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Gestational weight gain and group prenatal care: a systematic review and meta-analysis

BACKGROUND: Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weig...

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Autores principales: Kominiarek, Michelle A., Lewkowitz, Adam K., Carter, Ebony, Fowler, Susan A., Simon, Melissa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327616/
https://www.ncbi.nlm.nih.gov/pubmed/30626345
http://dx.doi.org/10.1186/s12884-018-2148-8
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author Kominiarek, Michelle A.
Lewkowitz, Adam K.
Carter, Ebony
Fowler, Susan A.
Simon, Melissa
author_facet Kominiarek, Michelle A.
Lewkowitz, Adam K.
Carter, Ebony
Fowler, Susan A.
Simon, Melissa
author_sort Kominiarek, Michelle A.
collection PubMed
description BACKGROUND: Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain. METHODS: A keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I(2) statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies. RESULTS: One RCT, one secondary analysis of an RCT, one study with “random assignment”, and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97–1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79–1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis. CONCLUSIONS: Group prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-018-2148-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-63276162019-01-15 Gestational weight gain and group prenatal care: a systematic review and meta-analysis Kominiarek, Michelle A. Lewkowitz, Adam K. Carter, Ebony Fowler, Susan A. Simon, Melissa BMC Pregnancy Childbirth Research Article BACKGROUND: Group visits for chronic medical conditions in non-pregnant populations have demonstrated successful outcomes including greater weight loss compared to individual visits for weight management. It is plausible that group prenatal care can similarly assist women in meeting gestational weight gain goals. The purpose of this study was to evaluate the effect of group vs. traditional prenatal care on gestational weight gain. METHODS: A keyword search of Medline, Embase, Scopus, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and Google Scholar was performed up to April 2017. Studies were included if they compared gestational weight gain in a group prenatal care setting to traditional prenatal care in either randomized controlled trials, cohort, or case-control studies. The primary and secondary outcomes were excessive and adequate gestational weight gain according to the Institute of Medicine guidelines. Heterogeneity was assessed with the Q test and I(2) statistic. Pooled relative risks (RRs) and confidence intervals (CI) were reported with random-effects models from the randomized controlled trials (RCT) and cohort studies. RESULTS: One RCT, one secondary analysis of an RCT, one study with “random assignment”, and twelve cohort studies met the inclusion criteria for a total of 13,779 subjects. Thirteen studies used the CenteringPregnancy model, defined by 10 sessions that emphasize goal setting and self-monitoring. Studies targeted specific populations such as adolescents, African-Americans, Hispanics, active-duty military or their spouses, and women with obesity or gestational diabetes. There were no significant differences in excessive [7 studies: pooled rates 47% (1806/3582) vs. 43% (3839/8521), RR 1.09, 95% CI 0.97–1.23] or adequate gestational weight gain [6 studies: pooled rates 31% (798/2875) vs. 30% (1410/5187), RR 0.92, 95% CI 0.79–1.08] in group and traditional prenatal care among the nine studies that reported categorical gestational weight gain outcomes in the meta-analysis. CONCLUSIONS: Group prenatal care was not associated with excessive or adequate gestational weight gain in the meta-analysis. Since outcomes were overall inconsistent, we propose that prenatal care models (e.g., group vs. traditional) should be evaluated in a more rigorous fashion with respect to gestational weight gain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-018-2148-8) contains supplementary material, which is available to authorized users. BioMed Central 2019-01-09 /pmc/articles/PMC6327616/ /pubmed/30626345 http://dx.doi.org/10.1186/s12884-018-2148-8 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kominiarek, Michelle A.
Lewkowitz, Adam K.
Carter, Ebony
Fowler, Susan A.
Simon, Melissa
Gestational weight gain and group prenatal care: a systematic review and meta-analysis
title Gestational weight gain and group prenatal care: a systematic review and meta-analysis
title_full Gestational weight gain and group prenatal care: a systematic review and meta-analysis
title_fullStr Gestational weight gain and group prenatal care: a systematic review and meta-analysis
title_full_unstemmed Gestational weight gain and group prenatal care: a systematic review and meta-analysis
title_short Gestational weight gain and group prenatal care: a systematic review and meta-analysis
title_sort gestational weight gain and group prenatal care: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327616/
https://www.ncbi.nlm.nih.gov/pubmed/30626345
http://dx.doi.org/10.1186/s12884-018-2148-8
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