Group Prenatal Care as a Health Literacy Intervention: A Systematic Review and Meta-Analysis

Background: Health literacy (HL), the ability to understand and apply health information, impacts pregnancy outcomes. While group prenatal care (GPC) models emphasize education and social support, no existing reviews evaluate its ability to improve HL relative to traditional prenatal care (TPC). This review aims to evaluate the evidence for GPC as a health literacy intervention compared to TPC. Methods: We searched MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science (Clarivate Analytics), Embase (Elsevier), APA PsycInfo (ProQuest), Cochrane Library (Wiley), CAB Abstracts (Ovid), and Global Health (Ovid) for peer‑reviewed studies. Eligible studies directly compared pregnant patients in GPC versus TPC, used randomized controlled trial, cohort, or pre–post designs, and assessed HL or shared decision‑making (SDM). No restrictions were applied based on age, risk level, language, or geographic location. We extracted and synthesized HL knowledge scores using the Cochrane RevMan web tool. Risk of bias was assessed using Cochrane RoB 2.0 and ROBINS‑I. Data were pooled using standardized mean differences, as appropriate. We quantified between-study heterogeneity using I2. Results: Eight studies met inclusion criteria, with substantial heterogeneity in design and HL measures. Among four randomized studies, the standardized mean difference was 0.31 points between GPC and TPC (p<.001; 95% CI: 0.24, 0.37; I²=0%). In four non‑randomized studies, women in GPC scored 1.36 points lower than those in TPC, with no statistically significant difference (p=.64; 95% CI: −1.37, 0.85; I²=97%). No studies assessed SDM. Conclusions: GPC is associated with improved HL compared to TPC, particularly in randomized designs, suggesting potential effectiveness as an HL intervention; however, additional high‑quality studies are needed.