Table 7

Systematic reviews on the impact of ANC on stillbirth and perinatal mortality


Location and Type of Study


Stillbirths/Perinatal Outcomes

Reviews and meta-analyses

Hodnett and Fredericks. 2003 [70]

France, Australia, USA, South Africa, England, Argentina, Brazil, Cuba, and Mexico.

Meta-analysis (Cochrane). 11 randomised controlled trials (RCTs) (N = 9507 women) included.

Compared additional support during pregnancies at risk of low birth weight by either a professional (social worker, midwife, or nurse) or specially trained layperson, to routine care. Additional support included emotional support, information/advice, and physical help.

PMR: RR = 1.15 (95% CI: 0.89–1.51) [NS]a

Gagnon and Sandall.

2007 [71]

Canada, USA.

Cochrane review. 1 RCT (N = 1280 women) included (N = 641 intervention group, N = 634 controls).

As part of a strategy to define predisposing, enabling, and reinforcing factors for deciding to attempt a vaginal birth after Caesarean (VBAC), the study compared pregnancy outcomes among an intervention group given individualised prenatal education and support by a trained research nurse and a resource person with personal experience of a VBAC to a group of controls given a pamphlet highlighting the benefits of a VBAC.

PMR: RR = 0.50 (95% CI: 0.09–2.69) [NS]

[2/643 vs. 4/637 in intervention group vs. controls, respectively]

Villar et al. 2001 [65]

Scotland, UK.

Meta-analysis (Cochrane). 2 RCTs (N = 2890 low-risk women) included.

To assess the effects of ANC programs for low-risk women, particularly whether care provided by a midwife/general practitioner was as effective as obstetrician/gynecologist-led shared care.

PMR: Odds ratio (OR) = 0.59 (95% CI: 0.28–1.26) [NS]

Carroli and Villar 2001 [57]

Multiple countries.

Meta-analysis (World Health Organization, WHO). 7 RCTs (N = 57,418 women) included (N = 30,799 in intervention groups, N = 26,619 in standard ANC groups). 5 RCTs reported perinatal mortality (N = 54,005 women).

To test the impact of a reduced number of ANC visits, with or without goal-oriented components, on perinatal mortality against standard ANC.

PMR: OR = 1.06 (95% CI: 0.82–1.36) [NS]

aNS = Non-significant

Yakoob et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S3   doi:10.1186/1471-2393-9-S1-S3

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