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A Randomized Controlled Trial

Robert S. McDuffie, Jr, MD; Arne Beck, PhD; Kimberly Bischoff, MSHA; Jean Cross, MHA; Miriam Orleans, PhD

JAMA. 1996;275(11):847-851.

Abstract
Objective.
—In 1989, the Expert Panel on the Content of Prenatal Care established guidelines on the timing and content of prenatal care, including a schedule consisting of fewer prenatal visits than traditionally provided, for women at low risk of adverse perinatal outcomes. We tested the hypothesis that there are no significant increases in adverse perinatal outcomes when low-risk women are seen in a prenatal care visit schedule of fewer visits than routinely advised.

Design.
—Randomized controlled trial.

Setting.
—Group-model health maintenance organization.

Patients.
—A total of 2764 pregnant women, judged to be at low risk of adverse perinatal outcomes.

Interventions.
—Following risk assessment, participants were randomly assigned to an experimental schedule (nine visits) or a control schedule (14 visits) with additional visits as indicated or as desired by the patient.

Main Outcome Measures.
—Preterm delivery, preeclampsia, cesarean delivery, low birth weight, and patients' satisfaction with care.

Results.
—On average, there were 2.7 fewer visits observed in the experimental group than in the control group. There were no significant increases in the main outcomes of the experimental group: preterm delivery (relative risk [RR], 1.08; 95% confidence interval [CI], 0.92 to 1.27; P=.19), preeclampsia (RR, 0.94; 95% CI, 0.78 to 1.14; P=.74), cesarean delivery (RR, 1.04; 95% CI, 0.93 to 1.17; P=.25), and low birth weight (RR, 0.94; 95% CI, 0.78 to 1.12; P=.76). There were no differences between the two groups in patients' satisfaction with quality of prenatal care.

Conclusion.
—In this study, good perinatal outcomes and patient satisfaction were maintained when the prenatal visit schedule proposed by the Expert Panel on the Content of Prenatal Care was observed.

(JAMA. 1996;275:847-851)

Author Affiliations
From the Departments of Obstetrics and Gynecology (Dr McDuffie) and Research and Development (Dr Beck and Mss Bischoff and Cross), Kaiser Permanente, Denver, Colo, and the Department of Preventive Medicine and Biometrics (Dr Orleans), University of Colorado Health Sciences Center, Denver.

Footnotes
Reprint requests to Department of Obstetrics and Gynecology, Kaiser Permanente, 2045 Franklin St, Denver, CO 80205 (Dr McDuffie).

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