CenteringPregnancy
CenteringPregnancy is a multifaceted model of group maternity care that incorporates health assessment, education, and support. Eight to ten women with similar gestational ages meet to learn care skills, participate in a facilitated discussion, and develop a support network with other group members. Each pregnancy group follows the recommended schedule of 10 prenatal visits; visits range from 90 minutes to 2 hours long. Participants take their own weight and blood pressure, record their health data, and have private time with their provider for belly checks before group discussion and activities1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Improved prenatal care
Improved birth outcomes
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased patient satisfaction
What does the research say about effectiveness? This strategy is rated scientifically supported.
There is strong evidence that CenteringPregnancy improves birth outcomes, particularly among disadvantaged populations such as low income black and Hispanic women2, 3, 4, 5, 6, 7, 8. Participants in CenteringPregnancy are more likely to receive adequate prenatal care than non-participating peers6, 9, 10, 11.
CenteringPregnancy improves infant birth weight2, 3, 7, 8 and reduces the likelihood of preterm delivery2, 4, 5, 6, 7 in disadvantaged groups. CenteringPregnancy may also reduce the risk of a NICU stay2 and fetal demise3. CenteringPregnancy participants may engage in healthier behaviors7, 12, 13 and have more appropriate gestational weight gain than non-participants12, 14. CenteringPregnancy participants also appear to be more likely to engage in breastfeeding6, 12, 15, 16, 17, 18, 19.
CenteringPregnancy may also improve mental health for some participants12, 20, 21. Women in the program learn more about healthy pregnancy6, 22 and report feeling better prepared for delivery6 and more satisfied with their prenatal care than non-participating women8, 9, 10, 23. Greater fidelity to the model appears to lower the odds of intensive utilization of care24.
Preparing clinics and staff to implement CenteringPregnancy costs approximately $20,000 over the first 2 years, with an ongoing annual membership cost of $500 per year25; the program does not appear to differ in cost from traditional care once established6. Cost benefit modeling for group prenatal care in a practice serving disadvantaged patients suggests that the CenteringPregnancy staffing model would be cost neutral with only five patients per group25.
Centering Pregnancy Plus, an intervention with an additional focus on reducing risky sexual behavior, has been shown to reduce unprotected sex, sexually transmitted infections, and repeat pregnancies26, 27. The program can also increase self-esteem and decrease depression during and after pregnancy28.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
As of 2016, CenteringPregnancy and CenteringParenting programs have been implemented at over 400 sites in the United States and abroad, serving over 48,000 patents in 20151.
Implementation Resources
CHI - Centering Healthcare Institute (CHI). CenteringPregnancy overview.
Footnotes
* Journal subscription may be required for access.
1 CHI - Centering Healthcare Institute (CHI). CenteringPregnancy overview.
2 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.
3 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.
4 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.
5 Tandon 2012 - Tandon S. D, 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):476–81.
6 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):330-9.
7 Grady 2004 - Grady MA, Bloom KC. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. Journal of Midwifery and Women’s Health. 2004;49(5):412-20.
8 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):1051-7.
9 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):1169-77.
10 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.
11 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.
12 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.
13 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.
14 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.
15 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.
16 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.
17 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.
18 Tanner-Smith 2013a - Tanner-Smith EE, Steinka-Fry KT, Lipsey MW. Effects of CenteringPregnancy group prenatal care on breastfeeding outcomes. Journal of Midwifery & Women’s Health. 2013;58(4):389–395.
19 Klima 2009 - Klima C, Norr K, Vonderheid S, Handler A. Introduction of CenteringPregnancy in public health clinic. Journal of Midwifery & Women’s Health. 2009;54(1):27-34.
20 Heberlein 2016 - Heberlein EC, Picklesimer AH, Billings DL, et al. The comparative effects of group prenatal care on psychosocial outcomes. Archives of Women’s Mental Health. 2016;19(2):259–269.
21 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.
22 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.
23 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.
24 Novick 2013 - Novick G, Reid AE, Lewis J, et al. Group prenatal care: Model fidelity and outcomes. American Journal of Obstetrics and Gynecology. 2013;209(2):112.e1-112.e6.
25 Rowley 2016 - Rowley RA, Phillips LE, O’Dell L, et al. Group prenatal care: A financial perspective. Maternal and Child Health Journal. 2016;20(1):1–10.
26 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.
27 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.
28 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):235-50.
Related What Works for Health Strategies
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