Group and Individual Prenatal Care Elicit Similar Gestational Diabetes Risk

The risk for developing gestational diabetes is similar between patients who receive group prenatal care (GPNC) and those who receive individual prenatal care (IPNC), according to study findings published in JAMA Network Open.

To determine the effects of the GPNC model on risk for gestational diabetes and its progression, researchers performed a secondary analysis of a single-center, parallel-group, randomized clinical trial (ClinicalTrials.gov Identifier: NCT02640638) conducted from February 2016 to March 2020 at a large health care system Greenville, South Carolina.

Patients were aged 14 through 45 years with pregnancies earlier than 21 weeks. The researchers stratified the sample by race and ethnicity and randomly assigned patients to receive either group-based care (via the Centering Healthcare Institute’s Centering Pregnancy curriculum) or individual-based care.

The researchers separated the GPNC group into groups of 8 to 12 patients for ten 2-hour sessions. Each patient in the IPNC group received traditional individual prenatal care as recommended by the American College of Obstetricians and Gynecologists for a total of 13 visits. Patients in the GPNC group were also allowed IPNC visits as needed.

Patients completed a baseline survey at less than 24 gestational weeks and a second survey at 30 to 36 gestational weeks. Surveys included questions about demographics, medical and reproductive history, and maternal health behavior. Patients self-reported their race and ethnicity.

The primary outcome was the incidence of gestational diabetes, which the researchers determined via administering the 50-g oral glucose challenge between 24 and 30 weeks of gestation. Secondary outcomes included progression of gestational diabetes according to the White classification (A1 to A2 gestational diabetes) and obstetric adverse outcomes associated with poor glycemic control, such as:

• Primary cesarean delivery;
• Pre-eclampsia; and,
• Large-for-gestational-age (LGA) birth.

The researchers used an intention-to-treat (ITT) approach to compare primary and secondary outcomes between the GPNC and IPNC groups, whereas they used a modified ITT approach for sensitivity analyses.

The ITT population included a total of 2348 patients, of whom 1175 received GPNC and 1173 received IPNC. Of the total sample, 91.3% of patients had completed the screening for gestational diabetes. The patients self-identified as:

• Black (40.5%);
• White (36.8%);
• Hispanic (21.4%); and,
• Other race or multiracial (1.3%).

Baseline characteristics and prognostic factors were similar between groups, but the rate of smoking 3 months before pregnancy was slightly higher in the IPNC group (38.7%) compared with the GPNC group (32.9%).

The overall incidence of gestational diabetes was 6.7%, with no significant difference between the GPNC (7.1%) and IPNC (6.3%) groups. The adjusted risk difference (RD) was 0.7% (95% CI, -1.2% to 2.7%). The incidence of gestational diabetes did not vary across patients of different races and ethnicities, with adjusted RDs of:

• 0.5% (95% CI, -2.0% to 3.0%; Black patients);
• -0.5% (95% CI, -5.8% to 4.9%; Hispanic patients); and,
• 2.6% (95% CI, -0.7% to 6.0%; White patients).

Of those with gestational diabetes, 49% of patients (48.2% of the GPNC group and 50.0% of the IPNC group) progressed to A2 gestational diabetes. The adjusted RD was -6.1% (95% CI, -21.3% to 9.1%).

The researchers measured no significant difference in the incidence of obstetric adverse events between groups. However, proportions of patients experiencing pre-eclampsia, primary cesarean delivery, and LGA birth were slightly lower in the GPNC group compared with the IPNC group, with adjusted RDs of:

• -7.9% (95% CI, -17.8% to 1.9%; pre-eclampsia);
• -8.2% (95% CI, -12.2% to 13.9%; cesarean delivery); and,
• -1.2% (95% CI, -6.1% to 3.8%; LGA).

Study limitations include its early termination due to COVID-19, which limited the sample size, and low attendance among patients in the GPNC group.

The researchers concluded, “In this [randomized controlled trial] among pregnant individuals, participants receiving GPNC had similar risk of developing [gestational diabetes], compared with participants receiving IPNC, suggesting that GPNC could be a feasible care option for some patients.”

This article originally appeared on Endocrinology Advisor