Group prenatal care

There is some evidence that group prenatal care (GPC) improves birth outcomes for disadvantaged populations, particularly Black women (Carter 2016, Byerley 2017, Crockett 2022, Heberlein 2021, Crockett 2019, Cunningham 2019, Carter 2017b, Park 2023, Abshire 2019). However, additional evidence is needed to confirm if outcomes improve for wider populations.

Perinatal outcomes. Overall, GPC and individual prenatal care have similar positive effects on birthweight and preterm birth outcomes (Liu 2021b, Crockett 2022). However, in some cases, including when patients attend at least five GPC visits, GPC can reduce preterm births (Heberlein 2021, Crockett 2019, Abshire 2019, Cunningham 2019) and reduce low birthweight births (Crockett 2019, Abshire 2019, Cunningham 2019), particularly for Black women (Crockett 2022).

Among disadvantaged groups, GPC can improve infant birthweight (Park 2023, Tubay 2019, Crockett 2019, Abshire 2019, Carter 2017b, Gareau 2016, Ickovics 2003) and reduce the likelihood of preterm delivery (Park 2023, Crockett 2019, Abshire 2019, Carter 2016, Gareau 2016, Picklesimer 2012, Tandon 2012, Ickovics 2007); improvements may be stronger for women who are older (Park 2023). GPC may also reduce the risk of a NICU stay (Heberlein 2021, Crockett 2019, Cunningham 2019, Carter 2017b, Abshire 2019, Gareau 2016). While some studies suggest GPC may reduce fetal demise (Tanner-Smith 2014a) and perinatal mortality (Park 2023), other studies have not seen the same impacts (Carter 2017b). GPC may also decrease elective (Risisky 2018) and overall cesarean section surgeries (Carter 2017b).

GPC participants appear to be more likely to initiate breastfeeding (Byerley 2017, Robinson 2018, Risisky 2018, Short 2023, Brumley 2016, Schellinger 2016, Trotman 2015, Zielinksi 2014), especially participants who are Black (Robinson 2018). Patients receiving Medicaid that attend at least five GPC visits are more likely to attend recommended well-child visits, particularly for low birthweight infants and infants who are Black (Heberlein 2023).

Participants in GPC are more likely to receive adequate prenatal care than non-participating peers (Ickovics 2007, Kennedy 2011, Tandon 2013, Trudnak 2013). Less structured group prenatal care initiatives may provide adequate care; however, more structured programs may be necessary to improve health outcomes (Groskaufmanis 2018).

Maternal outcomes. Overall, little evidence is available regarding GPC’s impact on maternal outcomes (Tucker 2021). While some studies suggest GPC participants have more appropriate gestational weight gain than non-participants (Byerley 2017, Tanner-Smith 2014), others suggest that there appears to be no difference in impact, either positive or negative, on maternal weight gain (Kominiarek 2019). GPC and individual prenatal care appear to have similar effects on gestational diabetes (Chen 2023). GPC may increase vaccinations for influenza (Roussos-Ross 2020) and Tdap during pregnancy (Roussos-Ross 2020, Short 2023). One South Carolina-based study found GPC participants were more likely to develop pregnancy-induced hypertension, although most participants were Black and at higher risk; no impact was found on rates of pre-eclampsia (Momodu 2023). GPC that includes an additional focus on reducing risky sexual behavior can reduce unprotected sex, sexually transmitted infections (STIs), and rapid repeat pregnancies (Ickovics 2016, Kershaw 2009). GPC may improve mental health for some participants (Benediktsson 2013, Ickovics 2011), including adolescents and women with low incomes (Byerley 2017). Overall, GPC appears to reduce postpartum depression at different time points within the first year (McKinney 2020, Liu 2021b, Trotman 2015), but effects may not persist to 12 months (Liu 2021b), and one study found no impact at six weeks postpartum compared to those in individual prenatal care (Boothe 2022).

