Kaiser Permanente researchers examine combination of webinar, in-person care
A virtual group prenatal care option delivered by webinar, along with in-person visits, resulted in pregnant patients having the same or better outcomes as patients who received virtual and in-person care on an individual basis, according to a Kaiser Permanente study published in JAMA Network Open.
Parents who attended 5 or more group sessions also reported less stress and better sleep, higher perceived quality of prenatal care, and feeling better prepared to care for a newborn.
The analysis assessed 390 pregnant patients of Kaiser Permanente Northern California (KPNC) between August 2020 and April 2021. Half chose to enroll in the CenteringPregnancy program and received prenatal care in groups of 10 to 12 other patients and their partners. They were compared to a group who received traditional individual prenatal visits, but had told the researchers they would have chosen group visits if they were available.
Previous research has shown that patients benefit from the group prenatal care in the CenteringPregnancy curriculum. During the COVID-19 pandemic, KPNC adopted a multimodal care model that combined virtual (phone, video) and in-person visits for both group and traditional individual prenatal care. This is the first study to evaluate a multimodal prenatal care delivery model with group care delivered through webinars.
The study found that outcomes such as depression, anxiety, and breastfeeding initiation didn’t differ between the 2 groups. However, patients in the CenteringPregnancy program had 21% less perceived stress.
“For those who are interested in experiencing prenatal care with a small group in a combination of virtual and in-person visits, our research is reassuring and suggests that they will have outcomes as good as those in traditional individual care with virtual and in-person visits, and may also experience unique benefits,” said lead author Lyndsay Avalos, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research.
“We have seen so many patients benefit from learning about pregnancy and childbirth with others, sharing a profound life experience together,” said study senior author Joanna Stark, MD, an ob/gyn and hospitalist with The Permanente Medical Group. “These findings are encouraging because they show that the virtual version of that group experience can provide those same benefits.”
CenteringPregnancy was developed by a Boston-based non-profit organization as a method to reduce preterm birth and has been used across the country at more than 500 practice sites. KPNC adopted it in 2016 and offers it in 8 of 15 service areas; most are now in-person group sessions, though some remain virtual.
Patients choosing group prenatal care received the same approximate number of prenatal care visits as those who received traditional individual care, with similar timing. Patients who had group visits would attend 7 to 10 interactive 60- to 90-minute online webinars. They routinely saw their provider for an in-person visit to collect vital signs, weight, and other necessary tests.
Individual care included 5 in-person visits during pregnancy, along with 4 phone or video visits.
Each virtual group visit includes a presentation followed by discussion among participants and the presenter.
“It’s very interactive,” Avalos said. “There’s time to cover many topics and answer a lot of questions. And there’s a social aspect. The cohorts may become very close and remain friends for years, like forming a new moms’ group. This social support comes from being with a group of people who are all experiencing similar things at the same time.”
The researchers said it was important that all the participants were interested in the group prenatal care model.
“These findings are generalizable to people who would choose to participate in group prenatal care if given the opportunity,” Avalos said. “That is an important caveat: the people who chose group prenatal care were probably more likely to do well with it.”
The findings are reassuring for health systems that have multimodal models of care and provide support to those considering offering a virtual group prenatal care option, Avalos said.
The study was funded by The Permanente Medical Group Delivery Science and Applied Research Program.
Additional co-authors were Nina Oberman, MPH, Lizeth Gomez, BA, Charles Quesenberry, PhD, Elaine Kurtovich, MPH, Erica P. Gunderson, PhD, MPH, RD, and Monique Hedderson, PhD, MPH, of the Division of Research; and Fiona Sinclair, PA, MHS, of Kaiser Permanente Northern California.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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