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PregnancyNCT02169024

Development of a Nationally Scalable Model of Group Prenatal Care to Improve Birth Outcomes: "Expect With Me"

A study testing Expect With Me group prenatal care and Standard individual prenatal care in people with Pregnancy and Premature Birth, run by Yale University at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study addresses the intractable challenges of adverse birth outcomes, including preterm delivery and low birthweight, by proposing the development, implementation and evaluation of a model of group prenatal care that could be scaled nationally. Read more about this study

Who is it for?
Any age, women onlyHealthy volunteers can take part
What is being tested?
Expect With Me group prenatal care and Standard individual prenatal care
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,402 participants
Where
2 sitesUnited States
Study dates
Feb 2014to Dec 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • Women only
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • less than 24 weeks pregnant
  • able to attend groups conducted in English or Spanish
  • consent to share their data with the study

Who cannot join

  • severe medical problem requiring individual care only, as determined by the participating clinical practice

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Wayne State University

    Detroit, Michigan, 48201

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

Other trials in United States

About this study

This study addresses the intractable challenges of adverse birth outcomes, including preterm delivery and low birthweight, by proposing the development, implementation and evaluation of a model of group prenatal care that could be scaled nationally. Group prenatal care models have been demonstrated through rigorous research to provide significantly improved birth outcomes with implications for maternal-child health and substantial cost savings. However, group prenatal care is currently available to only a small fraction of the more than four million women who give birth annually in the US. Through the development, implementation and evaluation of a new model of group prenatal care, we will create an outcomes-focused model of group prenatal care that will be scalable nationally with an eye toward improving US birth outcomes.

The long-term objective of the proposed study is to reduce the risk for adverse perinatal outcomes during and after pregnancy among women and families receiving prenatal care in health centers in 3 geographic locations serving vulnerable populations: Hidalgo County Texas, Nashville Tennessee, and Detroit Michigan. We will develop, disseminate, and evaluate a new and improved model of group prenatal care, "Expect with Me," based on our previous research on group models of prenatal care, which has already yielded favorable behavioral and biological results in two randomized controlled trials.

Read more

We hypothesize that, relative to women who receive standard individual prenatal care, the women who receive "Expect with Me" group prenatal care will be significantly more likely to:

  1. have better perinatal outcomes, including better health behaviors during pregnancy (e.g., nutrition, physical activity), better birth outcomes (e.g., decreased preterm labor, low birthweight, Neonatal Intensive Care Unit stays), and better postpartum indicators (e.g., increased breastfeeding);
  2. report greater change in risk-related behaviors and psychosocial characteristics that could be considered potential mechanisms for the program's effectiveness;
  3. have lower rates of sexually transmitted diseases and rapid repeat pregnancy one year postpartum;
  4. have lower healthcare costs through improved outcomes (e.g., appropriate care utilization, fewer complications, reduced NICU admissions/length of stays)

Comparisons based on propensity-score matched sample of women receiving standard individual prenatal care at the same clinical sites.

Read the detailed description

This study addresses the intractable challenges of adverse birth outcomes, including preterm delivery and low birthweight, by proposing the development, implementation and evaluation of a model of group prenatal care that could be scaled nationally. Group prenatal care models have been demonstrated through rigorous research to provide significantly improved birth outcomes with implications for maternal-child health and substantial cost savings. However, group prenatal care is currently available to only a small fraction of the more than four million women who give birth annually in the US. Through the development, implementation and evaluation of a new model of group prenatal care, we will create an outcomes-focused model of group prenatal care that will be scalable nationally with an eye toward improving US birth outcomes.

