The danger for growing gestational diabetes is comparable between sufferers who obtain group prenatal care (GPNC) and people who obtain particular person prenatal care (IPNC), in keeping with examine findings printed in JAMA Community Open.
To find out the results of the GPNC mannequin on threat for gestational diabetes and its development, researchers carried out a secondary evaluation of a single-center, parallel-group, randomized scientific trial (ClinicalTrials.gov Identifier: NCT02640638) carried out from February 2016 to March 2020 at a big well being care system Greenville, South Carolina.
Sufferers have been aged 14 by means of 45 years with pregnancies sooner than 21 weeks. The researchers stratified the pattern by race and ethnicity and randomly assigned sufferers to obtain both group-based care (by way of the Centering Healthcare Institute’s CenteringPregnancy curriculum) or individual-based care.
The researchers separated the GPNC group into teams of 8 to 12 sufferers for ten 2-hour classes. Every affected person within the IPNC group obtained conventional particular person prenatal care as really useful by the American Faculty of Obstetricians and Gynecologists for a complete of 13 visits. Sufferers within the GPNC group have been additionally allowed IPNC visits as wanted.
Sufferers accomplished a baseline survey at lower than 24 gestational weeks and a second survey at 30 to 36 gestational weeks. Surveys included questions on demographics, medical and reproductive historical past, and maternal well being conduct. Sufferers self-reported their race and ethnicity.
The first end result was the incidence of gestational diabetes, which the researchers decided by way of administering the 50-g oral glucose problem between 24 and 30 weeks of gestation. Secondary outcomes included development of gestational diabetes in keeping with the White classification (A1 to A2 gestational diabetes) and obstetric adversarial outcomes related to poor glycemic management, comparable to:
- Major cesarean supply;
- Pre-eclampsia; and,
- Massive-for-gestational-age (LGA) start.
The researchers used an intention-to-treat (ITT) strategy to match main and secondary outcomes between the GPNC and IPNC teams, whereas they used a modified ITT strategy for sensitivity analyses.
On this [randomized controlled trial] amongst pregnant people, contributors receiving GPNC had related threat of growing [gestational diabetes], in contrast with contributors receiving IPNC, suggesting that GPNC may very well be a possible care possibility for some sufferers.
The ITT inhabitants included a complete of 2348 sufferers, of whom 1175 obtained GPNC and 1173 obtained IPNC. Of the whole pattern, 91.3% of sufferers had accomplished the screening for gestational diabetes. The sufferers self-identified as:
- Black (40.5%);
- White (36.8%);
- Hispanic (21.4%); and,
- Different race or multiracial (1.3%).
Baseline traits and prognostic components have been related between teams, however the fee of smoking 3 months earlier than being pregnant was barely larger within the IPNC group (38.7%) in contrast with the GPNC group (32.9%).
The general incidence of gestational diabetes was 6.7%, with no vital distinction between the GPNC (7.1%) and IPNC (6.3%) teams. The adjusted threat distinction (RD) was 0.7% (95% CI, -1.2% to 2.7%). The incidence of gestational diabetes didn’t differ throughout sufferers of various races and ethnicities, with adjusted RDs of:
- 0.5% (95% CI, -2.0% to three.0%; Black sufferers);
- -0.5% (95% CI, -5.8% to 4.9%; Hispanic sufferers); and,
- 2.6% (95% CI, -0.7% to six.0%; White sufferers).
Of these with gestational diabetes, 49% of sufferers (48.2% of the GPNC group and 50.0% of the IPNC group) progressed to A2 gestational diabetes. The adjusted RD was -6.1% (95% CI, -21.3% to 9.1%).
The researchers measured no vital distinction within the incidence of obstetric adversarial occasions between teams. Nevertheless, proportions of sufferers experiencing pre-eclampsia, main cesarean supply, and LGA start have been barely decrease within the GPNC group in contrast with the IPNC group, with adjusted RDs of:
- -7.9% (95% CI, -17.8% to 1.9%; pre-eclampsia);
- -8.2% (95% CI, -12.2% to 13.9%; cesarean supply); and,
- -1.2% (95% CI, -6.1% to three.8%; LGA).
Examine limitations embody its early termination as a result of COVID-19, which restricted the pattern measurement, and low attendance amongst sufferers within the GPNC group.
The researchers concluded, “On this [randomized controlled trial] amongst pregnant people, contributors receiving GPNC had related threat of growing [gestational diabetes], in contrast with contributors receiving IPNC, suggesting that GPNC may very well be a possible care possibility for some sufferers.”