(129) Impact of group prenatal care on postpartum contraception choice and rapid repeat pregnancy

Objective: Group prenatal care (GPNC) offers extended time for health education on topics including family planning (contraception methods, healthy pregnancy spacing). Patients who receive evidence-based family planning counseling often choose long acting reversible contraceptive (LARC) options. We sought to compare the initiation rates of postpartum LARC in patients participating in GPNC versus individual prenatal care (IPNC).

Study Design: This was a secondary analysis of a single-center 1:1 randomized controlled trial comparing pregnancy outcomes for patients in GPNC versus IPNC, stratified by self-reported race and ethnicity. Patients with a spontaneous abortion, fetal demise, or who were lost to follow-up after delivery were excluded. The primary outcome was initiation of LARC by 8 weeks postpartum. Secondary outcomes included initiation of LARC across racial and ethnic groups, initiation of LARC prior to hospital discharge, and short-interval pregnancies. A sensitivity analysis compared outcomes in per compliance ( >5 visits in assigned arm, PC) groups. Multivariable logistic regression was used to adjust for baseline differences between groups.

Results: 1,998 (85.0%) of the Centering and Racial Disparities (CRADLE) participants met inclusion criteria for this analysis. Demographic characteristics were similar between treatment groups with the exception of tobacco use prior to pregnancy. There was no significant difference in the rates of LARC initiation between GPNC and IPNC participants at 8 weeks postpartum (adjusted odds ratio [aOR] 1.08, 95% confidence interval [CI] 0.89, 1.30). LARC initiation did not differ by racial and ethnic groups across exposures. There was also no significant difference between the rate of LARC initiation at hospital discharge (aOR 1.05, 95% CI 0.87, 1.26) nor the frequency of short-interval pregnancies (odds ratio 1.04, 95% CI 0.81, 1.33). These findings did not differ when comparing PC groups.

Conclusion: In this secondary analysis, participation in GPNC was not associated with increased rates of LARC initiation or decreased rates of short-interval pregnancies.