Specific Aims:

The long-term objective of the proposed study is to reduce the risk for adverse perinatal outcomes during and after pregnancy among women and families receiving prenatal care in health centers in 3 geographic locations serving vulnerable populations: Hidalgo County Texas, Nashville Tennessee, and Detroit Michigan. We will develop, disseminate, and evaluate a new and improved model of group prenatal care, "Expect with Me," based on our previous research on group models of prenatal care, which has already yielded favorable behavioral and biological results in two randomized controlled trials. The overall objective of this project is to improve maternal health and reduce adverse birth outcomes. We will meet this objective by achieving three specific goals:

  1. Develop a new and improved model of group prenatal care, including curriculum, training materials, IT infrastructure and marketing materials to support broad adoption of group prenatal care, enhance consumer experience, monitor patient outcomes, and ensure national scalability.
  2. Implement group prenatal care in three communities at high risk for adverse perinatal outcomes (Hidalgo County TX, Nashville TN, Detroit MI), engaging and training providers in group facilitation and the established curriculum, engaging patients through improved in-reach and outreach strategies, and implementing IT infrastructure to improve uptake, patient experience, and sustainability through the monitoring of patient outcomes.
  3. Evaluate the effect of implementing group prenatal care through a rigorous process and outcome evaluation that identifies any barriers to national scalability and examines maternal health and birth outcomes and resultant cost implications.

Specific Study Hypotheses

We hypothesize that, relative to women who receive standard individual prenatal care, the women who receive "Expect with Me" group prenatal care will be significantly more likely to:

  1. have better perinatal outcomes, including better health behaviors during pregnancy (e.g., nutrition, physical activity), better birth outcomes (e.g., decreased preterm labor, low birthweight, Neonatal Intensive Care Unit stays), and better postpartum indicators (e.g., increased breastfeeding);
  2. report greater change in risk-related behaviors and psychosocial characteristics that could be considered potential mechanisms for the program's effectiveness;
  3. have lower rates of sexually transmitted diseases and rapid repeat pregnancy one year postpartum;
  4. have lower healthcare costs through improved outcomes (e.g., appropriate care utilization, fewer complications, reduced NICU admissions/length of stays)
Being tested
Expect With Me group prenatal care, Standard individual prenatal care
Keywords
prenatal care, group care, Expect With Me, evaluation studies, group prenatal care
Medical subject headings
Premature Birth, Sexually Transmitted Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Expect With Me group prenatal careBehavioural

    Also called group prenatal care

    Expect With Me group prenatal care was designed based on: principles of group care; evidence from RCTs demonstrating improved birth outcomes; ACOG clinical guidelines; and research on patient and provider engagement through technology. Designed with national dissemination as a primary consideration, Expect With Me incorporates best evidence-based aspects of existing models of group care, with a novel IT platform to improve patient engagement and support, enhance health behaviors and decision making, connect providers and patients, and improve health service delivery. Expect With Me provides care to groups of 8-12 women of the same gestational age, implemented after initial individual assessment through delivery. Group visits are 90-120 minutes each, and follow a structured curriculum that incorporates standard content of prenatal care, and emphasizes critical health issues relevant to pregnancy, such as nutrition, physical activity, stress/mental health and sexual health.

  • Standard individual prenatal careOther

    Also called Individual Care Only

    Standard of care- individual prenatal care

Study groups in NCT02169024
Study groupRoleWhat they receive
Expect With Me group prenatal careExperimentalreceiving prenatal care through an Expect With Me group
Receives: Behavioral: Expect With Me group prenatal care
Individual Care OnlyActive comparatorStandard of Care- individual prenatal care
Receives: Other: Standard individual prenatal care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Risk of preterm birth incidence

    Incidence risk of delivery before 37 weeks gestation

    Measured: up to 37 weeks gestation

  2. Risk of low birth weight incidence

    Incidence risk of infant weight at birth < 2500 grams

    Measured: delivery

  3. Risk of small for gestational age incidence

    Incidence risk of infant weight below the 10th percentile for the gestational age at birth

    Measured: delivery

  4. Risk of neonatal intensive care unit (NICU) admission incidence

    Incidence risk of being admitted to the neonatal intensive care unit (NICU) at birth

