Nonprofit hospitals conduct a community health needs assessment every three years to maintain federal tax-exempt status. Federal rules do not require these assessments to consider climate-related health risks, despite evidence that climate change affects health and health care delivery. This study examined the extent to which hospitals address climate-related health in community health needs assessments. We reviewed a nationally representative sample of 566 community health needs assessments (2021-24) from 3,468 US hospitals. Climate-related content was scored on an eighteen-point rubric including climate hazards and health risks (for example, extreme heat and flooding). The assessments' climate-related content was limited (mean score, 2.51 of 18). Hospitals serving more climate-vulnerable communities, especially those with greater socioeconomic disadvantage, were less likely to identify climate-related health risks. Scores in the Northeast and West were nearly twice those in the South and Midwest, although they were still low. Federal requirements should better align community health needs assessments with emerging public health risks, including climate change, to improve health system resilience.

Consistent with a social-ecological framework, there is an urgent need to shift psychological science from an individual focus to one that addresses population-level health and mental health. Population health research necessitates transdisciplinary collaboration as well as advances in theory, methods, and analytic approaches to address the complex and interrelated determinants of human health. This commentary introduces a new monthly series in Health Psychology that will offer a critical perspective on contemporary issues and topics relevant to health psychology and the public. Our intent is to contribute to a deeper understanding of health, inspire innovative research, and ultimately improve health at the population level. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Rapid urbanization and escalating climate crises place cities at the critical juncture of environmental and public health action. Urban areas are home to more than half of the global population, contributing 75

BACKGROUND:Food insecurity is a risk factor for depressive symptoms during pregnancy, while resilience and social support are protective. This study evaluated models testing the collective influence of food insecurity, resilience, and social support on depressive symptoms among pregnant individuals. METHODS:Racially-diverse pregnant individuals (N = 669) receiving Expect With Me group prenatal care in Detroit, Michigan and Nashville, Tennessee completed surveys during second and third trimesters of pregnancy. Based on responses at both timepoints, participants were classified as food secure, acutely food insecure (second or third trimester), or chronically food insecure (second and third trimester). Mediation models explored the direct association of food insecurity (acute or chronic) with depressive symptoms and its indirect association via resilience. Additionally, we simultaneously examined how social support moderated the relationship between food insecurity, resilience, and depressive symptoms. RESULTS:Acute and chronic food insecurity were reported by 18 % and 14 % of respondents, respectively. Resilience partially mediated (17.1-17.9 %) the association between food insecurity and depressive symptoms. Social support moderated the direct effect of the mediation model, specifically in the association between acute food insecurity and depressive symptoms (B = -0.45, 95 % CI -0.81, -0.09). This moderation effect was not observed for chronic food insecurity. Social support moderated the indirect effect of acute (B = 0.06, 95 % CI 0.01, 0.12) and chronic (B = 0.05, 95 % CI 0.01, 0.10) food insecurity on depressive symptoms through resilience. CONCLUSION:Efforts to strengthen resilience and social support may help mitigate the adverse effects of food insecurity on depressive symptoms during pregnancy.

BACKGROUND:Maternal mental health can impact health care access and utilization for both the birthing parent and infant. We examined the association between prenatal depressive symptoms (episodic and chronic) and receipt of the postpartum 6-week visit and infant vaccinations in the first year postpartum. METHODS:Postpartum individuals (N = 672) who attended Expect With Me group prenatal care in Nashville, Tennessee and Detroit, Michigan completed surveys during the second and third trimesters of pregnancy, as well as 6- and 12- months postpartum. We conducted multiple logistic regression to examine associations between prenatal depressive symptoms and attendance at the six-week postpartum check-up, and infant receipt of recommended vaccinations by 12 months, controlling for potential confounders. RESULTS:During pregnancy, 17.0 % of individuals experienced episodic depression, and 6.4 % experienced chronic depression. Individuals with chronic prenatal depression were less likely to receive their six-week postpartum check-up compared to those without chronic prenatal depression (Adjusted Odds Ratio [AOR] 0.55; 95 % confidence interval [CI] = 0.31, 0.99). No significant association was found for patients with episodic or chronic prenatal depression and the likelihood of infants receiving all recommended vaccines by 12 months old. CONCLUSIONS:Chronic prenatal depression was associated with not receiving recommended six-week postpartum healthcare, which is essential to detect postpartum complications and address family planning. We did not observe impacts of maternal depression on infant receipt of vaccines. Maternal mental health intervention is warranted to ensure birthing parents receive the necessary support and treatment for overall well-being.

