Randomized Controlled Trial on the Effect of Group Versus Individual Prenatal Care on Psychosocial Outcomes.

The study was conducted at a single large academic medical center in the Southeastern United States, so generalizability is unclear. Group-care attendance was low: 624 of 1,175 participants (53.19%) attended at least five sessions, 277 (23.57%) attended none, and 52 (4.42%) attended all 10 sessions. The instrumental variable analysis adjusted for noncompliance, but the authors noted this approach may still distort the effect of group prenatal care among compliant participants. Survey 2 was timed between 30 and 34 weeks gestation, and group-care participants completed it slightly earlier (32.38 weeks gestation compared to 32.63 for individual care, p = 0.01), so many had limited exposure to the full group model. Stress management, coping, and empowerment were measured only at survey 2, so changes in these outcomes could not be assessed. The authors modified some scales, including excluding five of 20 CES-D items and using 11 items from the R-PCI, which may introduce measurement bias. Many patients were ineligible or declined participation: 3,818 (41.58%) of patients assessed were ineligible, and 3,019 (56.87%) eligible patients declined. The authors noted that the less than 2-point depression differences and 2 to 3-point coping differences may have limited clinical significance.

The authors reported no conflicts of interest or relevant financial relationships.

Do not conclude that group prenatal care improves psychosocial outcomes overall. The main analysis found no significant differences in prenatal distress, anxiety, depression, stress management, or empowerment. The one significant main finding was greater reported coping-strategy use, and group attendance was low.