The impact of group prenatal care on breastfeeding: A planned secondary analysis of the CRADLE randomized controlled trial

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.