Highlight
- A randomized controlled trial compared enhanced group prenatal care (eGPC) with enhanced individual prenatal care (eIPC) among Medicaid-eligible pregnant people in California’s San Joaquin Valley.
- Both care models yielded favorable prenatal and intrapartum care experiences, with no significant difference between group and individual approaches.
- The mostly Latine, low-income population showed good but generally suboptimal care experience scores, emphasizing the need for ongoing improvement in prenatal care quality.
Study Background
Optimal prenatal care experiences are critical for improving pregnancy outcomes and maternal well-being, particularly among underserved populations with social and economic vulnerabilities. Low-income and racial-ethnic minority groups, such as Latine communities in California’s San Joaquin Valley, often face disparities in access to respectful, high-quality prenatal care. Although enhanced care models, including group prenatal care (e.g., CenteringPregnancy) and individualized enhanced care approaches, have been proposed to improve health outcomes and patient satisfaction, comparative evidence on their impact on care experiences remains limited. Understanding how these models affect perceptions of care during pregnancy and labor can inform strategies to reduce disparities and improve maternal health.
Study Design
This pragmatic randomized controlled trial, known as EMBRACE (Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone), enrolled 678 pregnant individuals eligible for Medicaid insurance between November 2019 and January 2024 in California’s San Joaquin Valley. Participants were randomized to receive either enhanced group prenatal care (eGPC) or enhanced individual prenatal care (eIPC). The primary aim focused on depression outcomes; this article addresses the secondary aim related to participants’ experiences of prenatal and intrapartum care.
Enhanced care interventions included tailored supports beyond standard prenatal care, delivered either in group sessions or one-on-one visits. Key outcomes assessed were person-centered prenatal care (PCPC), respect during care as measured by the Mothers on Respect index (MORi), prenatal care satisfaction (PCSS), and person-centered maternity care in the U.S. (PCMC-US) scales. Scores were standardized from 0 to 100, with higher scores indicating better care experiences. Scores ≥75 were categorized as good care experiences and ≥90 as optimal.
Subgroup analyses examined care experience differences based on prenatal visit attendance (at least one visit and four or more visits post-randomization) and self-reported race and ethnicity (specifically Black and Latine participants). The statistical approach involved restricted maximum likelihood mixed linear regression models adjusted for covariates and accounted for clinician-level clustering.
Key Findings
Of 1,663 screened, 678 were randomized; 674 participants were analyzed (294 in eGPC, 380 in eIPC). The cohort predominantly consisted of Latine individuals (72%). Prenatal care experience scores were generally good but did not reach the optimal threshold in either arm. Mean adjusted PCPC scores were 90.5±3.2 for eGPC and 88.7±3.2 for eIPC, with an adjusted mean difference (aMD) of 1.8 (95% CI, -0.5 to 4.1), indicating a small and statistically nonsignificant difference favoring eGPC. Similarly, MORi and PCSS scores showed minimal differences between groups (aMDs near zero) and were not statistically significant.
Intrapartum care experiences measured by PCMC-US were also good but not optimal across both groups, with no significant differences.
Subgroup analyses by prenatal attendance and racial-ethnic groups presented results consistent with the primary findings, showing no substantial differences in care experience outcomes between eGPC and eIPC. Notably, all groups reported better-than-average but suboptimal experiences, pointing to potential areas for prenatal care quality enhancement even within enhanced care models.
Expert Commentary
This well-designed pragmatic trial contributes to the sparse comparative data on prenatal care models in low-income, predominantly Latine populations. The modest differences between enhanced group and individual care suggest that both models can support positive care experiences when appropriately resourced and implemented. Group prenatal care models have been previously associated with improved social support and patient engagement, yet in this trial, enhanced individual care performed similarly, underscoring the importance of enhancement components beyond visit format.
Study strengths include a sizeable, real-world sample reflective of a high-disparity region, use of validated, multidimensional care experience scales, and rigorous statistical adjustment. However, limitations include potential measurement ceiling effects given generally high care experience scores, and the focus on a specific demographic region which may limit generalizability to other populations or health systems.
Further research should explore which components of enhanced prenatal care most effectively improve care experience and associated clinical outcomes, including psychological well-being and birth outcomes. Interventions tailored to individual barriers and preferences alongside system-level supports may optimize experiences more than visit format alone.
Conclusion
Both enhanced group and individual prenatal care models yield generally favorable prenatal and intrapartum care experiences in a predominantly low-income Latine population. Although care experience ratings are good, they remain below optimal, highlighting ongoing gaps in prenatal care quality and patient-centeredness. Healthcare systems serving Medicaid populations should consider adopting enhanced care elements while also pursuing continuous quality improvements tailored to community needs to support equitable and respectful maternity care.
Funding and Clinical Trial Registration
This study was registered at ClinicalTrials.gov (NCT04154423). Funding sources were not specified in the summary; readers should consult the original publication for detailed disclosures.
References
- Afulani PA, León-Martínez D, Carraway K, et al. Comparative Effect of Two Enhanced Prenatal Care Models on Care Experiences: A Randomized Controlled Trial. Obstet Gynecol. 2026 Mar 12;148(1):121-131. PMID: 41818754.
- Picklesimer AH, Billings D, Hale NE, et al. The Effect of Group Prenatal Care on Individualized Prenatal Outcomes and Care Utilization. J Womens Health (Larchmt). 2012;21(3):322-327.
- Novick G. Women’s Experience of Prenatal Care: An Integrative Review. J Midwifery Women’s Health. 2009;54(3):226-237.