Compared to routine prenatal care (RPC), group care, such as Centering Pregnancy (CP), has been associated with much lower rates of preterm delivery (PTD). Mechanism(s) are unclear but selection bias and differences in quality of care have not been fully excluded. Military patients have relatively low rates of PTD. We sought to determine if the CP method would further reduce risk of PTD in the military.
A prospective randomized clinical trial. To reduce bias, after counseling, subjects selected a favored method of care. Subjects desiring CP, were randomized to CP study or RPC (RPC1) control groups. Subjects desiring RPC formed a second control group (RPC2). Surveys and outcomes were evaluated. Outcomes included incidences of PTD < 37 wks and PTD <32 wks. We evaluated, stress, anxiety, sense of control, and depression scores and other known risks.
1811 women were randomized: n=631 CP, n=591 RPC1 and, n=589 RPC2. Nine subjects with incomplete data were excluded. The incidence of PTD <37 wks was 9.0%. There were no group differences in the rate of PTD <37 wks (p = 0.65). Despite initial randomization, more Black women (vs White and Other) were in the CP vs the control groups (22% vs 14%, p <0.0001). The overall incidence of PTD< 37 wks in Blacks was higher than Whites (14.9% vs 8.8 %, p = 0.0018). More Blacks than Whites delivered <32 wks (p = 0.007). The CP group experienced lower rates of PTB < 32 wks than control (p = 0.029) groups despite more Blacks in the CP group. The difference was not explained by Stress, Anxiety, Control or Depression scores or age, parity, military rank, or Active Duty status. CP did not have any apparent effect on PTD < 37 or <32 wks in Whites.
CP does not reduce the overall incidence of PTD <37 wks compared to RPC. However, CP is associated with a decreased risk of early PTD (<32 wks) that seems to predominately benefit Black women beyond even quality RPC. The mechanism of this apparent benefit needs further study.
© 2014 Published by Elsevier Inc.