Introduction:More than 2 million women of childbearing age live in U.S. counties without access to maternity care-counties referred to as maternity care deserts. The objective of this study was to identify whether living in a state with a high prevalence of maternity care deserts is associated with maternal and child health access and utilization and contributing to adverse health outcomes among Medicaid recipients. Methods:This is a descriptive, cross-sectional, secondary data analysis using most recent data available (2021-2023) from multiple existing state-level sources (e.g., Medicaid Health Care Core Data Sets, March of Dimes Peristats, Pregnancy Risk Assessment Monitoring System). State-level analyses included all U.S. states, District of Columbia, and Puerto Rico (N=52). Analyses were stratified by state prevalence of maternity care deserts (high=states where ≥21% of counties have no hospital/birth center providing obstetric services). Multivariate analyses of covariance were used to test associations with 3 domains of dependent variables: healthcare access (i.e., mental health, pediatrics, family medicine), utilization (e.g., timely access to pre and postnatal care, vaccinations), and maternal/child health outcomes (e.g., maternal and infant mortality). Results:Three multivariate analysis of covariance tests indicated significant main effects for state-level maternity care desert prevalence and all domains (all p<0.009), with large effect sizes (η2≥0.14). Effects were durable, even after controlling for state-level covariates. States/territories with high prevalence of maternity care deserts had more rural counties (t= -4.22, p<0.001), lower levels of educational attainment (t= -2.32, p=0.024), and lower median household income (t=3.09, p=0.004). Those living in states/territories with high prevalence of maternity care deserts had 30% fewer mental healthcare providers (487.50 vs 696.50/100,000 population) and 36% fewer pediatricians (14.25 vs 22.31/100,000 population). They were ∼14% less likely to receive timely prenatal and postpartum care. Infants were 28.62% less likely to receive influenza vaccinations before second birthday. Critically, those in states/territories with high prevalence of maternity care deserts had 34.20% greater risk of maternal mortality, 18.34% greater risk of infant mortality, and 8.92% greater risk of low birthweight. Conclusions:High state-level prevalence of maternity care deserts is associated with adverse maternal and child outcomes; exacerbating concerns as health during the perinatal period sets the trajectory for health across the lifespan. Policy and practice solutions must address pervasive health inequities associated with maternity care deserts (e.g., expanding access to maternity care through family medicine physicians, doulas, telehealth access, and supporting rural obstetric readiness).

Objective To systematically review the literature on associations between climate drivers and health outcomes among pregnant people. This review fills a gap by synthesizing evidence for a clinician audience. Data Sources Systematic scoping review of articles published in PubMed and clinicaltrials.gov from January 2010 through December 2023. Study Eligibility Criteria Empirical studies published in English-language peer-reviewed journals, assessing associations between select climate drivers and adverse maternal and birth outcomes. The review included studies examining heat, storms, sea level rise, flooding, drought, wildfires, and other climate-related factors. Health outcomes included preterm birth, low birthweight, small for gestational age, gestational diabetes, pre-eclampsia/eclampsia, miscarriage/stillbirth and maternal mortality. Study Appraisal and Synthesis Methods The scoping review protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202410004, January 3, 2024) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Data were extracted by two authors; quality and risk of bias was assessed independently. Results Total of 966 references were screened; 16.35% (k=158) met inclusion criteria. The majority of studies (146/158; 92.4%) documented statistically significant and clinically meaningful associations between climate drivers and adverse perinatal health outcomes, including risk of preterm birth, low birthweight, and stillbirth as well as preeclampsia, gestational diabetes, miscarriage, and maternal death. Among the most durable findings: extreme heat exposure in early and late pregnancy were associated with increased risk of preterm birth and stillbirth. Driven in part by large (often population-based) studies and objective outcomes from surveillance data or medical record reviews, studies in this scoping review were evaluated as high quality (scoring 7-9 on the Newcastle-Ottawa Scale). Risk of bias was generally low. Conclusions Climate drivers are consistently associated with adverse health outcomes for pregnant people. Continuing education for clinicians, and clinician-patient communications should be expanded to address risks of climate change and extreme weather exposure, especially risks of extreme heat in late-pregnancy. Results from this review should inform multi-level interventions to address adverse health effects of climate during pregnancy as well as practice advisories, protocols, checklists, and clinical guidelines in obstetrics.

