Group prenatal care effective for managing gestational diabetes

Group prenatal care effective for managing gestational diabetes | Image Credit: © Chinnapong - © Chinnapong - stock.adobe.com.

According to a recent study published in JAMA Network Open, a group-based prenatal care (GPNC) model may be effective for managing gestational diabetes (GD) risk.

Four percent to 8% of pregnancies are impacted by GD, with an over 10-fold increase observed in the United States over the past 40 years. GD is associated with increased risks of adverse outcomes including primary cesarean delivery, preeclampsia, birth injury, large for gestational age (LGA) birth, and macrosomia.

Lifestyle interventions such as diet and physical activity have been used to treat GD with a modest effect. However, studies on lifestyle interventions rarely include a racial and ethnic diversity, despite GD burden differing by race and ethnicity.

GPNC is a model of care which reduces disparities and may also be used to improve outcomes. To determine if GPNC leads to lower risks of GD and associated adverse outcomes compared to individual prenatal care (IPNC), investigators conducted a secondary analysis of the Centering and Racial Disparities (CRADLE) study.

The CRADLE study analyzed how GPNC impacted preterm birth and low birth weight, with the effects on GD incidence and progression examined as a secondary outcome. Participants were recruited from February 24, 2016, to March 16, 2020, and included individuals aged 14 to 45 years with a singleton pregnancy and entry to prenatal care before 20 weeks and 6 days of gestation.

Exclusion criteria included having chronic hypertension, a body mass index of 45 or greater, or other complications that would make patients ineligible. Patients included in the analysis were assigned 1:1 to a GPNC or IPNC group. 

IPNC included traditional prenatal care scheduled based on recommendations from the American College of Obstetricians and Gynecologists (ACOG), which averaged at 13 visits. GPNC included care delivered in 10 2-hour sessions with groups of 8 to 12 participants. Extra IPNC visits were available to GPNC patients as needed.

Participants completed a survey at baseline, which was under 24 weeks of gestation, and an additional survey at 30 to 36 weeks of gestation. Research Electronic Data Capture software version 11.4.4 was used to administer the surveys. 

Demographic information collected included race and ethnicity, psychosocial measures, lifestyle measures, reproductive and medical history, and maternal health behavior. Medical data was obtained from patients’ electronic health records 8 weeks following delivery.

The primary outcome of the analysis was GD incidence, determined using ACOG recommended screening. GD screening occurred at 24 to 30 weeks of gestation. Investigators also analyzed adverse obstetric outcomes associated with poor individual glycemic control including preeclampsia, cesarean delivery and LGA.

There were 1175 participants in the GPNC group and 1173 in the IPNC group, with a complete GD screening found in 91.3%. Among patients with GD, all had available data on GD progression and 93.6% had data on delivery and birth outcomes. Baseline characteristics were similar between both groups, though smoking 3 months before pregnancy was more common in the IPNC group.

GD was found in 6.7% of patients, with incidence not differing between both groups. Progression to A2 GD was seen in 48.2% of GD patients in the GPNC group and 50% in the IPNC group. Slightly lower rates of preeclampsia, primary cesarean delivery, and LGA were seen in the GPNC group, though these differences were not statistically significant.

These results indicated similar risks of GD incidence from GPNC vs IPNC, indicating efficacy from GPNC. Investigators recommended future studies to evaluate how GPNC impacts GD progression.

Reference

Chen Y, Crockett AH, Britt JL, et al. Group vs individual prenatal care and gestational diabetes outcomes: asecondary analysis of a randomized clinical trial. JAMA Netw Open. 2023;6(8):e2330763. doi:10.1001/jamanetworkopen.2023.30763