Pilot Randomized Controlled Trial of Diabetes Group Prenatal Care

Approximately 10% of pregnant women have type 2 diabetes or gestational diabetesmellitus (GDM), increasing the risk of poor perinatal outcomes such as macrosomia, shoulder dystocia, preeclampsia, or cesarean delivery. One potential strategy to help manage these conditions in this patient population is group prenatal care. The aim of this study was to determine the feasibility of group care for diabetic, pregnant women and its effectiveness in promoting healthy, self-care activities to manage their condition. This was a pilot, randomized controlled trial conducted at 2 urban medical centers where the patient populations were lowincome, uninsured, receiving Medicaid, and predominantly African American or Latina. Pregnant women were recruited for the study if they were English- or Spanish-speaking, diagnosed with type 2 diabetes or GDM at ≤32 weeks' gestation, were able to have their initial study visit between 22 and 34 weeks of gestation, and could attend diabetes group prenatal visits. Excluded were those with type 1 diabetes, multiple gestation, fetal anomalies, or serious comorbidity. Eligible women were randomized to either the diabetes group prenatal care (group care) or individual care. Pregnant women assigned to group care attended biweekly, 2-hour sessions with up to 10 other women, a facilitator, and a certified nurse midwife, obstetrician, or maternal fetal medicine physician. The group-care sessions focused on addressing patient needs and relationships versus specific topics related to their condition. Those in group care were seen individually if complications arose before 37 weeks and for routine diabetes prenatal care after 37 weeks. Those in the individual care group received routine prenatal care and reviews of blood sugar logs and medication every 2 weeks up to 37 weeks of gestation an then once a week until delivery. Women in both groups were scheduled for postpartum follow-up at 6 weeks. A total of 78 patients were included in the study analysis.40 were randomized for group care and 38 for individual care. Significantly more women in group care reported eating 5 or more servings of fruits and vegetables on more days per week than those in individual care (5.1 days per week ± 2.0 vs 3.4 days per week ± 2.6; P < 0.01). Other self-care activities related to diet, exercise, blood sugar testing, and medication adherence were similar between the study arms. The number of visits the women made and the percent of visits to which they brought their glucose log or meter were also similar between the study arms. There was a statistically significant difference in gestational weight gain during the study (0.2 lb/wk [interquartile range = 0.0.0.7] for women in group care vs 0.5 lb/wk [interquartile range = 0.2.0.9]; P = 0.03 for those in individual care). No significant differenceswere observed for other maternal outcomes, such as hypertensive disorder of pregnancy or cesarean delivery, or neonatal outcomes, such as preterm birth or shoulder dystocia. Of the 78 women in the study analysis, 40 had GDM, and 38 had type 2 diabetes. Among those with GDM, women in group care were 3.5 times more likely to return for glucose tolerance testing at 6 weeks postpartum than those in individual care (70% vs 21%; relative risk = 3.50; 95%confidence interval = 1.40.8.80). For those with type 2 diabetes, the hemoglobin A1c before delivery was similar for both study arms (6.3 ± 0.7 for group care vs 6.8 ± 0.9 for individual care; P = 0.09). Group care is a strategy that may be effective in promoting self-care activities to manage type 2 diabetes or GDM in pregnant women. Group care was shown to improve diet, reduce gestational weight gain, and increase adherence to postpartum diabetes testing.