GPC may increase return visits for postpartum contraception compared to individual prenatal care (DeCesare 2015, Hale 2014). GPC may increase long-acting reversible contraceptive (LARC) use (Byerley 2017, DeCesare 2015, Patberg 2021, Keller 2023) and may reduce rapid repeat pregnancies (Keller 2023). GPC may be as effective as individual prenatal care for establishing the use of other types of highly effective contraception postpartum (Olatunde 2022). Attending five or more GPC visits may increase the likelihood that patients attend postpartum visits (Heberlein 2020). For patients with opioid use disorder, GPC increases postpartum visits (Short 2023).

Women in GPC programs learn more about healthy pregnancies (Boothe 2022, Heberlein 2016a, Ickovics 2007) and report feeling better prepared for delivery (Ickovics 2007) and more satisfied with their prenatal care than non-participating women (Byerley 2017, Liu 2017, Lathrop 2013, Tandon 2013, Kennedy 2011, Ickovics 2003), and adolescents’ satisfaction with care appears to increase with greater rates of attendance (Cunningham 2017).

Cost. A pilot project in South Carolina suggests that enhanced reimbursement by a Medicaid managed care organization to clinics for each patient attending at least five GPC visits has the potential to reduce NICU visits, providing significant cost savings (Crockett 2017).

There is strong evidence that group prenatal care (GPC) has the potential to decrease disparities in birth outcomes for women from disadvantaged backgrounds, including those who are Black (Crockett 2022, Carter 2017b, Carter 2016) and those with low incomes (Park 2023, Byerley 2017). GPC may also have the potential to reduce economic inequalities in access to care (Heberlein 2023, Park 2023, Byerley 2017) and racial inequalities in access to prenatal care, quality of care, and maternal mortality (Moyett 2023). It may also increase breastfeeding initiation among women who are Black (Robinson 2018, Byerley 2017). However, GPC’s benefits can vary depending on patients’ social, racial and ethnic, or economic group (Carter 2016). For example, GPC appears to have a limited impact on women who are Hispanic (Park 2023, Abshire 2019), but those with gestational diabetes may derive some additional benefits (Schellinger 2017).

Preterm birth is approximately 50% higher among Black births than white births, low birthweight is almost double for Black infants, and infant mortality is more than twice as high (Mehra 2017). The maternal mortality rate in the U.S. is higher than in any other developed country (Tucker 2021), and there are stark disparities in maternal outcomes and maternal mortality between Black and white populations (Tucker 2021, CWF-Hostetter 2019), as well as racial bias and discrimination in maternity care for Black women (Tucker 2021). Pregnancy-related mortality is three times higher for Black women, and two times higher for American Indian and Alaska Native women compared to their white counterparts; maternal death rates and racial disparities increased during the COVID-19 pandemic (KFF-Hill 2022).

The Federal Housing Administration’s redlining practices concentrated poverty (Kaplan 2007) and entrenched racial residential segregation in the U.S., resulting in fewer health care facilities, resources, and funding in urban areas with largely Black populations (Lee 2023, Lee 2022c). Past residential redlining and present day disparities in access to health care are associated with delays in disease diagnosis and treatment of health conditions, fewer preventive health visits, shortages of behavioral health clinicians, and larger Medicaid or uninsured populations in neighborhoods with residents that are primarily Black and low income (Lee 2023). Living in redlined areas exposes pregnant women to a variety of factors that can contribute to preterm birth, including poor quality housing, reduced neighborhood resources, and urban heat islands (Lee 2022c). Segregation continues to be associated with increased risk of preterm birth and low birthweight for patients who are Black, with risks increasing as segregation in neighborhoods increases (Mehra 2017).

Increased barriers to abortion following the overturning of Roe v. Wade in 2023 may increase existing disparities in maternal and infant health (KFF-Hill 2022).

• What disparities in birth and maternal outcomes exist in your community?
• What resources are available for prenatal care in your community? Are certain groups less able to access the care and services available?
• What are the barriers to high quality, linguistically and culturally appropriate prenatal care?

