Comparative Effect of Two Enhanced Prenatal Care Models on Care Experiences: A Randomized Controlled Trial

Abstract

Objective: To compare the effect of enhanced group prenatal care (eGPC) and enhanced individual prenatal care (eIPC) on prenatal and intrapartum care experiences.

Methods: EMBRACE (Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone) was a pragmatic, randomized trial comparing the effect of eGPC and eIPC on depression (primary aim), care experiences (secondary aim), and preterm birth (exploratory aim) among pregnant people who are eligible for Medicaid insurance in California's San Joaquin Valley. This article focuses on care experiences. Outcomes included scores from the PCPC (Person-Centered Prenatal Care), MORi (Mothers on Respect index), PCSS (Prenatal Care Satisfaction Scale), and PCMC-US (Person-Centered Maternity Care - United States) scales. Scores were summed and standardized (range 0-100; higher scores indicate better experiences; scores of 75 or higher and 90 or higher are considered good and optimal, respectively). Subgroup analyses included prenatal care attendance (at least one visit and four or more visits postrandomization) and self-reported race and ethnicity (Black and Latine). A sample size of 657 was planned to compare the effects of eGPC to those of eIPC on depression (primary outcome). We used restricted maximum likelihood mixed linear regression models adjusted for selected covariates, with random intercepts for clinician, and present adjusted mean differences (aMDs) in scores.

Results: From November 2019 to January 2024, 1,663 people were screened, 678 were randomized, and 674 were analyzed (n=294 eGPC, n=380 eIPC). Most participants (72.0%) identified as Latine. Mean adjusted prenatal care experience scores were good, but generally suboptimal, for both groups, with PCPC scores of 90.5±3.2 and 88.7±3.2 among participants randomized to eGPC and eIPC, respectively. The aMDs were 1.8 (95% CI, -0.5 to 4.1), 0.2 (95% CI, -1.8 to 2.3), and 1.6 (95% CI, -1.8 to 4.9) for PCPC, MORi, and PCSS, respectively. Intrapartum care experience scores were also good, but not optimal, in both randomization groups and did not differ significantly. Subgroup analyses yielded similar findings.

Conclusion: Both enhanced prenatal care models yielded favorable prenatal care experiences in this predominantly Latine population with low income.

Clinical trial registration: ClinicalTrials.gov, NCT04154423.