Background: Discrimination is an important social determinant of perinatal depression; however, evidence is limited regarding modifiable social and psychological factors that may moderate this association. We examined whether social support and resilience could protect against the adverse effects of discrimination on perinatal depressive symptoms. Methods: Pregnant people ( N = 589) receiving Expect With Me group prenatal care in Nashville, TN and Detroit, MI completed surveys during third trimester of pregnancy and six months postpartum. Linear regression models tested the association between discrimination and depressive symptoms, and the moderating effects of social support and resilience, during pregnancy and postpartum. Results: The sample was predominantly Black (60.6 %), Hispanic (15.8 %) and publicly insured (71 %). In multivariable analyses, discrimination was positively associated with depressive symptoms during pregnancy (B = 4.44, SE = 0.37, p <= 0.001) and postpartum (B = 3.78, SE = 0.36, p < 0.001). Higher social support and resilience were associated with less depressive symptoms during pregnancy (B = -0.49, SE = 0.08, p < 0.001 and B = -0.67, SE = 0.10, p < 0.001, respectively) and postpartum (B = -0.32, SE = 0.07, p < 0.001 and B = -0.56, SE = 0.08, p < 0.001, respectively). Social support was protective against discrimination (pregnancy interaction B = -0.23, SE = 0.09, p = 0.011; postpartum interaction B = -0.35, SE = 0.07, p < 0.001). There was no interaction between discrimination and resilience at either time. Limitations: The study relied on self -reported measures and only included pregnant people who received group prenatal care in two urban regions, limiting generalizability. Conclusions: Social support and resilience may protect against perinatal depressive symptoms. Social support may also buffer the adverse effects of discrimination on perinatal depressive symptoms, particularly during the postpartum period.

Background: Mindful eating is a promising strategy to address problematic eating behaviors; however, little is known about its applicability during pregnancy. No studies have examined the combined effects of mindful and practical eating skills on eating behaviors. Aim: We examined associations between mindful and practical eating skills and eating behaviors (nutritional intake and emotional eating) among pregnant women who received psychoeducation on healthy eating and pregnancies. Methods: Participants were racially-diverse pregnant women (14–42 years) from four clinical sites in Detroit, Michigan, and Nashville, Tennessee (N = 741). We conducted multiple linear regression to examine associations between mindful (hunger cues, satiety cues, mindful check-ins) and practical (food diary/journal, MyPlate method) eating skills and nutritional intake. We calculated residualized change scores to represent changes in the quality of nutritional intake from second to third trimester. We performed multiple logistic regression to examine associations between mindful and practical eating skills and emotional eating. Results: Women improved over time in eating behaviors (better nutrition, less emotional eating). Regular use of MyPlate was associated with better nutritional intake (unstandardized coefficient [B] = −0.61), but food diaries were not. We found a significant interaction in predicting emotional eating: For those regularly paying attention to hunger cues, some use of MyPlate (Adjusted Odds Ratio [AOR] = 0.39) and especially regular use of MyPlate (AOR = 0.13) reduced the likelihood of emotional eating during pregnancy. Conclusion: Enhancing both mindful and practical eating skills, such as paying attention to hunger cues, and using the MyPlate method, may facilitate pregnant women's ability to improve their eating behaviors.

