Forty Weeks: an innovative intervention in prenatal care to reduce prematurity

For the first time in Brazil, the study adapted and implemented group prenatal care — with ten women and a meeting per month for eight weeks — as a way to increase access to quality care for pregnant women and test the impacts of the intervention.

Adapted from the United States and Europe, the intervention included 86 Brazilian pregnant women, with another 248 receiving traditional individualized prenatal care as a control group. Divided into groups of ten, the pregnant women who participated in the study met once a month for eight months at family clinics in Rio de Janeiro. They received an easy-to-use manual as a guideto allow them to conduct the meetings themselves, with the support of a nurse and obstetrician. At the site, they focused on weight control, measured blood pressure, performed ultrasounds and collected urine for testing. To assess the impact of the intervention, three questionnaires were fielded and the outcomes after delivery were assessed using the Live Birth Information System (SINASC).

The rate of prematurity among babies whose mothers received the intervention was 8 percent, as compared to 11 percent of those who had conventional prenatal care – the same rate as in the city of Rio de Janeiro.

It is the first time that group prenatal care has been implemented in Brazil and its effects have been measured and evaluated.

Improve the prenatal care quality. Although prenatal service coverage is considered to be practically universal in Brazil, it is not always adequate. According to Pesquisa Nascer no Brasil, which surveyed 23,894 women, 60 percent of pregnant women still start prenatal care late, after 12 weeks of gestation. In addition, a quarter of them participate in less than six consultations, the minimum number recommended by the Ministry of Health. Although they have not conducted a cost-effectiveness analysis, the researchers estimate that with R$8,000 a month it would be possible to support a team of a nurse and a doctor, as well as provide the facilities for four two-hour long meetings per month, or once per week, within of a health unit.

With the proper training of the team, it is possible to expand group prenatal care to family health clinics in other cities. Researchers have already been contacted by administrators in Rio for this, but the talks have not moved toward implementation.

With appropriate language and content adaptations to the local context of the handbook for pregnant women, it is possible to expand the program to other countries.

The researchers consider the study a proof of concept that group prenatal care can reduce rates of prematurity. They now plan to obtain additional funding for a second study, with a larger sample of 800 women, in other cities or capitals.