As of 2021, nine states (California, Louisiana, Michigan, Montana, New Jersey, Ohio, South Carolina, Texas, and Utah) provide enhanced Medicaid reimbursement for group prenatal care (GPC); Maryland and Ohio are investing in GPC expansion efforts (Pto3-GPC).

CenteringPregnancy is the most popular group prenatal care program and has been implemented across the country. Many other GPC programs are based on it (Pto3-GPC). As of 2024, CenteringPregnancy and CenteringParenting programs have been implemented at over 500 practice sites in 44 states and territories, serving 60,000 patients per year (CHI).

Less studied models of group prenatal care include the March of Dimes’ Supportive Pregnancy Care, Expect with Me, Pregnancy & Parenting Partners (P3), Honey Child, and Children’s Hospital of Philadelphia’s Mama Care (Pto3-GPC, CHOP-Mama Care). P3 has been implemented at sites across the country (P3).

CHI - Centering Healthcare Institute (CHI). CenteringPregnancy.

Pekkala 2019 - Pekkala J, Cross-Barnet C, Kirkegaard M, et al. Key considerations for implementing group prenatal care: Lessons from 60 practices. Journal of Midwifery and Women’s Health. 2019;65(2):208-215.

* Journal subscription may be required for access.

Abshire 2019* - Abshire C, Mcdowell M, Crockett AH, Fleischer NL. The impact of CenteringPregnancy group prenatal care on birth outcomes in Medicaid eligible women. Journal of Women’s Health. 2019;28(7):919-928.

Benediktsson 2013 - Benediktsson I, McDonald SW, Vekved M, et al. Comparing CenteringPregnancy® to standard prenatal care plus prenatal education. BMC Pregnancy & Childbirth. 2013;13(Suppl 1):S5.

Boothe 2022* - Boothe E, Olenderek M, Noyola MC, et al. Psychosocial outcomes of group prenatal care. Journal of Public Health (Germany). 2022;30:1373-1380.

Brumley 2016* - Brumley J, Cain MA, Stern M, Louis JM. Gestational weight gain and breastfeeding outcomes in group prenatal care. Journal of Midwifery & Women’s Health. 2016;00:1-6.

Byerley 2017 - Byerley BM, Haas DM. A systematic overview of the literature regarding group prenatal care for high-risk pregnant women. BMC Pregnancy and Childbirth. 2017;17:329.

Carter 2016 - Carter EB, Temming LA, Akin J, et al. Group prenatal care compared with traditional prenatal care: A systematic review and meta-analysis. Obstetrics & Gynecology. 2016;128(3):551-561.

Carter 2017b - Carter EB, Barbier K, Sarabia R, et al. Group versus traditional prenatal care in low-risk women delivering at term: A retrospective cohort study. Journal of Perinatology. 2017;37(7):769-771.

Chen 2023 - Chen Y, Crockett AH, Britt JL, et al. Group vs individual prenatal care and gestational diabetes outcomes: A secondary analysis of a randomized clinical trial. JAMA Network Open. 2023;6(8):e2330763.

CHI - Centering Healthcare Institute (CHI). CenteringPregnancy.

CHOP-Mama Care - Children's Hospital of Philadelphia (CHOP). Mama Care Prenatal Care and Support Group.

Crockett 2017* - Crockett A, Heberlein EC, Glasscock L, et al. Investing in CenteringPregnancy™ group prenatal care reduces newborn hospitalization costs. Maternal Health. 2017;27(1):60-66.

Crockett 2019* - Crockett AH, Heberlein EC, Smith JC, et al. Effects of a multi-site expansion of group prenatal care on birth outcomes. Maternal and Child Health Journal. 2019;23:1424-1433.

