Group Prenatal Care Versus Individual Prenatal Care: A Systematic Review and Meta-Analyses
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OBJECTIVE: To compare the effects of group prenatal care (GPC) and individual prenatal care (IPC) on perinatal health outcomes, including our primary outcomes of preterm birth (PTB < 37 weeks) and low birth weight (< 2500 g). DATA SOURCES: We searched Medline, Embase, CINAHL, and the references of selected articles. STUDY SELECTION: Two reviewers independently performed each step of the systematic review. Of the 4178 non-duplicate titles and abstracts identified, 77 were selected for full-text review. An additional eight full-text articles were selected from reference lists. Overall, 85 full-text articles were reviewed. Studies included assessed maternal or infant health outcomes. DATA EXTRACTION AND DATA SYNTHESIS: Two reviewers independently extracted data from eligible full-text articles. Statistical analyses were completed using Review Manager, version 5.0 (Copenhagen: The Nordic Cochrane Centre, Cochrane Collaboration, 2011), whereby dichotomous variables and continuous outcomes were analyzed using relative risk and mean difference, respectively. The random effects model was employed to pool data. Where available, adjusted data were used to assess the independent effect of GPC. Eight studies of mostly low quality (three randomized controlled trials and five cohort studies) were included, involving 3242 women, most at high risk. Women randomized to GPC had lower rates of PTB (RR 0.71; 95% CI 0.52 to 0.96), no difference in rates of LBW (RR 0.91; 95% CI 0.65 to 1.27) or IUGR (RR 0.85; 95% CI 0.61 to 1.19), fewer Caesarean sections (RR 0.80; 95% CI 0.67 to 0.93), and slightly higher rates of breastfeeding (RR 1.08; 95% CI 1.02 to 1.14). CONCLUSION: Studies comparing GPC with IPC are mostly of low quality and in high-risk groups, although two randomized studies, one a secondary analysis, showed improvement in some outcomes, including rates of PTB in women participating in GPC. In order to determine generalizability, more high-quality studies of GPC are needed.
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