Well Child Visit Attendance for Group Prenatal Care Participants

Published:October 08, 2022DOI:



      Participation in group prenatal care (GPNC) has been associated with increased attendance at prenatal, family planning and postpartum visits. We explored whether GPNC participation is associated with pediatric care engagement by measuring well-child visit (WCV) attendance among infants whose births were covered by Medicaid.


      We used Medicaid claims and vital statistics from the South Carolina Department of Health and Human Services and GPNC site participation records (2013–2018). We compared WCV attendance of CenteringPregnancy GPNC patients to a propensity-score matched cohort of individual prenatal care patients (IPNC) across 21 prenatal care practices using linear probability models. The primary outcome measure was attending 6 or more WCVs in the first 15 months, a Healthcare Effectiveness Data and Information Set (HEDIS) performance measure.


      No differences in WCV were observed when comparing any exposure to GPNC (one or more sessions) to IPNC. We identified 3191 patients who participated in GPNC and matched these with 5184 in IPNC. Participation in 5 or more GPNC sessions compared to 5 or more prenatal visits was associated with higher rates of WCV compliance over the first 15 months (4.7 percentage point difference [95% CI 3.1–6.3%, P < .001]), with stronger associations between GPNC and WCV attendance for low birthweight infants, for Black infants, and for infants of mothers with no previous live births.


      This study suggests GPNC may modestly influence WCV attendance. The potential mechanisms and dose response require further investigation. Gaps in WCV attendance compared to benchmarks persist regardless of PNC model.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Academy of Pediatrics, The American College of Obstetricians & Gynecologists
        Guidelines for Perinatal Care.
        2017 (Accessed 22 September 2021.)
      1. Hagan JF Shaw JS Duncan PM Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. American Academy of Pediatrics, Elk Grove Village, IL2017
        • Kogan MD
        • Alexander GR
        • Jack BW
        • et al.
        The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States.
        Pediatrics. 1998; 102: 25-30
        • Freed GL
        • Clark SJ
        • Pathman DE
        • et al.
        Influences on the receipt of well-child visits in the first two years of life.
        Pediatrics. 1999; 103: 864-869
        • Ronsaville DS
        • Hakim RB.
        Well child care in the United States: racial differences in compliance with guidelines.
        Am J Public Health. 2000; 90: 1436-1443
        • Cogan LW
        • Josberger RE
        • Gesten FC
        • et al.
        Can prenatal care impact future well-child visits? The experience of a low income population in New York state Medicaid managed care.
        Matern Child Health J. 2012; 16: 92-99
        • Reichman NE
        • Corman H
        • Noonan K
        • et al.
        Effects of prenatal care on maternal postpartum behaviors.
        Rev Econ Househ. 2010; 8: 171-197
        • Kotelchuck M.
        The adequacy of prenatal care utilization index: its US distribution and association with low birthweight.
        Am J Public Health. 1994; 84: 1486-1489
        • Wolf ER
        • Donahue E
        • Sabo RT
        • et al.
        Barriers to attendance of prenatal and well-child visits.
        Acad Pediatr. 2021; 21: 955-960
        • Abdus S
        • Selden TM.
        Adherence with recommended well-child visits has grown, but large gaps persist among various socioeconomic groups.
        Health Aff. 2013; 32: 508-515
        • National Academy of Sciences, Engineering and Medicine
        Leveraging the health care system to improve outcomes and promite health equity.
        in: Negussie Y Gellar A DeVoe JE Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. The National Academies Press, Washington, DC2019: 301-388
        • Peahl AF
        • Smith RD
        • Moniz MH.
        Prenatal care redesign: creating flexible maternity care models through virtual care.
        Am J Obstet Gynecol. 2020; 223: 389.e1-389.e10
        • Carter EB
        • Temming LA
        • Akin J
        • et al.
        Group prenatal care compared with traditional prenatal care: a systematic review and meta-analysis.
        Am J Obstet Gynecol. 2016; 128: 551
        • Group prenatal care
        ACOG committee opinion No. 731. American College of Obstetricians and Gynecologists.
        Obstet Gynecol. 2018; 131: e104-e108
        • Ickovics JR
        • Kershaw TS
        • Westdahl C
        • et al.
        Group prenatal care and perinatal outcomes: a randomized controlled trial.
        Obstet Gynecol. 2007; 110: 330-339
        • Crockett AH
        • Heberlein EC
        • Smith JC
        • et al.
        Effects of a multi-site expansion of group prenatal care on birth outcomes.
        Matern Child Health J. 2019; 23: 1424-1433
        • Cunningham SD
        • Grilo S
        • Lewis JB
        • et al.
        Group prenatal care attendance: determinants and relationship with care satisfaction.
        Matern Child Health J. 2017; 21: 770-776
        • Ickovics JR
        • Earnshaw V
        • Lewis JB
        • et al.
        Cluster randomized controlled trial of group prenatal care: perinatal outcomes among adolescents in New York City health centers.
        Am J Public Health. 2016; 106: 359-365
        • Hale N
        • Picklesimer AH
        • Billings DL
        • et al.
        The impact of centering pregnancy group prenatal care on postpartum family planning.
        Am J Obstet Gynecol. 2014; 210: 50.e1-50.e7
        • Heberlein E
        • Smith J
        • Willis C
        • et al.
        The effects of CenteringPregnancy group prenatal care on postpartum visit attendance and contraception use.
        Contraception. 2020; 102: 46-51
        • Rising SS
        • Kennedy HP
        • Klima CS.
        Redesigning prenatal care through centering pregnancy.
        J Midwifery Womens Health. 2004; 49: 398-404
      2. Child and Adolescent Well-Care Visits. Accessed 10 January 2022.