    Measured: birth

Secondary outcomes (17)
  1. breastfeeding

    initiation and duration of breastfeeding

    Measured: 6 and 12 months postpartum

  2. nutrition

    nutritional choices, food security, and use of mindful eating practices

    Measured: 2nd and 3rd trimester of pregnancy and 6 and 12 months postpartum

  3. physical activity

    level of physical activity in a typical week

    Measured: 2nd and 3rd trimester and 6 and 12 months postpartum

  4. readiness for labor and delivery

    readiness for labor and delivery

    Measured: measured at 2nd and third trimester

  5. readiness for taking care of baby

    readiness for taking care of baby

    Measured: 2nd and 3rd trimester of pregnancy

  6. social support

    multidimensional scale of perceived social support subscale

    Measured: 2nd and 3rd trimester and 6 and 12 months postpartum

  7. condom use self-efficacy

    condom use self efficacy scale

    Measured: 2nd and 3rd trimester and 6 and 12 months postpartum

  8. substance use

    use of cigarettes, alcohol, and drugs

    Measured: 2nd and 3rd trimester and 6 and 12 months postpartum

  9. care satisfaction

    satisfaction with Expect With Me group prenatal care and use of program components

    Measured: 3rd trimester

  10. adherence to medical recommendations

    adherence to medical recommendations (e.g., 6-week postpartum check, pediatric visits, vaccinations, infant feeding)

    Measured: 6 & 12 months postpartum

  11. postpartum body mass index

    individual's body weight divided by the square of their height (kg/m2)

    Measured: measured at 6 and 12 months postpartum

  12. maternal weight gain

    weight gain as compared to medical recommendations

    Measured: measured at 2nd and 3rd trimester and birth

  13. mode of delivery

    mode of delivery (e.g., cesarean, vaginal)

    Measured: delivery

  14. sexual risk: condom use

    condom use percent (0-100%)

    Measured: measured at 2nd and 3rd trimester and 6 and 12 months postpartum

  15. sexual risk: contraceptive use (LARC)

    use of other contraceptives to prevent pregnancy (no/yes)

    Measured: measured at 2nd and 3rd trimester and 6 and 12 months postpartum

  16. sexual risk: number of sexual partners

    number of partners

    Measured: measured at 2nd and 3rd trimester and 6 and 12 months postpartum

  17. sexual risk: sexually transmitted infection

    sexually transmitted infection (no/yes, during pregnancy or incident postpartum)

    Measured: measured at 2nd and 3rd trimester and 6 and 12 months postpartum

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jun 2014 (estimated)
  2. Study startFeb 2014
  3. Primary completionDec 2016
  4. Study completionDec 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
Expect With Me group prenatal care vs. Individual Care Only prenatal care
Masking
None (open label)
Enrolment
2,402 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02169024
Sponsor's protocol ID
1304011772
Status last verified
May 2020
First submitted
18 Jun 2014
Last updated
29 May 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Masters C, Carandang RR, Lewis JB, Hagaman A, Metrick R, Ickovics JR, Cunningham SD. Group prenatal care successes, challenges, and frameworks for scaling up: a case study in adopting health care innovations. Implement Sci Commun. 2024 Mar 4;5(1):20. doi: 10.1186/s43058-024-00556-1.

    PubMed 38439113
  • Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med. 2021 Dec;153:106853. doi: 10.1016/j.ypmed.2021.106853. Epub 2021 Oct 20.

    PubMed 34678329
  • Cunningham SD, Lewis JB, Thomas JL, Grilo SA, Ickovics JR. Expect With Me: development and evaluation design for an innovative model of group prenatal care to improve perinatal outcomes. BMC Pregnancy Childbirth. 2017 May 18;17(1):147. doi: 10.1186/s12884-017-1327-3.

    PubMed 28521785

Questions about this trial

What is this clinical trial studying?

A study testing Expect With Me group prenatal care and Standard individual prenatal care in people with Pregnancy and Premature Birth, run by Yale University at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 May 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Risk of preterm birth incidence (time frame: up to 37 weeks gestation). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02169024, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 May 2020.

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