Group prenatal care

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Disparity Rating  
Disparity rating: Potential to decrease disparities

Strategies with this rating have the potential to decrease or eliminate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.

Health Factors  
Date last updated

Group prenatal care (GPC) is delivered in a group setting and facilitated by a trained health care provider that incorporates health assessments, education, and social support. Eight to twelve pregnant people with similar gestational ages meet to learn care skills, participate in a facilitated discussion, and develop a support network. Groups meet every two to four weeks, usually for a total of 15 to 20 hours of prenatal care, compared with two to four hours for those following traditional, individual prenatal care schedules1. GPC was originally designed for low-risk, uncomplicated pregnancies, but has been adapted for other populations, including women living with HIV2, women with complex medical needs3, and patients with diagnosed fetal anomalies4.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Improved birth outcomes

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Increased breastfeeding

  • Improved prenatal care

  • Increased postpartum care

  • Improved mental health

  • Increased patient satisfaction

What does the research say about effectiveness?

There is some evidence that group prenatal care (GPC) improves birth outcomes for disadvantaged populations, particularly Black women3, 5, 6, 7, 8, 9, 10, 11, 12. 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 outcomes7, 13. However, in some cases, including when patients attend at least five GPC visits, GPC can reduce preterm births3, 8, 9, 12 and reduce low birthweight births8, 9, 12, particularly for Black women7.

Among disadvantaged groups, GPC can improve infant birthweight8, 10, 11, 12, 14, 15, 16 and reduce the likelihood of preterm delivery5, 8, 11, 12, 15, 17, 18, 19; improvements may be stronger for women who are older11. GPC may also reduce the risk of a NICU stay3, 8, 9, 10, 12, 15. While some studies suggest GPC may reduce fetal demise20 and perinatal mortality11, other studies have not seen the same impacts10. GPC may also decrease elective21 and overall cesarean section surgeries10.

GPC participants appear to be more likely to initiate breastfeeding6, 21, 22, 23, 24, 25, 26, 27, especially participants who are Black22. 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 Black28.

Participants in GPC are more likely to receive adequate prenatal care than non-participating peers19, 29, 30, 31. Less structured group prenatal care initiatives may provide adequate care; however, more structured programs may be necessary to improve health outcomes32.

Maternal outcomes. Overall, little evidence is available regarding GPC’s impact on maternal outcomes33. While some studies suggest GPC participants have more appropriate gestational weight gain than non-participants6, 34, others suggest that there appears to be no difference in impact, either positive or negative, on maternal weight gain35. GPC and individual prenatal care appear to have similar effects on gestational diabetes36. GPC may increase vaccinations for influenza37 and Tdap during pregnancy23, 37. 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-eclampsia38. GPC that includes an additional focus on reducing risky sexual behavior can reduce unprotected sex, sexually transmitted infections (STIs), and rapid repeat pregnancies39, 40. GPC may improve mental health for some participants41, 42, including adolescents and women with low incomes6. Overall, GPC appears to reduce postpartum depression at different time points within the first year2, 13, 26, but effects may not persist to 12 months13, and one study found no impact at six weeks postpartum compared to those in individual prenatal care43.

GPC may increase return visits for postpartum contraception compared to individual prenatal care44, 45. GPC may increase long-acting reversible contraceptive (LARC) use6, 44, 46, 47 and may reduce rapid repeat pregnancies47. GPC may be as effective as individual prenatal care for establishing the use of other types of highly effective contraception postpartum48. Attending five or more GPC visits may increase the likelihood that patients attend postpartum visits49. For patients with opioid use disorder, GPC increases postpartum visits23.

Women in GPC programs learn more about healthy pregnancies19, 43, 50 and report feeling better prepared for delivery19 and more satisfied with their prenatal care than non-participating women6, 16, 29, 30, 51, 52, and adolescents’ satisfaction with care appears to increase with greater rates of attendance53.

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 savings54.

How could this strategy advance health equity? This strategy is rated potential to decrease disparities: supported by strong evidence.

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 Black5, 7, 10 and those with low incomes6, 11. GPC may also have the potential to reduce economic inequalities in access to care6, 11, 28 and racial inequalities in access to prenatal care, quality of care, and maternal mortality58. It may also increase breastfeeding initiation among women who are Black6, 22. However, GPC’s benefits can vary depending on patients’ social, racial and ethnic, or economic group5. For example, GPC appears to have a limited impact on women who are Hispanic11, 12, but those with gestational diabetes may derive some additional benefits59.

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 high60. The maternal mortality rate in the U.S. is higher than in any other developed country33, and there are stark disparities in maternal outcomes and maternal mortality between Black and white populations33, 61, as well as racial bias and discrimination in maternity care for Black women33. 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 pandemic62.

What is the relevant historical background?

The Federal Housing Administration’s redlining practices concentrated poverty63 and entrenched racial residential segregation in the U.S., resulting in fewer health care facilities, resources, and funding in urban areas with largely Black populations64, 65. 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 income64. 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 islands65. 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 increases60.

Increased barriers to abortion following the overturning of Roe v. Wade in 2023 may increase existing disparities in maternal and infant health62.

Equity Considerations
  • 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?
Implementation Examples

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 efforts1.

CenteringPregnancy is the most popular group prenatal care program and has been implemented across the country. Many other GPC programs are based on it1. 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 year55.

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 Care1, 56. P3 has been implemented at sites across the country57.

Implementation Resources

Resources with a focus on equity.

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.

CHI - Centering Healthcare Institute (CHI). CenteringPregnancy.


* Journal subscription may be required for access.

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

2 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.

3 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.

4 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.

5 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.

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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 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.

13 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.

14 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.

15 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.

16 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.

17 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.

18 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.

19 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.

20 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.

21 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.

22 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.

23 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.

24 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.

25 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.

26 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.

27 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.

28 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.

29 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.

30 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.

31 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.

32 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.

33 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.

34 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.

35 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.

36 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.

37 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.

38 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.

39 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.

40 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.

41 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.

42 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.

43 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.

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

45 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.

46 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.

47 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.

48 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.

49 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.

50 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.

51 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.

52 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.

53 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.

54 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.

55 CHI - Centering Healthcare Institute (CHI). CenteringPregnancy.

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

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

58 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.

59 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.

60 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.

61 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.

62 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.

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

64 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.

65 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.