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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)