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Table 4 Studies evaluating programmes provided as an adjunct to comprehensive antenatal care

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) Interventions aimed at socioeconomically disadvantaged women
Home visiting
Kafatos, 1991/Greece Rural primary health
care clinics in
Florina, a
socioeconomically
disadvantaged rural
region in Northern
Greece.
Women living in a
socioeconomically
disadvantaged
rural area
Cluster
randomised
controlled
trial
An outreach health education/counselling service provided by nurses
attached to rural primary health clinics. Women receive regular
(fortnightly) nurse home visits with an emphasis on nutritional
counseling covering food sources and the methods for selecting a
balanced diet; instruction in practical techniques to improve the
quality of the woman's diet including selection of foods with a high
nutrient value and preparation/preservation techniques to reduce the
loss of nutrients). Other themes covered during pregnancy included
general hygiene, preparation for delivery, breastfeeding and care of
the newborn. Home visits continued after delivery until the infant
was 12 months old; these visits focused on infant health topics.
Kitzman, 1997/USA Public system of
obstetric care,
Memphis,
Tennessee.
Predominantly African-
American, low-income
women with multiple
socio-demographic risk
factors (unmarried,
unemployed and/or less
than 12 years education)
Randomised
controlled
trial
A programme based on the 'Elmira'/Family Nurse Partnership model.
The antenatal aspect of the interventions (which also includes
post natal home visits) involves an average of 7 home visits
focusing on improving health-related behaviour (nutrition,
smoking, alcohol and illegal drug use). Women are also taught
to recognize the signs and symptoms of pregnancy complications
and to act appropriately if these occur; and attention is paid
to compliance with treatment and to urinary tract infections
(UTIs) and sexually transmitted diseases (STDs).
Maternity care co-ordination
Buescher,
1991/USA
Services for Medicaid
eligible women, North
Carolina.
Low-income women Retrospective
cohort
study
The care coordinators help Medicaid-eligible women receive services
and also provide to provide social and emotional support. The
programme includes outreach, to help women apply for Medicaid,
assessment (psychosocial, nutritional, medical, educational and
financial), service planning (development of an individualized plan
and provision of assistance to access services), coordination and
referral, follow up and monitoring and education and counselling.
b) Interventions aimed at or evaluated in socioeconomically disadvantaged women with additional risk factors for PTB/LBW
Home visiting/telephone support
Bryce,
1991/Australia
Three public hospital
antenatal clinics in
Perth and the offices
of 87 obstetricians
and general
practitioners in
western Australia.
Women with a prior PTB or
other specified risk
factors for adverse
pregnancy outcome.
Intervention not
restricted to
socioeconomically
disadvantaged women but
stratified analysis of
intervention effect by
social class reported
Randomised
controlled
trial
Higher-risk women receive home visits from midwives at roughly
4-6 weekly intervals (more frequently if requested by the woman)
with intervening telephone calls. The midwives provide expressive
support ("empathy, understanding, acceptance, ...") and are
instructed to provide instrumental support ("information, advice
and material aid") only on request. Physical antenatal care is
provided only in an emergency.
Moore, 1998/USA Public health clinic,
Winston-Salem,
North Carolina
Low-income African-
American women and
low-income white
women with
additional risk
factors for PTB
Randomised
controlled
trial
Higher-risk women receive a booklet and additional instruction about
the signs and symptoms of preterm labour followed by three scheduled
nurse phone calls per week. Each call includes an assessment of health
status ("perception of uterine contractions and other pregnancy
changes, color of urine as an assessment of hydration, number of
meals eaten, number of cigarettes smoked, alcohol and drug use, and
ingestion of a prenatal vitamin capsule on the previous day");
recommendations based on the assessment; and a discussion of any
additional issues important to the mother
Oakley 1990/UK Four hospital
antenatal clinics
Disadvantaged,
predominantly
'working class'
women with a prior
LBW birth.
Randomised
controlled
trial
A structured social support intervention consisting of a minimum of
three antenatal home visits at 14, 20 and 28 weeks, plus two
telephone contacts. Midwives engage in a semi-structured, open
ended discussion with mothers on topics of the mother's choice;
the midwives provide advice or information only if requested and
do not provide clinical care (but may refer a mother for care if
required)
c) Interventions evaluated in other vulnerable/at risk groups
Higgins Nutrition Intervention Program
Dubois,
1997/Canada
Subjects recruited
from 15 Montreal
area hospitals but
location/setting
of the Montreal
Diet Dispensary
unclear.
Pregnant adolescents Retrospective
cohort
study
A nutritional programme delivered by trained dieticians as an adjunct
to routine antenatal care. The programme has four elements:
assessment of risks for the pregnancy; determination of an
individualized "dietary prescription"; teaching of food consumption
patterns that meet the individual's requirements while respecting
pre-existing food habits; and follow-up and supervision by the same
dietician at 2-week intervals.