Photo above, from left to right: Selina Lao Mason, CBJ Associate Director; Bridgette Blebu, PhD, MPH; Miriam Kuppermann, PhD, MPH (study Principal Investigator); Brittany Chambers Butcher, PhD, MPH; Areca Smit, CBJ Executive Director; Venise Curry, MD

For most pregnant people, clinical care throughout pregnancy, childbirth, and the postpartum period is provided through one-on-one visits with their prenatal care provider. An alternative approach, group prenatal care, connects patients with similar needs to improve education and social support while keeping individual screenings and physical assessments.

With funding from UCSF’s Preterm Birth Initiative, First 5 Fresno, and the Central Valley Health Policy Institute (CVHPI) at CSU Fresno, the researchers, led by Principal Investigator Dr. Miriam Kuppermann, developed and pilot-tested an enhanced group prenatal care model. Named “Glow! Group Prenatal Care and Support,” this Fresno community-developed program is based on CenteringPregancy with added services that address sleep, depression, anxiety, respectful care, and contraception. The program also provides transportation vouchers, childcare, food support, and presentations on available community resources. 

Based on the success of Glow! in the pilot test, UCSF and CVHPI obtained funding from the Patient Centered Outcomes Research Institute (PCORI) to conduct a comparative effectiveness study of Glow! versus enhanced individual care. The study, called EMBRACE (Engaging Mothers and Babies – Reimagining Antenatal Care for Everyone), was born directly from community-led efforts to address unacceptably high rates of preterm birth and Black infant mortality in Fresno County (despite being only 5.3% of the County’s total births, they accounted for 12.3% of total infant deaths in 2021).

Some of the study’s hypotheses were that, compared to participants assigned to enhanced individual care, participants assigned to enhanced group prenatal care would experience less depression and anxiety, more person-centered prenatal and intrapartum care, and less preterm birth. 

The enhanced individual prenatal care model to which Glow! was compared was provided through the California Comprehensive Perinatal Services Program (CPSP), a California Medicaid benefit offering culturally sensitive support services from approved community health workers, health educators, nurses, or prenatal care providers. Services include an initial health assessment and education, followed by three additional assessments tailored to each individual’s health and social needs.

674 people enrolled in EMBRACE, of whom 72% were Latine, 28% were born in Latin America, and 60% had no more than a high school education. All were low-income, as Medi-Cal eligibility was a required criterion for the study.

To compare their effects on depression and anxiety, the experience of care, and preterm birth, participants were randomly allocated to one of the two forms of prenatal care. Depression and anxiety symptoms were measured at study entry (8-25 weeks’ gestation), during the third trimester (30-36 weeks’ gestation), and postpartum (3 months after giving birth), and the experience of care was measured during the third trimester and postpartum.  

While participants in both groups experienced improvement in their depression and anxiety symptoms from the time they enrolled in the study to three months postpartum, there was very little difference between the two groups. In addition, patients receiving both models of care experienced similarly high satisfaction rates, and rates of preterm birth in the two groups were statistically similar.

From initial conception through study design, implementation, and interpretation of results, the research intentionally centered the voices of communities that have been historically disenfranchised and underrepresented in clinical research. To ensure authentic partnership, the research team included past patients and community members with lived experience who reflected the populations the study sought to serve. These research team members were trained and employed full-time.

This study represents a concrete example of decentralizing clinical research by conducting a large-scale trial within the community it was intended to serve, nearly 200 miles away from the partnering academic medical institution, UCSF.

Read all the EMBRACE research papers here:

1. Comparative Effect of Two Enhanced Prenatal Care Models on Care Experiences: A Randomized Controlled Trial. Afulani PA, León-Martínez D, Carraway K, Curry VC, Chambers Butcher BD, Simard B, Blat C, Coleman-Phox K, Blebu BE, Felder JN, Karasek D, Tesfalul MA, Garza MA, Mcculloch CE, Kuppermann M. Obstet Gynecol. 2026 Mar 12. doi: 10.1097/AOG.0000000000006237. PMID: 41818754
2. Enhanced Prenatal Care Models and Postpartum Depression: The EMBRACE Randomized Clinical Trial. Felder JN, León-Martínez D, Karasek D, Curry V, Carraway K, Afulani PA, Blebu B, Chambers-Butcher B, Coleman-Phox K, Simard BJ, Blat C, Garza MA, McCulloch CE, Kuppermann M. JAMA Netw Open. 2026 Feb 2;9(2):e2559883. doi: 10.1001/jamanetworkopen.2025.59883. PMID: 41697697
3. A study of implementation fidelity to an adapted community-based model of enhanced group prenatal care. Blebu B, Tesfalul M, Ramirez G, Carraway K, Martinez E, Garza MA, Garibay K, Kuppermann M. Transl Behav Med. 2026 Jan 7;16(1):ibag001. doi: 10.1093/tbm/ibag001. PMID: 41693064
4. Comparative effectiveness of two enhanced prenatal care models on preterm birth: an exploratory analysis of the EMBRACE randomized trial. León-Martínez D, Curry V, Carraway K, Blat C, Coleman-Phox K, Blebu BE, Karasek D, Butcher BDC, Afulani PA, Tesfalul MA, Felder JN, Ramirez GR, Garza MA, Lessard L, Downer C, Rand L, McCulloch CE, Kuppermann M. Am J Obstet Gynecol MFM. 2026 Jan 21;8(5):101893. doi: 10.1016/j.ajogmf.2026.101893. PMID: 41577131