Group Prenatal Care Intervention Shows Promising Results in Reducing Adverse Pregnancy Outcomes

Pregnant women who participated in a group prenatal care intervention focused on healthy lifestyle choices and weight management significantly reduced their risk of excess pregnancy weight gain and gestational diabetes, according to a new study led by researchers at the Yale School of Public Health, Brown University, and the Lyndon B. Johnson Tropical Medical Center in American Samoa.

Obesity is the most common health problem among women of reproductive age in the United States, affecting almost one-third of pregnant women in the U.S. By addressing multiple risk factors associated with obesity and gestational diabetes, the group intervention could improve maternal and infant health nationally, particularly among women in minority ethnic groups who bear a disproportionate burden of pregnancy complications. Importantly, the intervention may not only help reduce long-term cardiovascular and metabolic risks for women, but it may also reduce the intergenerational transmission of cardiometabolic disease risks, the researchers said.

The study appears in the peer-reviewed journal Obesity.

• Reduced gestational weight gain. Women enrolled in the group intervention gained about 5 kilograms less weight during pregnancy than those in a control group who participated in more traditional one-on-one health provider care (9.46 kg vs. 14.40 kg).
• Increased likelihood of exclusive breastfeeding at six weeks postpartum (44.4% group members vs. 25% usual care).
• Lower incidence of gestational diabetes (27.3% group vs. 40% usual care).
• Lower incidence of macrosomia, a term used to describe an infant that is larger than normal in size regardless of gestational age (8.3% group vs. 29% usual care).

The results of this small pilot randomized controlled study could potentially change current approaches in prenatal care for women with pre-pregnancy obesity. By demonstrating the effectiveness of group prenatal care in delivering behavioral interventions during pregnancy, the research offers new possibilities for improving maternal and child health outcomes. If replicated in larger trials, the intervention could be significant in reducing the incidence of gestational diabetes and promoting healthier outcomes for both mothers and babies for generations to come.

The study enrolled 80 pregnant women in American Samoa and compared a group prenatal care intervention with one-on-one usual care. The group intervention – Strong Together Raising Our Next Generation or STRONG – is based on the Expect With Me prenatal education model, which was developed by YSPH researchers in 2014 with colleagues from Vanderbilt University Medical Center and the UnitedHealth Group. Expect With Me incorporates routine medical visits with facilitated group discussions about pregnancy, childbirth, and wellness. The discussions focus on healthy lifestyle choices regarding nutrition (portion control, healthy snacking), physical activity, and mental health. As part of the program, patients set personal weight gain goals and tracked their weight and blood pressure during group appointments.

As pre-pregnancy obesity rises in the U.S., there also has been an increase in adverse perinatal outcomes, which now impact as many as one in five pregnancies. Obesity in pregnancy is particularly problematic in American Samoa, a low-resource unincorporated U.S. territory that has a shortage of health care professionals. Current estimates suggest 86% of American Samoan women enter pregnancy overweight or obese. Many American Samoan women also gain more weight than recommended during pregnancy with 78% exceeding the Institute of Medicine’s gestational weight gain guidelines. An estimated 14% develop gestational diabetes during pregnancy, although this is likely an underestimate. Further exacerbating the potential for the intergenerational transmission of obesity in American Samoa is the short average duration of exclusive breastfeeding, which is known to protect against overweight/obesity among infants. Despite almost universal initiation of breastfeeding, fewer than one-third of American Samoan women sustain breastfeeding beyond three weeks postpartum.

"As a practitioner well-versed with the Midwifery Partnership model of New Zealand, the Group Prenatal care model has proven transformative. This approach alleviates staffing pressures, reduces practitioner burnout, and fosters profound satisfactory care. The supportive environment of group care creates a cumulative positive impact on outcomes. Women developed lasting friendships, adopted healthier behaviors, and debunked myths prevalent in Samoan culture. This model also overcomes barriers such as language and access to care, offering free prenatal programs. The Group Prenatal care model is preferred for its effectiveness and cultural suitability for Samoans and has the potential to benefit other Pacific Island communities facing similar challenges." – Kima Faasalele-savusa, study co-author and program coordinator from the Obesity, Lifestyle, and Genetic Adaptations Study Group in Pago Pago, Samoa.

"Our findings demonstrate the potential for interventions delivered using group prenatal care to mitigate adverse pregnancy outcomes associated with pre-pregnancy obesity. By leveraging group prenatal care to deliver behavioral interventions, we can potentially break the cycle of intergenerational transmission of obesity and improve maternal and child health outcomes."–– Associate Professor Nicola Hawley, Yale School of Public Health Department of Epidemiology of Chronic Diseases and lead author.

Further research through a fully powered efficacy trial is needed to validate the results of the current study and explore the broader implications of this innovative approach to prenatal care.

Funding: This research was supported by a National Institutes of Health National Institute of Nursing Research grant R21NR016352.

Authors: Nicola L. Hawley, Mata’uitafa Faiai, Jeannette R. Ickovics, Erica Kocher, all of Yale School of Public Health; Kima Faasalele-savusa, Lynette Suiaunoa-Scanlon, Miracle Loia, of the Obesity, Lifestyle, and Genetic Adaptations Study Group, Pago Pago, Samoa; J, Christopher Piel, Physician Associate Program, Yale School of Medicine; Madison Mahoney and Rachel Suss; Yale College; and Marcela Trocha, Vrije Universiteit, Amsterdam, Netherlands. Rochelle K. Rosen, Centers for Behavioral Medicine, Brown University, Providence, R.I., and Bethel T. Muasau-Howard, Department of Obstetrics and Gynecology, Lyndon B Johnson Tropical Medical Center, Pago Pago, American Samoa, are senior authors on the study.