Table 3 Studies evaluating comprehensive antenatal care programmes

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)