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Table 3 Summary of assessments for preterm birth and stillbirth interventions (based on GRADE system)

From: Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

   Quality of evidence   Recommendation for Implementation
Intervention
(by stage or recipient)
SB PMR PTB LBW Other MNCH
Outcomes
SB/PMR PTB LBW Other MNCH
Outcomes
Interventions given before pregnancy  
Birth Spacing Low Mod Mod* Mod* Mod* Weak Weak Weak Strong:
Maternal and
Child Mortality
Periconceptional Folate Mod Mod Low Low High Weak Against Weak Weak Strong: Neural
Tube Defects
Indoor Air Pollution Control Low   Very Low** Low High Weak Weak Against Weak Strong:
Respiratory
Infections
Interventions given during pregnancy  
Smoking Cessation Programs Low Low High High High Weak Strong Strong Strong:
Smoking-Related
Diseases
Balanced Protein Energy Supplementation High - HighNo Effect High - Strong Strong Against Strong Strong: Infant
Mortality
Multiple Micronutrient Supplementation High No Effect Mod HighNo Effect High High (Maternal Anemia, I MR) Weak Against Strong Against Strong Weak Against:
Neonatal
Mortality
Iron and Folate Supplementation Mod No Effect** Mod No Effect** Mod No Effect** Mod No Effect** High (Maternal Anemia) Weak Against Weak Against Weak Against Strong: Anemia
Zinc Supplementation HighNo Effect HighNo Effect High High HighNo Effect Mod (Reduced C-Sections) Strong Against Weak Strong Against Weak
Magnesium Sulfate Supplementation High High Mod** Mod** High(Cerebral Palsy) Strong Against Weak Against Weak Against Weak:
Supplementation
Strong: Treatment
of Eclampsia and
Prevention of
Cerebral Palsy
Calcium Supplementation HighNo Effect - Mod Mod High (Preeclampsia) Strong Against Weak Weak Strong:
Preeclampsia
Supplementation with Fatty Acids - - HighNo Effect HighNo Effect - - Strong Against Strong Against -
Cardiotocographic Monitoring Low Mod -    Weak    
Doppler and Late Ultrasound Monitoring HighNo Effect   - -   Strong Against - -  
Pregnancy infections  
Screening and Treatment of Syphilis Mod* Very Low** Mod* Mod* Mod* Strong Weak Weak Strong: Congenital
Syphilis
Intermittent Presumptive Treatment During Pregnancy (IPTp) for malaria Mod High Low** High High Strong Weak Strong Strong: Maternal
Malaria
Insecticide-Treated Mosquito Nets (ITNs) High - Low** High High Strong Weak Against Strong Strong: Maternal
Malaria
Screening and Treatment of Asymptomatic Bacteriuria ** ** Low** High High (Maternal Morbidity)   Weak Strong Strong:
Pyelonephritis,
Maternal Morbidity
Screening and Treatment of Bacterial Vaginosis - - HighNo Effect HighNo Effect - - Strong Against Strong Against -
Prevention of Mother-to- Child Transmission of HIV Low Low Low   High (PMTCT) ** ** ** Strong: PMTCT
Anti-Helminthic Treatment Low Low Low Low High (Maternal Hookworm) Weak Against Weak Against Weak Against Strong: Maternal
Anemia
Screening and Treatment of Periodontal Disease   - Mod** Mod** Low (Maternal Oral Health)   Weak Against Weak Against Weak: Maternal
Oral Health
Interventions for pregnancies with high-risks of preterm birth or stillbirth  
Progesterone Mod   High High - Weak Against Strong Strong -
Cervical Cerclage HighNo Effect   High No Effect   - Weak Against Strong Against - -
Multivitamins for HIV+ Women Low Low Mod No Effect Mod No Effect - Weak Against Weak Against Weak Against -
Intrapartum interventions to prevent stillbirths  
Birth Preparedness High Mod - -   Strong - -  
Use of Partogram Low Low - -   Weak - -  
Fetal Movement Monitoring Low - - - -   Strong Against - -  
Emergency Obstetric Care Mod* Mod* -   Mod (Maternal Outcomes) Strong - - Strong: Maternal
Mortality
Cesarean Section for Breech Presentation - High - - - Strong - -  
Elective Induction for Post-Term Delivery Mod High - -   Strong - -  
Elective Induction for Term PROM   Mod    High (Maternal and Infant Outcomes) Weak    Strong: Maternal
and Infant
Outcomes
Home Delivery   Mod - -   Weak Against    
Intrapartum interventions to improve preterm survival  
Prophylactic Steroids in Preterm Labor - - High - High(Neonatal Morbidity) - Strong - Strong: Neonatal
Morbidity
Antibiotics for PROM - - High - High(Neonatal Morbidity)   Strong   Strong: Neonatal
Morbidity
Antibiotics for Preterm Labor with Intact Membranes - - High -    Strong Against   
Delayed cord clamping    High     Strong   
Postnatal interventions to improve preterm survival  
Neonatal Resuscitation          
• Modes of oxygen delivery and resuscitation techniques: CPR    Low   -   -   -
• Modes of delivery and techniques: bag and mask    Mod   -   -   -
• CPR techniques: long- & short-term outcomes    Low   -   -   -
• Room air (vs. 100% oxygen) for resuscitation    High   -   Strong   -
Training programs for health facilities    Mod   -   Weak   -
Vitamin A supplementation    Mod   -   Weak Against   -
Vitamin K supplementation    Mod   Mod (antenatal)   Strong   Weak:
antenatal
Zinc supplementation    Low   -   Weak Against   -
Selenium supplementation    Mod   -   Weak   -
Chlorhexidine treatment on the cord    Mod   -   -   -
Case management of neonatal sepsis and pneumonia    Mod   -   Strong   -
Kangaroo mother care (KMC)          
Hospital-based KMC    High   -   Strong   -
Community-based KMC    Low   -   -   -
Early breastfeeding    High   Mod (neonatal mortality)   Strong   -
Thermal care (skin to skin; plastic wraps)    Mod   -   Strong   -
Application of continued distending pressure to the lungs for RDS    High   High (reducing chronic lung disease, and as alternative to intubation) Low pneumothorax   Strong   Strong:
bronchopulmonary
dysplasia
Intravenous immune globulin (IVIG)    High     Weak   
Surfactant therapyfor RDS    High   High (reducing chronic lung disease)   Strong   Strong
  1. (*) Due to ethical issues, RCTs are not possible.
  2. (**) Limited evidence, or outcomes not reported.
  3. (-) Not applicable or no evidence