Objective: The objective of this study was to determine the preliminary effectiveness of an intervention to mitigate adverse pregnancy outcomes associated with pre-pregnancy obesity in American Samoa. Methods: We enrolled n = 80 low-risk pregnant women at <14 weeks' gestation. A complete case analysis was conducted with randomized group assignment (group prenatal care-delivered intervention vs. one-on-one usual care) as the independent variable. Primary outcomes were gestational weight gain and postpartum weight change. Secondary outcomes included gestational diabetes screening and exclusive breastfeeding at 6 weeks post partum. Other outcomes reported include gestational diabetes incidence, preterm birth, mode of birth, infant birth weight, and macrosomia. Results: Gestational weight gain was lower among group versus usual care participants (mean [SD], 9.46 [7.24] kg vs. 14.40 [8.23] kg; p = 0.10); postpartum weight change did not differ between groups. Although the proportion of women who received adequate gestational diabetes screening (78.4% group; 65.6% usual care) was similar, there were clinically important between-group differences in exclusive breastfeeding (44.4% group; 25% usual care), incidence of gestational diabetes (27.3% group; 40.0% usual care), and macrosomia (8.3% group; 29.0% usual care). Conclusions: It may be possible to address multiple risk factors related to intergenerational transmission of obesity in this high-risk setting using a group care-delivered intervention.

Background Group prenatal care enhances quality of care, improves outcomes, and lowers costs. However, this healthcare innovation is not widely available. Using a case-study approach, our objectives were to (1) examine organizational characteristics that support implementation of Expect With Me group prenatal care and (2) identify key factors influencing adoption and sustainability. Methods We studied five clinical sites implementing group prenatal care, collecting qualitative data including focus group discussions with clinicians ( n = 4 focus groups, 41 clinicians), key informant interviews ( n = 9), and administrative data. We utilized a comparative qualitative case-study approach to characterize clinical sites and explain organizational traits that fostered implementation success. We characterized adopting and non-adopting (unable to sustain group prenatal care) sites in terms of fit for five criteria specified in the Framework for Transformational Change: (1) impetus to transform, (2) leadership commitment to quality, (3) improvement initiatives that engage staff, (4) alignment to achieve organization-wide goals, and (5) integration. Results Two sites were classified as adopters and three as non-adopters based on duration, frequency, and consistency of group prenatal care implementation. Adopters had better fit with the five criteria for transformational change. Adopting organizations were more successful implementing group prenatal care due to alignment between organizational goals and resources, dedicated healthcare providers coordinating group care, space for group prenatal care sessions, and strong commitment from organization leadership. Conclusions Adopting sites were more likely to integrate group prenatal care when stakeholders achieved alignment across staff on organizational change goals, leadership buy-in, and committed institutional support and dedicated resources to sustain it. Trial registration The Expect With Me intervention’s design and hypotheses were preregistered: https://clinicaltrials.gov/study/NCT02169024 . Date: June 19, 2014.

In an effort to reduce racial disparities in prenatal health, a Yale-based transdisciplinary research team, clinicians, and payers developed a program to deliver prenatal care in a group format.

Pregnancy is a universal experience shaped by sociocultural contexts. News media presents a unique opportunity to analyze public narratives of pregnancy and how it differs across cultures. Our study aims to (1) identify the most prevalent overall themes in news media narratives of pregnancy across 19 English-speaking countries, and (2) compare pregnancy narratives across geographic regions. We used the largest English news media corpus that included over 30 million news articles from more than 7000 news websites across 19 countries, and extracted a one-year data subset (2019; 1.5 billion words). Of the primary search terms 'pregnant' and 'pregnancy', we collated 240,464 descriptors that met criteria of lexical proximity and semantic bonding. Thereafter, we used topic modelling to identify the five most prevalent pregnancy-related themes: (1) complications and risk, (2) crime, (3) celebration, (4) celebrity births, and (5) contraception. Although there were regional differences, themes of complications and risk were most common, comprising 39.6% of all pregnancy narratives in our big-data corpus. The second-most dominant theme was crime (20.8%). Narratives of contraception were more prevalent in Europe, North America, and Oceania (27.2-31.3%) compared to Africa and Asia (11.9-19.6%). Though the vast majority of pregnancies are healthy, themes of complications and risk dominated the news media discourse; unchecked, this may be an avenue for misinformation, stress, and anxiety. In addition, lower prevalence of contraception narratives in Africa and Asia may reflect a gap that requires the attention of policymakers in building culturally-adapted programs to promote family planning and encourage open discussions about sexual health. Results contribute to the academic repository of societal representations of pregnancy through a big-data lens, providing contextual information for future development, implementation and evaluation of localized pregnancy-related campaigns.