Crockett 2022 - Crockett AH, Chen L, Heberlein EC, et al. Group vs traditional prenatal care for improving racial equity in preterm birth and low birthweight: The Cradle randomized clinical trial study. American Journal of Obstetrics and Gynecology. 2022;227(6):893.e1-893.e15.

Cunningham 2017 - Cunningham SD, Grilo S, Lewis JB, et al. Group prenatal care attendance: Determinants and relationship with care satisfaction. Maternal and Child Health Journal. 2017;21(4):770-776.

Cunningham 2019* - Cunningham SD, Lewis JB, Shebl FM, et al. Group prenatal care reduces risk of preterm birth and low birth weight: A matched cohort study. Journal of Women’s Health. 2019;28(1):17-22.

CWF-Hostetter 2019 - Hostetter M, Klein S. Improving health for women by better supporting them through pregnancy and beyond. New York: The Commonwealth Fund (CWF); 2019.

DeCesare 2015* - DeCesare JZ, Amin R, Hannah DM. Postpartum contraception rates in CenteringPregnancy versus traditional obstetrical care. The Journal of Reproductive Medicine. 2015.

Gareau 2016* - Gareau S, Lòpez-De Fede A, Loudermilk BL, et al. Group prenatal care results in Medicaid savings with better outcomes: A propensity score analysis of CenteringPregnancy participation in South Carolina. Maternal and Child Health Journal, 2016;20(7):1384-1393.

Groskaufmanis 2018* - Groskaufmanis L, Brunner Huber LR, Vick T. Group prenatal visits: Maternal and neonatal health outcomes. Journal of Midwifery and Women’s Health. 2018;63(5):584-592.

Hale 2014* - Hale N, Picklesimer AH, Billings DL, Covington-Kolb S. The impact of Centering Pregnancy group prenatal care on postpartum family planning. American Journal of Obstetrics and Gynecology. 2014;210(1):50.e1-50.e7.

Heberlein 2016a* - Heberlein EC, Picklesimer AH, Billings DL, et al. Qualitative comparison of women’s perspectives on the functions and benefits of group and individual prenatal care. Journal of Midwifery & Women’s Health. 2016;61(2):224-234.

Heberlein 2020* - Heberlein E, Smith J, Willis C, et al. The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use. Contraception. 2020;102(1):46-51.

Heberlein 2021* - Heberlein EC, Smith JC, LaBoy A, Britt J, Crockett A. Birth outcomes for medically high-risk pregnancies: Comparing group to individual prenatal care. American Journal of Perinatology. 2021.

Heberlein 2023* - Heberlein EC, Smith JC, Marton J, et al. Well child visit attendance for group prenatal care participants. Academic Pediatrics. 2023;23(2):296-303.

Ickovics 2003 - Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and preterm birth weight: Results from a matched cohort study at public clinics. Obstetrics & Gynecology. 2003;102(5 Pt 1):1051-1057.

Ickovics 2007 - Ickovics JR, Kershaw TS, Westdahl C, et al. Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics & Gynecology. 2007;110(2 Pt 1):330-339.

Ickovics 2011* - Ickovics JR, Reed E, Magriples U, et al. Effects of group prenatal care on psychosocial risk in pregnancy: Results from a randomised controlled trial. Psychology & Health. 2011;26(2):235-250.

Ickovics 2016* - Ickovics JR, Earnshaw V, Lewis JB, et al. Cluster randomized controlled trial of group prenatal care: Perinatal outcomes among adolescents in New York City health centers. American Journal of Public Health. 2016;106(2):359-365.

Kaplan 2007* - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.

Keller 2023* - Keller JM, Norton JA, Zhang F, et al. The impact of group prenatal care on interpregnancy interval. American Journal of Perinatology. 2023;40(15):1659-1664.

Kennedy 2011* - Kennedy HP, Farrell T, Paden R, et al. A randomized clinical trial of group prenatal care in two military settings. Military Medicine. 2011;176(10):1169-1177.

