Patient Characteristics Associated With Group Prenatal Care Attendance in a Randomized Controlled Trial

Group prenatal care (GPNC) represents a promising alternative to individual prenatal care (IPNC) for better perinatal outcomes. Some studies suggest better perinatal outcomes with more GPNC sessions attended. The present study sought to examine patient characteristics associated with higher or lower GPNC session attendance.

We conducted a secondary analysis of data collected in a single-site randomized controlled trial comparing GPNC to IPNC, focusing solely on patients assigned to GPNC. The outcome of interest was GPNC session attendance. Predictors evaluated included patient sociodemographic, psychosocial, health, and health behavior characteristics. The association of patient characteristics with session attendance was assessed using Zero-Inflated Poisson regression.

The sample (n = 1,068) was racially diverse (40.7% Black, 35.8% white, 22.1% Hispanic) and largely Medicaid eligible (92.3%). The characteristics of older age (adjusted relative risk [aRR] = 1.01; 95% confidence interval [CI] [1.00, 1.01]; p = .012), foreign nativity (aRR = 1.14; 95% CI [1.06, 1.22]; p < .001), and prenatal distress (aRR = 1.09; 95% CI [1.01, 1.19]; p = .030) were associated with higher session attendance. Being in a committed relationship but unmarried (aRR = .91; 95% CI [.85, .97]; p = .007), less than high school education (aRR = .89; 95% CI [.82, .97]; p = .007), depressive symptoms (aRR = .93; 95% CI [.87, .99]; p = .027), housing instability (aRR = .92; 95% CI [.84, .99]; p = .049), housing issues (aRR = .88; 95% CI [.80, .97]; p = .008), life stressors (aRR = .92; 95% CI [.86, .98]; p = .010), gestational diabetes (aRR = .81; 95% CI [.71, .91]; p < .001), and smoking (aRR = .92; 95% CI [.85, .99]; p = .040) were associated with lower session attendance.

Patient characteristics were differentially associated with GPNC session attendance. Given that patients with less education, more depressive symptoms, housing instability, stressors, gestational diabetes, and prenatal cigarette use attended fewer sessions, adaptations to the GPNC model to reduce attendance barriers for these groups should be considered.