention designed to reduce negative birth outcomes, decrease sexual risk, and improve psychosocial outcomes within a model of group prenatal care, will result in increased self-esteem and social support as well as decreased stress, social conflict, and depression.
  2. The intervention will have an even greater effect for those at highest risk of adverse outcomes: younger age, African Americans, and those highest in stress.

Variables Measured, Instruments Used

  • Stress - the Perceived Stress Scale (PSS)
  • Self esteem - the Rosenberg Self Esteem Scale
  • Social support - seven items of the social support subscale of the Social Relationship Scale
  • Social conflict - seven items of the social conflict subscale of the Social Relationship Scale
  • Depression - affect-only component of the Center for Epidemiological Studies Depression Scale
  • Demographic and behavioral characteristics

Design—RCT

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Findings

  1. No significant differences in psychosocial function using intention-to-treat models; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care.
  2. High-stress women randomly assigned to CenteringPregnancy Plus (CP+) reported significantly increased self-esteem, decreased stress, and decreased social conflict in the third trimester of pregnancy. Social conflict and depression were significantly lower one year postpartum. CP+ improved psychosocial outcomes for high-stress women.
  3. Most notably, the strongest finding for CP+ women was the reduction in social conflict. This effect is probably attributed to the heavy emphasis in CP+ on developing effective communication and negotiation skills.

Limitations  

  • Overall effects of the intervention were not found using intention-to-treat analysis, though important subgroup differences were identified. In terms of the potency of the intervention, it may be necessary to strengthen the psychosocial components of CP+ in order to improve psychosocial functioning for everyone and not just those with high initial levels of stress.
  • High-risk sample: Sample represents a relatively restricted group of young, ethnic minority women of low socioeconomic status who attend urban hospital clinics for prenatal care. This is a group at highest risk of adverse perinatal and psychosocial outcomes and therefore may be most in need of substantive clinical intervention to reduce risk.
  • Replication with diverse patient populations and within diverse clinical settings is essential to ensure reliability, generalizability, and clinical effectiveness.