Original Article: Preterm Labor: Prevention and Management
Issue Date: March 15, 2017
Available online at: https://www.aafp.org/afp/2017/0315/p366.html
To the Editor: We would like to thank Drs. Rundell and Panchal for their article. Although there is existing literature regarding group pregnancy care as a model to reduce preterm delivery, at the time of the article's publication, the model had not yet been formally endorsed by the American College of Obstetricians and Gynecologists (ACOG) or the American Academy of Family Physicians (AAFP).
We are pleased to recommend the group prenatal care model as an added intervention to Drs. Rundell and Panchal's recommendations for prevention of preterm delivery. In March 2018, ACOG in collaboration with the AAFP released a committee opinion in support of group prenatal care.1 This opinion notes that in addition to offering important social and educational support for all patients, group prenatal care may offer additional benefits to the highest risk patients, including reductions in preterm delivery and low infant birth weight among black women.
Facilitated group prenatal programs, typically modeled after CenteringPregnancy, are designed to improve patient knowledge and social support, as well as health assessments (additional information available at https://www.centeringhealthcare.org). Outcomes in group prenatal care models are comparable with those of traditional care. In addition, studies demonstrate high levels of patient satisfaction and improved perinatal outcomes for some populations.2 ACOG's support aligns well with research findings that show CenteringPregnancy lowers preterm birth rates by 33% to 47%,1 equalizes the racial disparity in preterm birth rates between black and white women,3 and increases breastfeeding rates.4
Group prenatal care offers an opportunity to transform the delivery of care to patients in a way that supports individuals and communities, addresses equity in health care delivery, and improves important outcomes such as preterm delivery and low birth weight in vulnerable populations.
In Reply: We appreciate Drs. Darby-Stewart and Strickland bringing the recent ACOG bulletin to our attention. The bulletin clearly recognizes that group prenatal care, regardless of the specific model, is a viable alternative to individual prenatal care and may be more beneficial in certain patient populations. Some of the benefits include improved patient knowledge and readiness for labor and delivery, as well as satisfaction with care. There is also evidence of increased rates of breastfeeding.1 Although there is mixed evidence for the effect of group prenatal care on preterm birth outcomes overall, analyzed by race and income, there is clear evidence for improvement in preterm birth outcomes for low-income black women.2–4
In addition to supporting group prenatal care, we would like to add that the ACOG bulletin now includes a recommendation for a single course of betamethasone for women between 34 0/7 and 36 6/7 weeks' gestation who have a risk of delivery within seven days if they did not previously receive a course of steroids antenatally.5