The Effects of Group Prenatal Care on Infant Birthweight and Maternal Well-Being: A Randomized Controlled Trial.

INTRODUCTION: Group prenatal care models have been in use in the USA for over 20 years and have shown benefits in reducing rates of preterm birth and low birth weight infants in high-risk civilian populations. Group prenatal care has been widely implemented at military treatment facilities, despite a lack of high-quality evidence for improved perinatal outcomes in this population. MATERIALS AND METHODS: In this randomized, controlled trial, 129 patients at a military treatment facility received either traditional one-on-one prenatal care or group prenatal care using the CenteringPregnancy model. CenteringPregnancy care was administered by certified nurse midwives and family medicine residents and faculty. The primary outcomes were infant birthweight appropriateness for gestational age, maternal anxiety (as measured by the State-Trait Anxiety Inventory) and depression (as measured by the Center for Epidemiologic Studies-Depression scale), and patient satisfaction (as measured by the Short-Form Patient Satisfaction Questionnaire). Infant birthweights were compared using Chi-square tests for the categorical variables of small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age. Maternal mood and satisfaction scores were evaluated before, during, and after the intervention and analyzed using rank sum tests. Additional demographic and outcome data were collected directly from participants and extracted from patient records. RESULTS: Patients receiving group care were more likely to deliver an infant that was appropriate for gestational age, with an incidence ratio of 1.12 [CI = 1.01-1.25, p = 0.04]. Depression and anxiety levels remained similar between groups throughout the study. Satisfaction was similar between groups, though patients receiving group care reported higher satisfaction with the accessibility and convenience of their care at the study's end [p = 0.048]. There were no differences between groups in preterm births, maternal or neonatal morbidity, mode of delivery, maternal weight gain, or breastfeeding rates. CONCLUSIONS: Military parturients receiving group prenatal care in the CenteringPregnancy model were less likely to deliver an small for gestational age or large for gestational age newborn and were more likely to be satisfied with their access to care. Group prenatal care is well received by patients and may positively influence neonatal metabolic status.

Effects of Single and Multiple Energy Shots on Blood Pressure and Electrocardiographic Parameters.

We assessed the effects of single and multiple caffeinated energy shots on hemodynamic and electrocardiographic (ECG) parameters. This was a randomized, double-blinded, placebo-controlled, crossover study in otherwise healthy volunteers (n = 26) where a caffeinated energy shot or matching placebo was ingested. The study drink was consumed twice daily for 7 days during each phase, with a 7-day washout period in between. The primary end points of interest were systolic and diastolic blood pressure (BP), heart rate, PR interval, QRS duration, and QT and QTc intervals. All parameters were evaluated at baseline, 1, 3, and 5 hours on the first and seventh day of each phase. Systolic BP after a single energy shot consumption was significantly higher than placebo at 3 and 5 hours (p = 0.050 and p = 0.038, respectively). Similarly, diastolic BP after a single energy shot consumption was significantly higher at 1 and 5 hours (p = 0.019 and p = 0.043, respectively). The systolic and diastolic BP elevations were not significant after consistent consumption (all p values ≥ 0.079). None of the ECG parameters were significantly affected (all p values ≥ 0.108) compared with placebo. In conclusion, a single shot of a caffeinated energy drink significantly raised systolic and diastolic BPs. However, these elevations were not sustained with chronic consumption. ECG parameters were not altered.