Yale School of Public Health study: Mothers-to-be, babies benefit from group prenatal care

25 Dec

The Ontario Ministry of Children and Youth Services explains why healthy babies are important. “Healthy babies are more likely to develop into healthy children, and healthy children are more likely to grow up to be healthy teenagers and healthy adults.” http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/health/index.aspx

Science Daily reported in Mothers-to-be, babies benefit from group prenatal care, study finds:

Group prenatal care can substantially improve health outcomes for both mothers and their infants, a new study led by the Yale School of Public Health has found.

The paper was published online Dec. 21 in The American Journal of Public Health.

Women who received group — rather than individual — prenatal care were 33% less likely to have infants who were small for gestational age. In addition, group-care recipients had reduced risk for preterm delivery and low birthweight. Babies born to these women also spent fewer days in the neonatal intensive care unit. In addition, mothers with more group prenatal care visits were less likely to become pregnant again quickly after giving birth, an important outcome known as “birth spacing” that reduces the risk of having another baby at risk for preterm delivery.

“Few clinical interventions have had an impact on birth outcomes,” said Professor Jeannette R. Ickovics, the study’s lead author. “Group prenatal care is related to improved health outcomes for mothers and babies, without adding risk. If scaled nationally, group prenatal care could lead to significant improvements in birth outcomes, health disparities, and healthcare costs,” she added.

The research team conducted a randomized controlled trial in 14 health centers in New York City, and compared the birth outcomes of women who received CenteringPregnancy Plus group prenatal care to those who received traditional individual care. The more than 1,000 women in the study were placed in groups of 8 to 12 women at the same gestational point in their pregnancy, and were cared for by a clinician and a medical assistant. The study found that the higher the number of group visits attended, the lower the rates of adverse birth outcomes….             http://www.sciencedaily.com/releases/2015/12/151221193406.htm

Citation

Mothers-to-be, babies benefit from group prenatal care, study finds

Date:       December 21, 2015

Source:   Yale University

Summary:

Group prenatal care can substantially improve health outcomes for both mothers and their infants, a new study has found. Women who received group — rather than individual — prenatal care were 33% less likely to have infants who were small for gestational age, had reduced risk for preterm delivery and low birthweight, and babies born to these women also spent fewer days in the neonatal intensive care unit.

Journal Reference:

  1. Jeannette R. Ickovics, Valerie Earnshaw, Jessica B. Lewis, Trace S. Kershaw, Urania Magriples, Emily Stasko, Sharon Schindler Rising, Andrea Cassells, Shayna Cunningham, Peter Bernstein, Jonathan N. Tobin. Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers. American Journal of Public Health, 2015; e1 DOI: 10.2105/AJPH.2015.302960

Here is the press release from Yale:

Mothers-to-be and babies benefit from group prenatal care, study finds

December 21, 2015

Group prenatal care can substantially improve health outcomes for both mothers and their infants, a new study led by the Yale School of Public Health has found.

The paper published online Dec. 21 in The American Journal of Public Health.

Women who received group—rather than individual—prenatal care were 33% less likely to have infants who were small for gestational age. In addition, group-care recipients had reduced risk for preterm delivery and low birthweight. Babies born to these women also spent fewer days in the neonatal intensive care unit. Additionally, mothers with more group prenatal care visits were less likely to become pregnant again quickly after giving birth, an important outcome known as “birth spacing” that reduces the risk of having another baby at risk for preterm delivery.

“Few clinical interventions have had an impact on birth outcomes,” said Professor Jeannette R. Ickovics, the study’s lead author. “Group prenatal care is related to improved health outcomes for mothers and babies, without adding risk. If scaled nationally, group prenatal care could lead to significant improvements in birth outcomes, health disparities, and healthcare costs,” she added.

The research team conducted a randomized controlled trial in 14 health centers in New York City, and compared the birth outcomes of women who received CenteringPregnancy Plus group prenatal care to those who received traditional individual care. The more than 1,000 women in the study were placed in groups of eight to 12 women of the same gestational age, and were cared for by a clinician and a medical assistant. The study found that the higher the number of group visits attended, the lower the rates of adverse birth outcomes.

CenteringPregnancy group prenatal care includes the same components as individual visits, but all care (with the exception of matters that require privacy) take place in the group setting. Group visits build in additional time for education, skill building, and the opportunity to discuss and learn from the experience of peers, as well as more face time with caregivers.

Despite the opportunity for frequent visits, many mothers in at-risk groups, such as adolescents or those from low-income areas, still experience a high rate of negative birth outcomes. The study focused on adolescent women, ages 14 to 21, in disadvantaged areas, with no other known health risks to their pregnancies.

