The effect of the centering pregnancy model on diabetes self- management, self-efficacy, pregnancy experience, and perinatal outcomes in women with diabetes: a randomized controlled trial

Gestational diabetes mellitus (GDM) and type 2 diabetes in pregnancy pose significant maternal and perinatal risks. The Centering Pregnancy group care model may improve diabetes self-management and pregnancy experience, but its effectiveness in Iran—particularly on perinatal outcomes—remains unproven. This trial evaluated whether Centering Pregnancy improves diabetes self-management, self-efficacy, and pregnancy experience (primary outcomes), and secondary outcomes including maternal satisfaction, breastfeeding at 6 weeks postpartum, preterm delivery, NICU admission, and cesarean section, compared with standard care in Iranian women with GDM or type 2 diabetes. This randomized controlled trial enrolled 100 women (50 per group) from Tabriz clinics. The intervention group received four bi-weekly group sessions plus standard care; controls received routine care. Primary outcomes (diabetes self-care activities [SDSCA], self-efficacy [DMSES], and pregnancy experience [PES]) were measured at baseline and 36–39 weeks. Secondary outcomes included satisfaction (Visual Analogue Scale), breastfeeding performance (Agunbiade instrument) at 6 weeks postpartum, and perinatal outcomes including preterm delivery, NICU admission, and cesarean section. from medical records. Analysis followed intention-to-treat principles using ANCOVA, with 6-week postpartum follow-up. The intervention group showed significantly greater improvements in SDSCA (MD = 0.9, 95% CI: 0.3–1.4, p = 0.002), DMSES (MD = 0.8, 95% CI: 0.3–1.2, p = 0.001), and PES Uplifts (MD = 2.2, 95% CI: 0.3–4.1, p = 0.026) compared to the control group. Breastfeeding performance was significantly better in the intervention group compared to the control group (MD = 0.8, 95% CI: 0.4–1.3, p < 0.001). Perinatal outcomes showed lower rates in the intervention group but these differences were not statistically significant (p > 0.05). No significant between-group differences were observed for PES Hassles, or satisfaction (p > 0.05). The Centering Pregnancy model is an effective patient-centered strategy for enhancing diabetes self-management, self-efficacy, and positive pregnancy experiences in Iranian women with diabetic pregnancies. Favorable but non-significant trends in perinatal outcomes warrant investigation in larger trials. This approach may be considered for integration into standard care protocols. IRCT20220718010324N70. This study tested a new type of prenatal care for pregnant women with diabetes (gestational or type 2 diabetes) in Iran. We wanted to see if group care, called the “Centering Pregnancy” model, works better than the usual one-on-one doctor visits—particularly for helping women manage their diabetes, feel more confident, have a better pregnancy experience, and improve outcomes for themselves and their babies. We assigned 100 women to either the group care program or standard care. The women in the group care met together for four sessions, held every two weeks. In these meetings, they learned about managing their diabetes, had their health checked, and shared experiences and support with each other. We found that women in the group care program felt more confident and were better at looking after their diabetes—for example, by eating well and staying active. They also had a more positive experience of their pregnancy. After birth, they were more successful with breastfeeding. While fewer women in the group care had preterm births or needed their babies admitted to the neonatal intensive care unit (NICU), these differences were not large enough to be certain they were because of the program. In conclusion, group prenatal care is a promising and supportive method that can help women with diabetes during pregnancy feel more empowered, have a better pregnancy experience, and breastfeed more successfully. Healthcare providers should consider offering this group model as an option for women with diabetes in pregnancy.