Discussion
GD-related adverse
SECONDARY
In this secondary analysis of a large RCT, among 2348 pregnant participants from a single health care system, we found the risks of GD, progression to A2 GD, and GD-related adverse obstetric outcomes were similar between GPNC and IPNC groups. We did not find that the effect of GPNC on the risk of developing GD was different across participants of different races and ethnicities.Our RCT design is an important contribution to the understanding of the impact of GPNC on the risk of developing GD. Our team previously reported that participants receiving the GPNC had 42% lower odds of developing GD (odds ratio, 0.58; 95% CI, 0.38-0.89), compared with participants receiving IPNC in a large retrospective cohort of racially diverse pregnant participants.The diverse study population allowed us to explore potential variations in the benefits of GPNC among participants of different races and ethnicities. In our previous observational study,A few observational studiesA unique strength of this study is the eligibility criteria were consistent with what practitioners generally apply when recruiting for GPNC and therefore reflected the typical clinical context and maximized the generalizability of the study findings. Our study site has extensive experience in offering CenteringPregnancy GPNC for pregnant participants (ie, the site has been continuously certified by the Centering Healthcare Institute since 2009), indicating a high degree of fidelity to the model. In the current study, the GPNC was provided in both English and Spanish. Additional strengths of our study include the large sample size (>2000 participants), the racially and ethnically diverse population, and the rich measures of sociodemographic, psychosocial, behavioral, reproductive, and clinical factors at baseline and over pregnancy.