Going forward, researchers need to identify the reasons why group sessions yielded better outcomes, whether it is the additional time for education, the built-in social support, or other factors.

Additional studies are also needed to understand what influences patients to stick to group care session schedules, and to analyze cost-effectiveness. Future studies could also reveal whether the positive results from this study indicate that the group care model could be broadened to include other types of patients. Ickovics and colleagues are currently working with the United Health Foundation, UnitedHealth Innovation Group, and collaborators at Vanderbilt University and the Detroit Medical Center/Wayne State University to address many of these issues and to identify factors that could impact efforts to scale up and sustainability with a new model of group prenatal care, called Expect With Me.

Other Yale School of Public Health study authors include Valerie Earnshaw, Jessica Lewis, Trace Kershaw, Emily Stasko and Shayna Cunningham; and Urania Magriples of the Yale School of Medicine. Other co-authors included Sharon Schindler of Rising from the Centering Healthcare Institute in Boston, Jonathan Tobin and Andrea Cassells from the Clinical Directors Network in New York, and Peter Bernstein from the Albert Einstein College of Medicine in New York.                                                                   http://publichealth.yale.edu/news/article.aspx?id=11746

The program is called “Expect With Me.”

United Health Foundation describes the program:

Expect With Me

Yale School of Public Health and United Health Foundation have partnered to develop a new model of prenatal care designed to improve mothers’ and babies’ health and well-being during pregnancy, birth and infancy.  Prenatal care is delivered to pregnant women in a group setting, providing valuable education, skills, social and emotional support.

While expecting mothers typically spend 10-20 minutes with their doctors at each visit in traditional prenatal care, Expect With Me features 10 two-hour care sessions during the second and third trimesters. Each care session includes a physical assessment by a health care provider, and a focused group discussion session.

Expect With Me also includes a secure web portal and social networking features that enable expectant mothers to stay connected between care sessions and have access to a strong support network. Incentives, gaming and videos help patients engage, follow care recommendations and promote better health for both mothers and babies.

“Our goal in piloting this new prenatal care model is to improve the health of mothers and babies, and to improve perinatal health outcomes and reduce incidences of low birth weight and preterm birth.”

—Kate Rubin, United Health Foundation president.                                                                                                 http://www.unitedhealthfoundation.org/Initiatives/HealthCommunities/ExpectWithMe.aspx

The key is regular prenatal care.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development reports in What is prenatal care and why is it important?

Prenatal Care

Women who suspect they may be pregnant should schedule a visit to their health care provider to begin prenatal care. Prenatal visits to a health care provider include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams. These visits also include discussions about the mother’s health, the infant’s health, and any questions about the pregnancy.

Preconception and prenatal care can help prevent complications and inform women about important steps they can take to protect their infant and ensure a healthy pregnancy. With regular prenatal care women can:

  • Reduce the risk of pregnancy complications. Following a healthy, safe diet; getting regular exercise as advised by a health care provider; and avoiding exposure to potentially harmful substances such as lead and radiation can help reduce the risk for problems during pregnancy and ensure the infant’s health and development. Controlling existing conditions, such as high blood pressure and diabetes, is important to avoid serious complications in pregnancy such as preeclampsia.
  • Reduce the infant’s risk for complications. Tobacco smoke and alcohol use during pregnancy have been shown to increase the risk for Sudden Infant Death Syndrome. Alcohol use also increases the risk for fetal alcohol spectrum disorders, which can cause a variety of problems such as abnormal facial features, having a small head, poor coordination, poor memory, intellectual disability, and problems with the heart, kidneys, or bones.2 According to one recent study supported by the NIH, these and other long-term problems can occur even with low levels of prenatal alcohol exposure.3

In addition, taking 400 micrograms of folic acid daily reduces the risk for neural tube defects by 70%.4 Most prenatal vitamins contain the recommended 400 micrograms of folic acid as well as other vitamins that pregnant women and their developing fetus need.1,5 Folic acid has been added to foods like cereals, breads, pasta, and other grain-based foods. Although a related form (called folate) is present in orange juice and leafy, green vegetables (such as kale and spinach), folate is not absorbed as well as folic acid.

  • Help ensure the medications women take are safe. Certain medications, including some acne treatments6 and dietary and herbal supplements,7 are not safe to take during pregnancy.

Learn more about prenatal and preconception care.

http://www.nichd.nih.gov/health/topics/preconceptioncare/Pages/default.aspx

http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

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