The impact of group prenatal care on breastfeeding: A planned secondary analysis of the CRADLE randomized controlled trial.
5 affiliations
- 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Prisma Health/University of South Carolina School of Medicine Greenville Greenville South Carolina USA.
- 2Department of Obstetrics and Gynecology Prisma Health Greenville South Carolina USA.
- 3Department of Public Health Sciences, College of Behavioral, Social and Health Sciences Clemson University Clemson South Carolina USA.
- 4Department of Epidemiology, Fielding School of Public Health University of California Los Angeles Los Angeles South Carolina USA.
- 5Department of Obstetrics and Gynecology NorthShore University HealthSystem Evanston Illinois USA.
Abstract
Background
Despite providing both maternal and neonatal benefits, breastfeeding rates remain lower than goal targets. Prior observational studies suggest group prenatal care (GPNC) increases breastfeeding initiation compared to individual prenatal care (IPNC), but few randomized controlled trials (RCTs) have examined how GPNC impacts breastfeeding knowledge and self-efficacy. We aimed to determine if participating in GPNC impacts breastfeeding knowledge, breastfeeding self-efficacy, and breastfeeding prevalence postpartum.Materials and methods
This is a planned secondary analysis of the Centering and Racial Disparities (CRADLE) RCT comparing the impact of GPNC versus IPNC on preterm birth. The CRADLE trial enrolled 2350 participants and randomized them to GPNC or IPNC. Eligibility requirements included age of 14-45 years, singleton pregnancy, entering prenatal care before 21 weeks' gestation, and low-risk pregnancy by institutional standards. Questionnaires assessed breastfeeding knowledge (adapted from the Infant Feeding Practices II Survey) and self-efficacy (adapted from Wells' 20-item Prenatal Breast-feeding Self-Efficacy Scale). A per-compliance approach was used, including participants who attended at least five sessions in their assigned group. The primary outcome was breastfeeding at hospital discharge. Secondary outcomes were breastfeeding knowledge, breastfeeding self-efficacy, and breastfeeding prevalence at the postpartum visit. Chi-square, Students' t-test, and multivariable logistic regression were applied. Additionally, a sensitivity analysis was conducted among nulliparous participants.Results
Of the 2350 participants in the CRADLE study, 1561 were included in this secondary analysis. Participants self-identified as Black (38.3%), Hispanic (24.2%), White (36.2%), or another race and ethnicity (1.3%), and the majority were multiparous. GPNC participants reported higher rates of breastfeeding at hospital discharge compared to IPNC (72.8% IPNC vs. 78.2% GPNC; adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.02-1.72). GPNC participants also had greater breastfeeding knowledge, scoring higher on the composite knowledge questionnaire (score 18.5, standard deviation [SD] 4.3) compared to IPNC participants (score 17.5, SD 4.4; p < 0.001). No differences were observed in self-efficacy scores or postpartum breastfeeding rates between GPNC and IPNC participants. These findings were generally consistent for nulliparous participants; however, breastfeeding rate at hospital discharge did not differ between arms.Conclusion
GPNC increased breastfeeding knowledge and breastfeeding at hospital discharge but not breastfeeding at the postpartum visit. These findings suggest that education alone may be insufficient to create long-lasting changes in breastfeeding behavior.
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BibTeX
@article{campbell2026impact,
title = {{The impact of group prenatal care on breastfeeding: A planned secondary analysis of the CRADLE randomized controlled trial.}},
author = {Alexa I K Campbell and Meghan DuBose and Jessica Britt and Moonseong Heo and Lu Zhang and Liwei Chen and Lauren Keenan-Devlin and Amy H Crockett},
journal = {Pregnancy (Hoboken, N.J.)},
year = {2026},
month = oct,
doi = {10.1002/pmf2.70492},
url = {https://europepmc.org/article/MED/42923640},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The impact of group prenatal care on breastfeeding: A planned secondary analysis of the CRADLE randomized controlled trial.
AU - Alexa I K Campbell
AU - Meghan DuBose
AU - Jessica Britt
AU - Moonseong Heo
AU - Lu Zhang
AU - Liwei Chen
AU - Lauren Keenan-Devlin
AU - Amy H Crockett
PY - 2026
DA - 2026/10/22
JO - Pregnancy (Hoboken, N.J.)
DO - 10.1002/pmf2.70492
UR - https://europepmc.org/article/MED/42923640
AB - Background Despite providing both maternal and neonatal benefits, breastfeeding rates remain lower than goal targets. Prior observational studies suggest group prenatal care (GPNC) increases breastfeeding initiation compared to individual prenatal care (IPNC), but few randomized controlled trials (RCTs) have examined how GPNC impacts breastfeeding knowledge and self-efficacy. We aimed to determine if participating in GPNC impacts breastfeeding knowledge, breastfeeding self-efficacy, and breastfeeding prevalence postpartum.Materials and methods This is a planned secondary analysis of the Centering and Racial Disparities (CRADLE) RCT comparing the impact of GPNC versus IPNC on preterm birth. The CRADLE trial enrolled 2350 participants and randomized them to GPNC or IPNC. Eligibility requirements included age of 14-45 years, singleton pregnancy, entering prenatal care before 21 weeks' gestation, and low-risk pregnancy by institutional standards. Questionnaires assessed breastfeeding knowledge (adapted from the Infant Feeding Practices II Survey) and self-efficacy (adapted from Wells' 20-item Prenatal Breast-feeding Self-Efficacy Scale). A per-compliance approach was used, including participants who attended at least five sessions in their assigned group. The primary outcome was breastfeeding at hospital discharge. Secondary outcomes were breastfeeding knowledge, breastfeeding self-efficacy, and breastfeeding prevalence at the postpartum visit. Chi-square, Students' t-test, and multivariable logistic regression were applied. Additionally, a sensitivity analysis was conducted among nulliparous participants.Results Of the 2350 participants in the CRADLE study, 1561 were included in this secondary analysis. Participants self-identified as Black (38.3%), Hispanic (24.2%), White (36.2%), or another race and ethnicity (1.3%), and the majority were multiparous. GPNC participants reported higher rates of breastfeeding at hospital discharge compared to IPNC (72.8% IPNC vs. 78.2% GPNC; adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.02-1.72). GPNC participants also had greater breastfeeding knowledge, scoring higher on the composite knowledge questionnaire (score 18.5, standard deviation [SD] 4.3) compared to IPNC participants (score 17.5, SD 4.4; p < 0.001). No differences were observed in self-efficacy scores or postpartum breastfeeding rates between GPNC and IPNC participants. These findings were generally consistent for nulliparous participants; however, breastfeeding rate at hospital discharge did not differ between arms.Conclusion GPNC increased breastfeeding knowledge and breastfeeding at hospital discharge but not breastfeeding at the postpartum visit. These findings suggest that education alone may be insufficient to create long-lasting changes in breastfeeding behavior.
SN - 2997-9684
ER -