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Table 5 Effectiveness of 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 Study groups/sample size Effectiveness Evidence of effectiveness
Authors' conclusion/reviewer assessment
   PTB outcome Neonatal/infant mortality
outcome
PTB Neonatal/
infant mortality
a) Programmes targeting socioeconomically disadvantaged women without specific clinical risk factors for PTB/LBW
Group antenatal care
Ickovics,
2003
229 antenatal care
attendees who
volunteered to
receive group
antenatal care vs.
229 antenatal care
attendees selected
from the women who
did not volunteer
to receive group
antenatal care,
matched on age,
race/ ethnicity,
parity and date
of delivery.
Unadjusted % PTB
(<37 weeks):
9.2% vs. 9.6%, p = 0.83.
Unadjusted % early PTB
(<33 weeks):
0.9% vs. 3.1%
Unadjusted % late PTB
(33-36.9 weeks):
8.3% vs. 6.5%
Neonatal deaths, n (%):
0 (0%) vs. 3 (1.3%)
Possibly/No No/No
Ickovics,
2007
625 women randomised to
group antenatal care vs.
370 women randomised to
individual antenatal care.
Adjusted % PTB
(<37 weeks):
9.8% vs. 13.8%,
p = .045
Adjusted odds ratio
(95% CI) for PTB:
0.67 (0.44-0.98)
N/A Yes/Yes N/A
Temple Infant and Parent Support Services (TIPPS) programme
Reece,
2002
380 women enrolled in the
Temple Infant and Parent
Support Services (TIPPS)
vs. 437 women (not
randomised) receiving
usual care (matched for
age, parity, ethnicity,
health insurance and
smoking)
% PTB* (<37 weeks):
4.3% vs. 12.0%,
p < 0.005
N/A Yes/Possibly N/A
Tennessee Medicaid Managed Care programme (TennCare)
Conover,
2001
Before and after study with an adjacent
geographical area as a control
group.
Adjusted Odds Ratio (95% CI)
for PTB (<37 weeks):
Adjusted Odds Ratios (95% CI)
for neonatal death
(<28 days):
No conclusion
stated/No
No/No
  IB = Intervention area,
'before'
IA = Intervention area,
'after'
CB = Comparator area,
'before'
CA = Comparator area,
'after'
TN = Tennessee
NC = North Carolina
Sample size (births):
IB: 69329
IA:70045
CB: 94012
CA: 94910
Not randomised.
IB vs. CB: 0.764 (0.74-0.79)
IA vs. CA: 0.796 (0.77-0.82)
Ratio (IA vs. CA)/(CB vs. CA):
1.042 (1.00-1.09)
IB vs. CB: 0.862
(0.74-1.00)
IA vs. CA: 1.012
(0.87-1.18)
Ratio (IA vs. CA)/
(IB vs. CB):
1.174 (0.95-1.46)
Adjusted Odds Ratios (95% CI)
for infant death
(<1 year):
IB vs. CB (TN vs. NC, 'before'):
0.990 (0.88-1.11)
IA vs. CA (TN vs. NC, 'after'):
1.146 (1.02-1.29)
Ratio(IA vs. CA)/(IB vs. CB):
1.158 (0.98-1.37)
  
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
1774 high-risk women
attending a clinic
randomised to provide
the PTB prevention
programme vs. 880
high-risk women
attending a clinic
randomised to usual
care (clinics unaware
of women's risk scores).
Unadjusted % PTB (<37 weeks):
7.4% vs. 9.1% (C1), p = 0.063.
Adjusted * Odds Ratio (95% CI)
for PTB (<37 weeks):
0.78 (0.58-1.04). One-sided
test for treatment effect:
p = .045.
* Adjusted for number of
high risk problems.
N/A Yes/Possibly N/A
Alabama augmented antenatal care programme for high risk women
Klerman,
2001
318 women randomised to
receive augmented care
vs. 301 women randomised
to usual care
Unadjusted % PTB (undefined):
10.6% vs. 14.0%, p = 0.22
N/A No/No N/A
c) Programmes targeting other vulnerable/at risk groups
New York Prenatal Care Assistance Program (PCAP)
Newschaffer,
1998
240 eligible women (HIV
infected, drug abusing)
who received antenatal
care at a PCAP
participating clinic vs.
113 eligible women who
received antenatal care
at a non PCAP-
participating clinic.
Not randomised
Unadjusted % PTB (<37 weeks):
13% vs. 22.6%, p = .001
Adjusted * Odds Ratio ( 95% CI)
for PTB (<37 weeks):
0.57 (0.34-0.97)
*Adjusted for maternal characteristics.
N/A Yes/Possibly N/A
Turner,
2000
1298 eligible women
(HIV infected) who
received antenatal
care from a PCAP-
participating clinic
vs. 425 eligible
women who received
antenatal care from
a non PCAP-
participating clinic.
Not randomised
Adjusted Odds Ratio (95% CI)
for PTB (<37 weeks):
0.53 (0.40-0.70)*
*Adjusted for maternal
characteristics
Additional adjustment for
health care and social
service use during pregnancy,
illicit drug use, and for
adequacy of antenatal care
attenuates the effect, but
effects remain statistically
significant.
N/A Yes/Possibly N/A