Group Prenatal Care and Social Determinants of Health: A Retrospective Cohort Study at a Federally Qualified Health Center

Abstract

Objective: Group prenatal care (GPC) models are increasingly a focus of observational studies of birth outcomes, yet there are limited data on the socio-demographic and health characteristics of women who elect GPC compared to traditional primary care (TPC). The purpose of this study was to identify and describe potential differences in pregnancy characteristics, social determinants of health (SDOH), prenatal complications, and behavioral risk factors between women who elect GPC compared to TPC in a Federally Qualified Health Clinic (FQHC) setting. Study Design: This study was a retrospective cohort analysis of women who elected GPC compared to those who elected TPC, from a group of 2,376 patients entering prenatal care at the study site between 2011 and 2017. Cohort composition was examined with regards to pregnancy characteristics, social determinants of health (SDOH), behavioral risk factors, and diagnosis of medical complications during prenatal care. Variables were compared between cohorts using bivariate statistics, stratified by trimester at intake in order to compare women who entered prenatal care at similar gestational ages. Results: In the 1st trimester stratum, GPC was associated with 0.7 fewer prior pregnancies (P<0.001), 8.7% lower rate of Hispanic ethnicity (P=0.010), 5.7% higher rate of private insurance (P=0.043), 0.3 fewer people per family (P=0.013), and an average of 1.1 more years of education (P=0.031). GPC was associated with a higher rate of diagnosis with the following complications: 18.8% higher rate of anemia (P<0.001), 9.0% higher rate of uterine size-complicating pregnancy (P=0.001), a 7.6% higher rate of “other not elsewhere classified” complications (P=0.024). GPC was also associated with a 12.4% higher rate of parental alcohol or drug abuse (P=0.028), and, of those who reported illicit drug use, 2.4 fewer uses per week were reported (P<0.001). Conclusion: GPC and TPC cohorts differed significantly terms of pregnancy characteristics, SDOH, prenatal complications, and behavioral risk factors. The GPC cohort tended to have some indicators of higher socioeconomic status (SES), yet were more likely to be diagnosed with a complication or behavioral risk factor. These differences could be expected to influence the outcome findings of observational studies on GPC. Further research examining the maternal characteristics of subjects who elect GPC compared to TPC is recommended to confirm these findings and further explore the dynamics involved.