Association of Group Prenatal Care With Gestational Weight Gain

作者：Kominiarek Michelle A^*; Crockett Amy; Covington Kolb Sarah; Simon Melissa; Grobman William A

来源：Obstetrics and Gynecology, 2017, 129(4): 663-670.

DOI：10.1097/AOG.0000000000001940

OBJECTIVE: To compare gestational weight gain among women in group prenatal care with that of women in individual prenatal care.
METHODS: In this retrospective cohort study, women who participated in group prenatal care from 2009 to 2015 and whose body mass indexes (BMIs) and gestational weight gain were recorded were matched with the next two women who had the same payer type, were within 2-kg/m(2) prepregnancy BMI and 2-week gestational age at delivery, and had received individual prenatal care. Bivariate comparisons of demographics and antenatal complications were performed for women in group and individual prenatal care, and weight gain was categorized as "below," "met," or "exceeded" goals according to the 2009 Institute of Medicine guidelines. Logistic regression analysis estimated the association between excessive weight gain and model of care, with adjustment for confounders, stratified by BMI.
RESULTS: Women in group prenatal care (n=2,117) were younger and more commonly non-Hispanic black, nulliparous, and without gestational diabetes (P <=.005 for all). Women in group prenatal care more commonly exceeded the weight gain goals (55% compared with 48%, P<.001). The differences in gestational weight gain were concentrated among normal-weight (mean 34.2 compared with 32.1 pounds, P<.001; 47% compared with 41% exceeded, P=.008) and overweight women (mean 31.5 compared with 27.1 pounds, P<.001; 69% compared with 54% exceeded, P<.001). When adjusted for age, race-ethnicity, parity, education, and tobacco use, the increased odds for excessive gestational weight gain persisted among normal-weight (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.09-1.51) and overweight (OR 1.84, 95% CI 1.50-2.27) women. Nulliparity was associated with increased excessive gestational weight gain (OR 1.49, 95% CI 1.33-1.68), whereas Hispanic ethnicity was associated with decreased excessive gestational weight gain (OR 0.68, 95% CI 0.59-0.78).
CONCLUSION: Among normal-weight or overweight women, group prenatal care, compared with individual prenatal care, is associated with excessive gestational weight gain.

• 出版日期2017-4
• 单位西北大学