Kershaw 2009 - Kershaw TS, Magriples U, Westdahl C, Rising SS, Ickovics J. Pregnancy as a window of opportunity for HIV prevention: Effects of an HIV intervention delivered within prenatal care. American Journal of Public Health. 2009;99(11):2079-2086.

KFF-Hill 2022 - Hill L, Artiga S, Ranji U. Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. 2022.

Kominiarek 2019 - Kominiarek MA, Lewkowitz AK, Carter E, Fowler SA, Simon M. Gestational weight gain and group prenatal care: A systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2019;19:18.

Lathrop 2013* - Lathrop B. A systematic review comparing group prenatal care to traditional prenatal care. Nursing for Women’s Health. 2013;17(2):118-130.

Lee 2022c* - Lee EK, Donley G, Ciesielski TH, et al. Health outcomes in redlined versus non-redlined neighborhoods: A systematic review and meta-analysis. Social Science and Medicine. 2022;294:114696.

Lee 2023* - Lee EK, Donley G, Ciesielski TH, Freedman DA, Cole MB. Spatial availability of federally qualified health centers and disparities in health services utilization in medically underserved areas. Social Science and Medicine. 2023;328:116009.

Liu 2017 - Liu R, Chao MT, Jostad-Laswell A, Duncan LG. Does CenteringPregnancy group prenatal care affect the birth experience of underserved women? A mixed methods analysis. Journal of Immigrant and Minority Health. 2017;19(2):415-422.

Liu 2021b* - Liu Y, Wang Y, Wu Y, Chen X, Bai J. Effectiveness of the CenteringPregnancy program on maternal and birth outcomes: A systematic review and meta-analysis. International Journal of Nursing Studies. 2021;120:103981.

McKinney 2020* - McKinney J, Hickerson L, Guffey D, et al. Evaluation of human immunodeficiency virus-adapted group prenatal care. American Journal of Obstetrics & Gyncecology. 2020;2(3):100150.

Mehra 2017* - Mehra R, Boyd LM, Ickovics JR. Racial segregation and adverse birth outcomes: A systematic review and meta-analysis. Social Science & Medicine. 2017;191:237-250.

Momodu 2023* - Momodu OA, Horner RD, Liu J, Crouch EL, Chen BK. Participation in the CenteringPregnancy program and pregnancy-induced hypertension. American Journal of Preventive Medicine. 2023;65(3):476-484.

Moyett 2023 - Moyett JM, Ramey-Collier K, Zambrano Guevara LM, et al. CenteringPregnancy: A review of implementation and outcomes. Obstetrical & Gynecological Survey. 2023;78(8):490-499.

Olatunde 2022* - Olatunde A, Hosein S, Paoletti A, Pitcairn-Ramirez A, Gurney EP. Impact of group prenatal care on contraceptive use at twelve weeks postpartum. Maternal and Child Health Journal. 2022;26:1559-1566.

P3 - Pregnancy & Parenting Partners (P3). A comprehensive group approach to prenatal care.

Park 2023* - Park CH, Driver N, Richards RC, Ward P. The effects of CenteringPregnancy on maternal and infant health outcomes: A moderation analysis. Journal of Public Health. 2023;45(4):e746-e754.

Patberg 2021* - Patberg E, Young M, Archer S, et al. Postpartum contraceptive use and other reproductive health outcomes among CenteringPregnancy group prenatal care participants. Journal of Women’s Health. 2021;30(7):990-996.

Picklesimer 2012* - Picklesimer A, Billings D, Hale N, Covington-Kolb S. The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population. American Journal of Obstetrics and Gynecology. 2012;206(5):415.e1-415.e7.

Pto3-GPC - Group prenatal care. Prenatal-to-3 Policy Impact Center (Pto3).

Risisky 2018* - Risisky D, Chan RL, Zigmont VA, Asghar SM, DeGennaro N. Examining delivery method and infant feeding intentions between women in traditional and non-traditional prenatal care. Maternal and Child Health Journal. 2018;22:274-282.

