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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