Table 6

Effectiveness of interventions provided as an adjunct to comprehensive antenatal care

Study

Study groups/sample size

Effectiveness

Evidence of effectiveness:

authors' conclusion/reviewer assessment


PTB outcome

Neonatal/infant mortality

outcome

PTB

Neonatal/

infant mortality


a) Interventions aimed at socioeconomically disadvantaged women

Home visiting/telephone support

Kafatos,

1991

Florina intervention

programme. 296 women

attending one of the

clinics cluster randomised

to provide the interventions

vs. 263 women attending

one of the clinics

randomised to provide

normal care.

Unadjusted % PTB

(<37 weeks):

3.7% vs. 8.3%,

p < 0.04

Neonatal deaths, n (%)

(<27 days):

6 (2.1%) vs. 5 (2.0%)

Yes/Possibly

No/No

Kitzman,

1997

518 women randomised to

receive intensive nurse

home-visitation services

during pregnancy vs.

681 women randomised to

receive normal care

during pregnancy.

Unadjusted % PTB

(<37 weeks):

11% vs. 13%

Unadjusted %

spontaneous PTB

(<37 weeks):

8% vs. 9%

Adjusted Odds Ratio

(95% CI) for PTB

(<37 weeks):

0.8 (0.6-1.2)

Adjusted Odds Ratio

(95% CI) for

spontaneous PTB

(<37 weeks):

0.8 (0.5-1.3)

N/A

No/No

N/A

Maternity care coordination

Buescher,

1991

15,526 women who received maternity

care coordination vs. 34,463 women

who did not receive

maternity care coordination.

Not randomised

N/A

Unadjusted infant deaths

per 1000 live births:

9.9 vs. 12.2, p = 0.02

Adjusted Odds Ratio

(95% CI) for

infant death:

1.20 (0.98-1.47)

N/A

Possibly/

Possibly

b) Interventions aimed at or evaluated in socioeconomically disadvantaged women with additional risk factors for PTB/LBW

Home visits/telephone support

Bryce,

1991

981 women randomised to

receive additional

antenatal social

support vs. 986 women

randomised to receive

standard antenatal care.

Stratified Odds Ratio

(95% CI) for PTB

(stratified by

social class)

0.84 (0.65-1.09)

Odds Ratios by

social class:

Professional: 0.59

(0.36-0.96)

Clerical: 1.00

(0.64-1.56)

Manual: 0.96

(0.59-1.56)

Neonatal deaths before

hospital discharge:

1.4% vs. 0.6%

Postneonatal deaths

before hospital

discharge:

0% vs. 0.2%

No/No

No conclusion

stated/No

Moore,

1998

775 women randomised to

receive the nurse

telephone intervention

vs. 779 women randomised

to receive usual care.

% PTB (<37 weeks)

9.7% vs. 11.0%;

Relative Risk (RR)

(95% CI):

0.87 (0.62-1.22),

p = 0.415

Stratified analysis:

Black women, aged

< = 18 years:

11.0% vs. 7.9%

RR: 1.39 (0.72,2.67),

p = 0.039

Black women, aged

> = 19 years:

8.7% vs. 15.4%

RR: 0.56 (0.38-0.84),

p = 0.004

White or

other women,

aged < = 18 years:

7.8% vs. 4.1%

RR: 1.92 (0.61-6.02),

p = 0.255

White or

other women,

aged > = 19 years:

19.6% vs. 6.6%

RR: 2.99; (0.98-9.09),

p = 0.041

N/A

No*/No

*Authors conclude

intervention effective

in subgroup of black

women aged ≥19

N/A

Oakley

1990

255 women randomised

to receive social

support plus usual

care vs. 254 women

randomised to

receive usual care

% PTB (<37 weeks):

18% vs. 19%

% by gestational age:

<28 weeks:

2% vs. 1%

28-32 weeks:

3% vs. 4%

33-36 weeks:

13% vs. 14%

37+ weeks:

82% vs. 81%

Neonatal deaths (%):

1% vs. 1%

No conclusion

stated/No

No conclusion

stated/No

c) Interventions evaluated in other vulnerable/at risk groups

Higgins Nutrition Intervention Program

Dubois,

1997

1203 adolescents who

participated in the Higgins

Nutrition Intervention

during pregnancy vs. 1203

adolescents (matched on

site, year and age) who

did not receive the

intervention.

Not randomized.

Unadjusted % PTB

(<37 weeks):

8.2% vs. 12.8%

Unadjusted %

very preterm

(<34 weeks):

2.3% vs. 5.1%

Adjusted Odds Ratio

(95% CI) for

PTB (<37 weeks):

0.59 (0.45 - 0.78),

p < = 0.001

Adjusted Odds Ratio

(95% CI)

for very preterm birth

(<34 weeks)

0.53 (0.35 - 0.81),

p < = 0.001

Odds ratios also

reported for

subsamples-pregravid

weight <50 kg;

pregravid weight

50 kg or more;

13-17 yrs; 18-19 yrs.

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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