Table 5

Effectiveness of comprehensive antenatal care programmes

Study

Study groups/sample size

Effectiveness

Evidence of effectiveness

Authors' conclusion/reviewer assessment


PTB outcome

Neonatal/infant mortality

outcome

PTB

Neonatal/

infant mortality


a) Programmes targeting socioeconomically disadvantaged women without specific clinical risk factors for PTB/LBW

Group antenatal care

Ickovics,

2003

229 antenatal care

attendees who

volunteered to

receive group

antenatal care vs.

229 antenatal care

attendees selected

from the women who

did not volunteer

to receive group

antenatal care,

matched on age,

race/ ethnicity,

parity and date

of delivery.

Unadjusted % PTB

(<37 weeks):

9.2% vs. 9.6%, p = 0.83.

Unadjusted % early PTB

(<33 weeks):

0.9% vs. 3.1%

Unadjusted % late PTB

(33-36.9 weeks):

8.3% vs. 6.5%

Neonatal deaths, n (%):

0 (0%) vs. 3 (1.3%)

Possibly/No

No/No

Ickovics,

2007

625 women randomised to

group antenatal care vs.

370 women randomised to

individual antenatal care.

Adjusted % PTB

(<37 weeks):

9.8% vs. 13.8%,

p = .045

Adjusted odds ratio

(95% CI) for PTB:

0.67 (0.44-0.98)

N/A

Yes/Yes

N/A

Temple Infant and Parent Support Services (TIPPS) programme

Reece,

2002

380 women enrolled in the

Temple Infant and Parent

Support Services (TIPPS)

vs. 437 women (not

randomised) receiving

usual care (matched for

age, parity, ethnicity,

health insurance and

smoking)

% PTB* (<37 weeks):

4.3% vs. 12.0%,

p < 0.005

N/A

Yes/Possibly

N/A

Tennessee Medicaid Managed Care programme (TennCare)

Conover,

2001

Before and after study with an adjacent

geographical area as a control

group.

Adjusted Odds Ratio (95% CI)

for PTB (<37 weeks):

Adjusted Odds Ratios (95% CI)

for neonatal death

(<28 days):

No conclusion

stated/No

No/No

IB = Intervention area,

'before'

IA = Intervention area,

'after'

CB = Comparator area,

'before'

CA = Comparator area,

'after'

TN = Tennessee

NC = North Carolina

Sample size (births):

IB: 69329

IA:70045

CB: 94012

CA: 94910

Not randomised.

IB vs. CB: 0.764 (0.74-0.79)

IA vs. CA: 0.796 (0.77-0.82)

Ratio (IA vs. CA)/(CB vs. CA):

1.042 (1.00-1.09)

IB vs. CB: 0.862

(0.74-1.00)

IA vs. CA: 1.012

(0.87-1.18)

Ratio (IA vs. CA)/

(IB vs. CB):

1.174 (0.95-1.46)

Adjusted Odds Ratios (95% CI)

for infant death

(<1 year):

IB vs. CB (TN vs. NC, 'before'):

0.990 (0.88-1.11)

IA vs. CA (TN vs. NC, 'after'):

1.146 (1.02-1.29)

Ratio(IA vs. CA)/(IB vs. CB):

1.158 (0.98-1.37)

b) Programmes providing enhanced antenatal care to socioeconomically disadvantaged women with additional clinical risk factors for PTB/LBW

West Los Angeles Preterm Prevention Project

Hobel,

1994

1774 high-risk women

attending a clinic

randomised to provide

the PTB prevention

programme vs. 880

high-risk women

attending a clinic

randomised to usual

care (clinics unaware

of women's risk scores).

Unadjusted % PTB (<37 weeks):

7.4% vs. 9.1% (C1), p = 0.063.

Adjusted*Odds Ratio(95% CI)

for PTB(<37 weeks):

0.78 (0.58-1.04). One-sided

test for treatment effect:

p = .045.

* Adjusted for number of

high risk problems.

N/A

Yes/Possibly

N/A

Alabama augmented antenatal care programme for high risk women

Klerman,

2001

318 women randomised to

receive augmented care

vs. 301 women randomised

to usual care

Unadjusted % PTB (undefined):

10.6% vs. 14.0%, p = 0.22

N/A

No/No

N/A

c) Programmes targeting other vulnerable/at risk groups

New York Prenatal Care Assistance Program (PCAP)

Newschaffer,

1998

240 eligible women (HIV

infected, drug abusing)

who received antenatal

care at a PCAP

participating clinic vs.

113 eligible women who

received antenatal care

at a non PCAP-

participating clinic.

Not randomised

Unadjusted % PTB (<37 weeks):

13% vs. 22.6%, p = .001

Adjusted* Odds Ratio (95% CI)

for PTB (<37 weeks):

0.57 (0.34-0.97)

*Adjusted for maternal characteristics.

N/A

Yes/Possibly

N/A

Turner,

2000

1298 eligible women

(HIV infected) who

received antenatal

care from a PCAP-

participating clinic

vs. 425 eligible

women who received

antenatal care from

a non PCAP-

participating clinic.

Not randomised

Adjusted Odds Ratio (95% CI)

for PTB (<37 weeks):

0.53 (0.40-0.70)*

*Adjusted for maternal

characteristics

Additional adjustment for

health care and social

service use during pregnancy,

illicit drug use, and for

adequacy of antenatal care

attenuates the effect, but

effects remain statistically

significant.

N/A

Yes/Possibly

N/A


Hollowell et al. BMC Pregnancy and Childbirth 2011 11:13   doi:10.1186/1471-2393-11-13

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