Enhanced Prenatal Care Models Improve Perinatal Depression Scores
Key Clinical Summary
- A randomized clinical trial found no significant difference in perinatal depression outcomes between enhanced group prenatal care (eGPC) and enhanced individual prenatal care (eIPC).
- Both care models produced small to moderate reductions in depressive symptoms from baseline to 3 months postpartum.
- Findings suggest that integrating psychosocial and social-determinant supports into prenatal care, regardless of format, may improve perinatal mental health in low-income populations.
Perinatal depression symptoms improved significantly during pregnancy and early postpartum regardless of enhanced prenatal care format, according to a randomized clinical trial published in JAMA Network Open. The study found no significant difference in depressive symptom reduction between enhanced group prenatal care (eGPC) and enhanced individual prenatal care (eIPC) among Medicaid-eligible pregnant individuals, though both care models produced measurable improvements by 3 months postpartum.
Study Findings
Researchers recruited participants across 10 Medicaid-serving clinics in California’s San Joaquin Valley between November 2019 and January 2024. Participants were Medicaid-eligible pregnant individuals at less than 25 weeks’ gestation. Follow-up surveys continued through 12 weeks postpartum, and analyses were performed using an intention-to-treat approach.
The analyzed cohort included 674 participants with a mean age of 27.0 years (standard deviation [SD] 5.8) and was predominantly Latine (72.0%), with additional representation from African American or Black (7.4%), White (11.4%), biracial or multiracial (5.5%), and other racial or ethnic groups (3.6%).
Participants were randomized to either enhanced group prenatal care (n=294) or enhanced individual prenatal care (n=380).
Enhanced individual prenatal care included tailored assessments addressing psychosocial factors, clinical needs, oral health, and substance use. Enhanced group prenatal care incorporated broader social support, including childcare services, transportation stipends, free groceries, mental health screening and referrals, and information about community resources.
The primary outcome was change in depression symptoms, measured by Patient Health Questionnaire–9 (PHQ-9) scores from baseline to 3 months postpartum and assessed by masked evaluators.
Both groups experienced significant depressive symptom reductions, with a mean difference of −2.2 ([SD 5.3]; Cohen d −0.4; 95% CI −0.6 to −0.3; P < .001) in the eGPC group and −1.6 ([SD 4.5]; Cohen d −0.5; 95% CI −0.6 to −0.4; P < .001) in the eIPC group.
However, investigators found no statistically significant difference in symptom improvement between the 2 prenatal care models (Cohen d = 0.1; 95% CI, –0.1 to 0.3; P = .45), after adjusting for baseline depression severity, history of mental health conditions, language, and enrollment timing.
Clinical Implications
Perinatal depression disproportionately affects individuals facing economic disadvantage, limited healthcare access, and structural barriers. Addressing social determinants of health during pregnancy has been proposed as one strategy to reduce disparities in maternal mental health.
The trial’s findings indicate that both enhanced prenatal care models can improve depressive symptoms, even though one approach does not outperform the other. Each model integrated targeted psychosocial assessments or social support services, suggesting that embedding these supports within routine prenatal care may be a key mechanism for improvement.
For clinicians serving Medicaid populations or underserved communities, the results highlight the value of enhanced prenatal care frameworks that include mental health screening, social needs assessments, and referrals.
The findings may also inform healthcare delivery decisions. Clinics may choose either group-based or individualized enhanced prenatal care models depending on resource availability, staffing, patient preferences, and local infrastructure, without expecting major differences in depression outcomes.
Expert Commentary
“Although eGPC was not superior to eIPC, the observed symptom reductions across both conditions suggest that embedding brief, scalable mental health supports into routine prenatal care holds promise for addressing mental health disparities during the perinatal period,” wrote Jennifer N. Felder, PhD, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, and study coauthors. “Future research should investigate which specific components of enhanced prenatal care (eg, psychoeducation, peer support, increased time and attention from clinicians) are most critical,” they concluded.
