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 |