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Table 3 Studies evaluating comprehensive antenatal care programmes

From: The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review

Study/ Country Setting Target population Study design Intervention
a) Programmes targeting socioeconomically disadvantaged women without specific clinical risk factors for PTB/LBW
Group antenatal care     
Ickovics, 2003/ USA Three public antenatal clinics in Atlanta, Georgia and New Haven, serving predominantly low-income, uninsured (Medicaid or self- pay) minority women. Women without severe medical or psychiatric problems who entered antenatal care at one the three study clinics at 24 or less weeks'gestation between August 1999 and March 2002. Prospective cohort study Groups of 8-10 women with similar estimated due date receive the majority of their antenatal care in a communal/group setting. Groups meet periodically (typically fortnightly) with each group led by a trained practitioner. The group care model emphasizes education, skills- building, peer support and personal empowerment.
Ickovics, 2007/ USA Publicly funded obstetric clinics in two university affiliated hospitals in Connecticut and Georgia. Women aged less than 25 entering antenatal care at the two study sites between September 2001 and December 2004; less than 24 weeks' gestation; no "high-risk" medical problems (e.g. HIV); consenting to randomization. Multiple gestations excluded in PTB `analysis. Randomised controlled Trial See above (Ickovics, 2003).
Temple Infant and Parent Support Services (TIPPS) programme
Reece, 2002/ USA Community and hospital based maternity services in North Philadelphia, Pennsylvania. Medically indigent women who enrolled in the intensive maternity care programme(TIPPS) or who enrolled in usual antenatal care at the study hospital Prospective cohort study A comprehensive multidisciplinary service which includes complete antenatal and delivery care, well baby care, health education, nutritionist care and counselling and psychosocial care and a range of components to increase uptake and remove barriers to care, e.g. outreach teams interface with community-based organizations to identify pregnant women who are not receiving antenatal care.
Tennessee Medicaid Managed Care programme (TennCare)
Conover, 2001/ USA Antenatal services for Medicaid eligible women in Tennessee and North Carolina. Women resident in the two study areas delivering a singleton live births in 1993 and 1995. Study populations NOT restricted to Medicaid eligible women Before and after study with an adjacent US state as a control group. A public medical assistance programme which delivers antenatal care through a 'managed care' model.
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/ USA Public antenatal clinics in West Los Angeles, California. Women with a first antenatal clinic visit at one of the study sites between 1983 and 1986 and with a completed risk assessment indicating high-risk of PTB. Multiple pregnancies, those that aborted at <20 weeks gestation and those that resulted in stillbirth or major congenital anomaly excluded. Cluster randomised controlled trial Clinic-based enhanced antenatal care for high risk women. Eligible women attending the clinics providing the programme receive more frequent visits (every two weeks), pre-term prevention education (three classes covering "identification of pre-term labour, steps to take if signs or symptoms occurred, prevention strategies and what to expect at the hospital") as well as psychosocial and nutritional screening and crisis intervention.
Alabama augmented antenatal care programme for high risk women
Klerman, 2001/ USA Public health care system, Jefferson County, Alabama. African-American, Medicaid- eligible pregnant women seeking antenatal care from the Jefferson County Department of Health between March 1994 and June 1996; women at least 16 yrs old, less than 26 weeks' gestation, with a score of 10 or higher on a risk assessment scale (medical and social factors, including prior PTB, low pre-pregnancy weight, no car for transportation). Women with alcoholism, substance abuse, asthma, cancer, diabetes, epilepsy, high blood pressure, sickle cell disease or HIV/AIDS were excluded. Randomised controlled Trial Higher-risk women receive augmented care at a specially created Mother and Family Specialty Center. The programme focuses on informing women about their risk conditions and about what behaviour might improve their pregnancy. The programme includes elements covering smoking cessation,weight gain and vitamin-mineral supplementation and amelioration of psychosocial stress/isolation. Other features include group sessions, regular standing appointments, evening hours where needed, appointment reminders, transportation, and on-site childcare.
c) Programmes targeting other vulnerable/at risk groups
New York Prenatal Care Assistance Program (PCAP)
Newschaffer, 1998/USA New York State Medicaid antenatal clinics. HIV infected, drug abusing, Medicaid claimants who delivered a singleton between January 1993 and September 1994. Retrospective cohort Study The programme provides enhanced antenatal care to low income women through a network of accredited hospital clinics. The clinics receive financial incentives to providers to improve basic elements of management and coordination of antenatal care. PCAP accredited clinics must: provide patient outreach to facilitate timely prenatal care; meet frequency and content of care standards set by the American College of Obstetricians and Gynaecologists; conduct comprehensive risk assessment for adverse outcomes; develop prenatal care plans; and provide nutritional services, health education, psychological assessment and HIV related services involving testing, counselling and management referrals.
Turner, 2000/USA USA. Public antenatal care services, New York, New York State HIV-infected, New York State Medicaid enrolled women delivering a live- born singleton infant between January 1993 and October 1995 Retrospective cohort Study See above (Newschaffer, 1998)