Which enhanced prenatal care program is best for improving outcomes for low-income birthing people in Fresno?

Black and Latin/x birthing people have high rates of preterm birth

Fresno County has one of the highest rates of premature birth in California, especially among BIPOC people. Black birthing people are 1.6 times more likely to experience a preterm birth compared to white women. And Latinx women are 1.1 times more likely.

To address these stark realities, PTBi funded the development and feasibility testing of Glow!, a group prenatal care program with wrap-around services that was created in collaboration with Fresno stakeholders including researchers, payers, providers, women with lived experience, parents, and Fresno community leaders. With community input, the strategy was incubated through the Fresno PTBi and implemented by First 5 Fresno County in partnership with the Central Valley Health Policy Institute and UCSF

Why Group Prenatal Care?

Glow! is a novel group prenatal care demonstration project that builds on the CenteringPregnancy group prenatal care model by providing wrap-around services during sessions, and focusing on mindfulness and the role of sleep in reducing preterm birth risk. While group prenatal care is widely accepted as an important intervention, and a 2007 study showed a 33% reduction in preterm births for mothers participating in group prenatal care compared to standard, one-on-one prenatal care, a meta-analysis (analysis of the data from multiple studies) found no difference in preterm birth rates. However, there is some evidence to suggest that group prenatal care may decrease the risk of preterm birth among Black women.

How does GLOW! group prenatal care work?

Women attend up to 10 prenatal care sessions that last 90-120 minutes with a consistent group of 8-12 peers with similar due dates. The prenatal care provider performs brief but thorough individual prenatal exams behind a privacy screen while the other women socialize and help one another check their vital signs. The provider and a trained staff facilitator co-facilitate a discussion of topics and skills related to pregnancy, birth, and parenting for an hour. In addition to providing assistance with childcare, transportation and nutritious groceries at each session, Glow! staff facilitators invite representatives from local agencies to present on topics including WIC, perinatal mental health, lactation support, disability and paid family leave, dental health, pediatric care and other community resources. This model offers more time with the prenatal care provider than individual prenatal care, provides comprehensive wraparound services and resources, and facilitates peer support.

Download the GLOW! brochure

Evaluating GLOW! through the EMBRACE Study

Based on the success of the Glow! feasibility study, we were funded by the Patient-Centered Outcomes Research Institute (PCORI) to conduct EMBRACE, a comparative effectiveness study of two prenatal care programs to help women with low income get support and services to help ensure a healthy pregnancy and baby, Glow! and the Comprehensive Perinatal Service Program, which provides assessments and education to women who are receiving prenatal care in the usual one-on-one format. The goal of the study is to determine which enhanced prenatal care program results in lower preterm birth rates, less anxiety and depression, and greater satisfaction with care and perceptions of respectful care.

Women may be eligible to participate in EMBRACE if they are:

Seeking prenatal care at a participating site
No more than 24 weeks pregnant at enrollment
English- or Spanish-speaking
Eligible for Medi-Cal
Willing to receive prenatal care through either program

Participants in the EMBRACE Study, which began recruiting in November 2019, are assigned to receive prenatal care either individually or in a group setting based on their due date and provider. Learn more

EMBRACE: where are we now?

Recruitment for EMBRACE began in November 2019.
101 pregnant people enrolled before the COVID-19 pandemic, now referred to as the pre-COVID 101
Enrollment was paused in March 2020 but the study continued to follow the pre-COVID 101 participants, adding new items to the study questionnaires that explore the impact of the COVID-19 pandemic and the Black Lives Matter movement on their pregnancies and births.
Additional funding was awarded through PCORI to modify Glow! for telehealth, assess changes in and experiences of prenatal care during the pandemic, and to pilot test the modified Glow! intervention among 40 participants.
EMBRACE recruitment resumed on October 18, 2020 and we are currently testing the Glow! telehealth model.

EMBRACE News and Updates

EMBRACE Publications

Coming soon!

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