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

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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

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.
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

Findings

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.
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.
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.

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