Background

The United States has persistently high rates of preterm birth and low birthweight and is characterized by significant racial disparities in these rates. Innovative group prenatal care models, such as CenteringPregnancy, have been proposed as a potential approach to improve the rates of preterm birth and low birthweight and to reduce disparities in these pregnancy outcomes.

Objective

This study aimed to test whether participation in group prenatal care would reduce the rates of preterm birth and low birthweight compared with individual prenatal care and whether group prenatal care would reduce the racial disparity in these rates between Black and White patients.

Study Design

This was a randomized controlled trial among medically low-risk pregnant patients at a single study site. Eligible patients were stratified by self-identified race and ethnicity and randomly allocated 1:1 between group and individual prenatal care. The primary outcomes were preterm birth at <37 weeks of gestation and low birthweight of <2500 g. The primary analysis was performed according to the intent-to-treat principle. The secondary analyses were performed according to the as-treated principle using modified intent-to-treat and per-compliance approaches. The analysis of effect modification by race and ethnicity was planned.

Results

A total of 2350 participants were enrolled, with 1176 assigned to group prenatal care and 1174 assigned to individual prenatal care. The study population included 952 Black (40.5%), 502 Hispanic (21.4%), 863 White (36.8%), and 31 “other races or ethnicity” (1.3%) participants. Group prenatal care did not reduce the rate of preterm birth (10.4% vs 8.7%; odds ratio, 1.22; 95% confidence interval, 0.92–1.63; P=.17) or low birthweight (9.6% vs 8.9%; odds ratio, 1.08; 95% confidence interval, 0.80–1.45; P=.62) compared with individual prenatal care. In subgroup analysis, greater attendance in prenatal care was associated with lower rates of preterm birth and low birthweight. This effect was most noticeable for the rates of low birthweight for Black participants in group care: intent to treat (51/409 [12.5%]), modified intent to treat (36/313 [11.5%]), and per compliance (20/240 [8.3%]). Although the rates of low birthweight were significantly higher for Black participants than White participants seen in individual care (adjusted odds ratio, 2.00; 95% confidence interval, 1.14–3.50), the difference was not significant for Black participants in group care compared with their White counterparts (adjusted odds ratio, 1.58; 95% confidence interval, 0.74–3.34).

Conclusion

There was no difference in the overall rates of preterm birth or low birthweight between group and individual prenatal care. With increased participation in group prenatal care, lower rates of preterm birth and low birthweight for Black participants were observed. The role of group care models in reducing racial disparities in these birth outcomes requires further study.

中文翻译：

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改善早产和低出生体重种族平等的团体与传统产前护理：居中和种族差异随机临床试验研究

背景

美国的早产率和低出生体重率一直居高不下，其特点是这些比率存在显着的种族差异。创新的集体产前护理模式，如 CenteringPregnancy，已被提议作为提高早产率和低出生体重率并减少这些妊娠结果差异的潜在方法。

客观的

本研究旨在测试与个体产前护理相比，参与集体产前护理是否会降低早产和低出生体重的发生率，以及团体产前护理是否会减少黑人和白人患者在这些比率方面的种族差异。

学习规划

这是一项随机对照试验，在单一研究地点对医学上低风险的孕妇进行。符合条件的患者按自我认定的种族和族裔进行分层，并按 1:1 的比例在组和个体产前护理之间随机分配。主要结局是妊娠 <37 周时的早产和 <2500 g 的低出生体重。主要分析是根据意向治疗原则进行的。二次分析是根据实际治疗原则使用改良的意向治疗和依从性方法进行的。计划分析种族和民族的影响修改。

结果

共有 2350 名参与者入组，其中 1176 人被分配到团体产前护理，1174 人被分配到个体产前护理。研究人群包括 952 名黑人 (40.5%)、502 名西班牙裔 (21.4%)、863 名白人 (36.8%) 和 31 名“其他种族或民族”(1.3%) 参与者。团体产前护理并未降低早产率（10.4% 对 8.7%；优势比 1.22；95% 置信区间 0.92–1.63；P =.17）或低出生体重率（9.6% 对 8.9%；优势比， 1.08；95% 置信区间，0.80–1.45；P=.62) 与个人产前护理相比。在亚组分析中，更多的产前护理出勤率与较低的早产率和低出生体重率相关。这种影响对于团体护理中黑人参与者的低出生体重率最为显着：治疗意向 (51/409 [12.5%])、修正治疗意向 (36/313 [11.5%]) 和依从性 (20 /240 [8.3%]）。尽管黑人参与者的低出生体重率明显高于个体护理中的白人参与者（调整后的比值比为 2.00；95% 置信区间为 1.14-3.50），但与他们相比，团体护理中的黑人参与者的差异并不显着白人对应物（调整后的比值比，1.58；95% 置信区间，0.74–3.34）。

结论

团体和个人产前护理之间的早产或低出生体重的总体发生率没有差异。随着越来越多地参与集体产前护理，观察到黑人参与者的早产率和低出生体重率较低。团体护理模式在减少这些出生结果中的种族差异方面的作用需要进一步研究。