Robinson 2018* - Robinson K, Garnier-Villarreal M, Hanson L. Effectiveness of CenteringPregnancy on breastfeeding initiation among African Americans: A systematic review and meta-analysis. Journal of Perinatal and Neonatal Nursing. 2018;32(2):116-126.

Roussos-Ross 2020* - Roussos-Ross D, Prieto A, Goodin A, Watson AK, Bright MA. Increased Tdap and influenza vaccination acquisition among patients participating in group prenatal care. Journal of Primary Prevention. 2020;41:413-420.

Schellinger 2016* - Schellinger MM, Abernathy MP, Amerman B, et al. Improved outcomes for Hispanic women with gestational diabetes using the Centering Pregnancy© group prenatal care model. Maternal and Child Health Journal. 2016:1-9.

Schellinger 2017* - Schellinger MM, Abernathy MP, Amerman B, et al. Improved outcomes for Hispanic women with gestational diabetes using the Centering Pregnancy© group prenatal care model. Maternal and Child Health Journal. 2017;21:297-305.

Schwarz 2020* - Schwarz JG, Froh E, Farmer M-C, et al. A model of group prenatal care for patients with prenatally diagnosed fetal anomalies. Journal of Midwifery & Women’s Health. 2020;65(2):265-270.

Short 2023* - Short VL, Hand DJ, Mancuso F, et al. Group prenatal care for pregnant women with opioid use disorder: Preliminary evidence for acceptability and benefits compared with individual prenatal care. Birth. 2023:1-8.

Tandon 2012* - Tandon SD, Colon L, Vega P, Murphy J, Alonso A. Birth outcomes associated with receipt of group prenatal care among low-income Hispanic women. Journal of Midwifery & Women’s Health. 2012;57(5):476-481.

Tandon 2013* - Tandon SD, Cluxton-Keller F, Colon L, Vega P, Alonso A. Improved adequacy of prenatal care and healthcare utilization among low-income Latinas receiving group prenatal care. Journal of Women’s Health. 2013;22(12):1056-1061.

Tanner-Smith 2014 - Tanner-Smith EE, Steinka-Fry KT, Gesell SB. Comparative effectiveness of group and individual prenatal care on gestational weight gain. Maternal and Child Health Journal. 2014;18(7):1711-1720.

Tanner-Smith 2014a* - Tanner-Smith EE, Steinka-Fry KT, Lipsey MW. The effects of CenteringPregnancy group prenatal care on gestational age, birth weight, and fetal demise. Maternal and Child Health Journal. 2014;18(4):801-809.

Trotman 2015* - Trotman G, Chhatre G, Darolia R, et al. The effect of Centering Pregnancy versus traditional prenatal care models on improved adolescent health behaviors in the perinatal period. Journal of Pediatric and Adolescent Gynecology. 2015;28(5):395-401.

Trudnak 2013* - Trudnak TE, Arboleda E, Kirby RS, Perrin K. Outcomes of Latina women in CenteringPregnancy group prenatal care compared with individual prenatal care. Journal of Midwifery & Women’s Health. 2013;58(4):396-403.

Tubay 2019 - Tubay AT, Mansalis KA, Simpson MJ, et al. The effects of group prenatal care on infant birthweight and maternal well-being: A randomized controlled trial. Military Medicine. 2019;184(5-6):e440-e446.

Tucker 2021* - Tucker CM, Felder TM, Dail RB, Lyndon A, Allen K-C. Group prenatal care and maternal outcomes: A scoping review. MCN: The American Journal of Maternal/Child Nursing. 2021;46(6):314-322.

Zielinksi 2014 - Zielinski R, Stork L, Deibel M, Kothari CL, Searing K. Improving infant and maternal health through CenteringPregnancy: A comparison of maternal health indicators and infant outcomes between women receiving group versus traditional prenatal care. Open Journal of Obstetrics and Gynecology. 2014;4(9):497-505.