INTRODUCTION Pregnancy is a major life event during which women may experience increased psychological distress and changes in eating behaviors. However, few studies have investigated the influence of psychological distress on pregnant women's eating behaviors. The primary objective of this prospective study was to examine the associations of changes in perceived stress and depressive symptoms with emotional eating and nutritional intake during pregnancy. In addition, we examined the direct and moderating effects of perceived social support. METHODS Participants were racially diverse pregnant women (14-42 years) from 4 clinical sites in Detroit, MI, and Nashville, TN (N = 678). We used multiple linear and logistic regression models to determine if changes in stress and depressive symptoms across pregnancy were associated with changes in emotional eating and nutritional intake. We examined residualized change in stress and depressive symptoms from second to third trimester of pregnancy; positive residualized change scores indicated increased stress and depressive symptoms. RESULTS Participants showed significant improvement in emotional eating and nutritional intake from second to third trimester of pregnancy (P < .001 for both). At second trimester, higher depressive symptoms were associated with a greater likelihood of emotional eating (P < .001) and worse nutritional intake (P = .044) at third trimester. Increased stress and depressive symptoms during pregnancy were both associated with increased risk, whereas increased perceived social support reduced risk of emotional eating at third trimester (stress: adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.26; depressive symptoms: AOR, 1.05; 95% CI, 1.01-1.08; social support: AOR, 0.93; 95% CI, 0.88-0.99). None were associated with changes in nutritional intake. Perceived social support did not show any moderating effects. DISCUSSION Increased psychological distress during pregnancy may increase emotional eating. Efforts to promote healthy eating behaviors among pregnant women should consider and address mental health.

Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04–1.11) and perceived stress (AOR 1.12, 95% CI 1.04–1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88–0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98–0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95–0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.

Background Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women’s experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women’s perspectives on how these experiences may influence their health. Methods Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. Results Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) “You’re a liability”; difficulty seeking employment during pregnancy; 2) “This is not working”; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) “It’s really depressing. I wanna work”; the stressors of experiencing pregnancy discrimination and bias. Conclusion Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.

Background A disproportionate number of people who are killed by police each year are Black. While much attention rightly remains on victims of police brutality, there is a sparse literature on police brutality and perinatal health outcomes. We aimed to explore how Black pregnant women perceive police brutality affects them during pregnancy and might affect their children. Methods This qualitative study involved semi-structured interviews among 24 Black pregnant women in New Haven, Connecticut (January 2017 to August 2018). Interview questions explored neighborhood factors, safety, stressors during pregnancy, and anticipated stressors while parenting. Grounded theory informed the analysis. Results Participants, regardless of socioeconomic status, shared experiences with police and beliefs about anticipated police brutality, as summarized in the following themes: (1) experiences that lead to police distrust – “If this is the way that mommy’s treated [by police]”; (2) anticipating police brutality – “I’m always expecting that phone call”; (3) stress and fear during pregnancy – “It’s a boy, [I feel] absolutely petrified”; and (4) ‘the talk’ about avoiding police brutality – “How do you get prepared?” Even participants who reported positive experiences with police anticipated brutality towards their children. Conclusions Interactions between Black people and police on a personal, familial, community, and societal level influenced how Black pregnant women understand the potential for police brutality towards their children. Anticipated police brutality is a source of stress during pregnancy, which may adversely influence maternal and infant health outcomes. Police brutality must be addressed in all communities to prevent harming the health of birthing people and their children.

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended >= 5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.gov NCT02169024.