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Am J Perinatol 2023; 40(15): 1659-1664
DOI: 10.1055/s-0041-1739413
Original Article

The Impact of Group Prenatal Care on Interpregnancy Interval

Justine M. Keller 
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Jessica A. Norton
2   Affinia Healthcare, St. Louis, Missouri
,
Fan Zhang
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Rachel Paul 
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Tessa Madden
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Nandini Raghuraman
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
,
Molly J. Stout
3   Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
,
Ebony B. Carter
1   Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
› Author Affiliations Funding Funding was provided by funds from the Institute for Public Health at Washington University in St. Louis and the Washington University Institute of Clinical Translational Sciences (grant numbers: UL1 TR000448 and TL1 TR000449) from the National Center for Advancing Translational Sciences. Dr. Carter is supported by the Robert Wood Johnson Foundation (grant number 74250), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIHD, grant number: K23HD095075), and the American Diabetes Association (ADA, grant number: 1-19 ACE-02).
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Abstract

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months.

Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education.

Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57).

Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care.

Key Points

  • CenteringPregnancy is associated with a significant decrease in interpregnancy intervals ≤6 and ≤12 months.

  • LARC uptake is significantly higher among patients participating in CenteringPregnancy.

  • CenteringPregnancy participation enhances self-efficacy in making contraception decisions and promotes healthy pregnancy spacing.

Keywords

prenatal care - CenteringPregnancy - long-acting reversible contraception - prenatal visits - interpregnancy interval - family planning - Medicaid

Supplementary Material



Publication History

Received: 09 November 2020

Accepted: 03 October 2021

Article published online:
10 December 2021

© 2021. Thieme. All rights reserved.

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