      3. Centering Healthcare Institute. Accessed 14 January 2022.

        • Heberlein EC
        • Smith JC
        • LaBoy A
        • et al.
        Birth outcomes for medically high risk pregnancies: comparing group to individual prenatal care.
        Am J Perinatol. 2021;
        • Rosenbaum PR
        • Rubin DB.
        The central role of the propensity score in observational studies for causal effects.
        Biometrika. 1983; 70: 41-55
        • Rubin DB.
        The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials.
        Stat Med. 2007; 26: 20-36
      4. Tanner-Smith E, Steinka-Fry K, Lipsey M. A multi-site evaluation of the CenteringPregnancy programs in Tennessee: final report prepared for the Tennessee Department of Health. 2012.

        • Rosenbaum PR
        • Rubin DB.
        Constructing a control group using multivariate matched sampling methods that incorportate the propensity score.
        Am Stat. 1985; 39: 33-38
        • Garrido MM
        • Kelley AS
        • Paris J
        • et al.
        Methods for constructing and assessing propensity scores.
        Health Services Res. 2014; 49: 1701-1720
        • Arpino B
        • Cannas M.
        Propensity score matching with clustered data: an application to the estimation of the impact of caesarean section on the Apgar score.
        Stat Med. 2016; 35: 2074-2091
        • Cochran WG
        • Rubin DB.
        Controlling bias in observational studies: a review.
        Sankhyā. 1973; 35 (Accessed 5 September 2022): 417-446
        • Martin JA
        • Hamilton BE
        • Osterman MJK
        Births: Final Data for 2017.
        Natl Vital Stat Rep. 2018; 67 (Accessed 6 May 2022): 1-50
        • Wolf ER
        • Hochheimer CJ
        • Sabo RT
        • et al.
        Gaps in well-child care attendance among primary care clinics serving low-income families.
        Pediatrics. 2018; 142e20174019
        • Lipkin PH
        • Macias MM
        • Norwood KW
        • et al.
        Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening.
        Pediatrics. 2020; 145e20193449
        • Tom JO
        • Chen C
        • Zhou YY.
        Personal health record use and association with immunizations and well-child care visits recommendations.
        J Pediatr. 2014; 164: 112-117
        • Shumskiy I
        • Richardson T
        • Brar S
        • et al.
        Well-child visits of Medicaid-insured children with medical complexity.
        J Pediatr. 2018; 199: 223-230.e2
        • Callo-Quinte G
        • Del-Ponte B
        • Ruivo ACO
        • et al.
        Maternal depression symptoms and use of child health-care services at The Pelotas 2004 Birth Cohort.
        J Affect Disord. 2019; 253: 303-307
        • Jarlenski MP
        • Krans EE
        • Kim JY
        • et al.
        Five-year outcomes among Medicaid-enrolled children with in utero opioid exposure.
        Health Aff (Millwood). 2020; 39: 247-255
        • Hackley B
        • Elyachar-Stahl E
        • Savage AK
        • et al.
        A qualitative study of women's recall of content and skills developed in group prenatal and well-baby care 2 years later.
        J Midwifery Womens Health. 2019; 64: 209-216
        • Irigoyen MM
        • Leib SM
        • Paoletti AM
        • et al.
        Timeliness of immunizations in CenteringParenting.
        Acad Pediatr. 2021; 21: 948-954
        • Gullett H
        • Salib M
        • Rose J
        • et al.
        An evaluation of CenteringParenting: a group well-child care model in an urban federally qualified community health center.
        J Altern Complement Med. 2021; 25: 727-732
        • Corman H
        • Dave DM
        • Reichman N.
        Effects of prenatal care on birth outcomes: reconciling a messy literature.
        NBER Work Pap Ser. 2018; (No. w24885.)