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Table 6 Effectiveness of interventions 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 Study groups/sample size Effectiveness Evidence of effectiveness: authors' conclusion/reviewer assessment
   PTB outcome Neonatal/infant mortality outcome PTB Neonatal/ infant mortality
a) Interventions aimed at socioeconomically disadvantaged women
Home visiting/telephone support
Kafatos, 1991 Florina intervention programme. 296 women attending one of the clinics cluster randomised to provide the interventions vs. 263 women attending one of the clinics randomised to provide normal care. Unadjusted % PTB (<37 weeks): 3.7% vs. 8.3%, p < 0.04 Neonatal deaths, n (%) (<27 days): 6 (2.1%) vs. 5 (2.0%) Yes/Possibly No/No
Kitzman, 1997 518 women randomised to receive intensive nurse home-visitation services during pregnancy vs. 681 women randomised to receive normal care during pregnancy. Unadjusted % PTB (<37 weeks): 11% vs. 13% Unadjusted % spontaneous PTB (<37 weeks): 8% vs. 9% Adjusted Odds Ratio (95% CI) for PTB (<37 weeks): 0.8 (0.6-1.2) Adjusted Odds Ratio (95% CI) for spontaneous PTB (<37 weeks): 0.8 (0.5-1.3) N/A No/No N/A
Maternity care coordination
Buescher, 1991 15,526 women who received maternity care coordination vs. 34,463 women who did not receive maternity care coordination. Not randomised N/A Unadjusted infant deaths per 1000 live births: 9.9 vs. 12.2, p = 0.02 Adjusted Odds Ratio (95% CI) for infant death: 1.20 (0.98-1.47) N/A Possibly/ Possibly
b) Interventions aimed at or evaluated in socioeconomically disadvantaged women with additional risk factors for PTB/LBW
Home visits/telephone support
Bryce, 1991 981 women randomised to receive additional antenatal social support vs. 986 women randomised to receive standard antenatal care. Stratified Odds Ratio (95% CI) for PTB (stratified by social class) 0.84 (0.65-1.09) Odds Ratios by social class: Professional: 0.59 (0.36-0.96) Clerical: 1.00 (0.64-1.56) Manual: 0.96 (0.59-1.56) Neonatal deaths before hospital discharge: 1.4% vs. 0.6% Postneonatal deaths before hospital discharge: 0% vs. 0.2% No/No No conclusion stated/No
Moore, 1998 775 women randomised to receive the nurse telephone intervention vs. 779 women randomised to receive usual care. % PTB (<37 weeks) 9.7% vs. 11.0%; Relative Risk (RR) (95% CI): 0.87 (0.62-1.22), p = 0.415 Stratified analysis: Black women, aged < = 18 years: 11.0% vs. 7.9% RR: 1.39 (0.72,2.67), p = 0.039 Black women, aged > = 19 years: 8.7% vs. 15.4% RR: 0.56 (0.38-0.84), p = 0.004 White or other women, aged < = 18 years: 7.8% vs. 4.1% RR: 1.92 (0.61-6.02), p = 0.255 White or other women, aged > = 19 years: 19.6% vs. 6.6% RR: 2.99; (0.98-9.09), p = 0.041 N/A No*/No *Authors conclude intervention effective in subgroup of black women aged ≥19 N/A
Oakley 1990 255 women randomised to receive social support plus usual care vs. 254 women randomised to receive usual care % PTB (<37 weeks): 18% vs. 19% % by gestational age: <28 weeks: 2% vs. 1% 28-32 weeks: 3% vs. 4% 33-36 weeks: 13% vs. 14% 37+ weeks: 82% vs. 81% Neonatal deaths (%): 1% vs. 1% No conclusion stated/No No conclusion stated/No
c) Interventions evaluated in other vulnerable/at risk groups
Higgins Nutrition Intervention Program
Dubois, 1997 1203 adolescents who participated in the Higgins Nutrition Intervention during pregnancy vs. 1203 adolescents (matched on site, year and age) who did not receive the intervention. Not randomized. Unadjusted % PTB (<37 weeks): 8.2% vs. 12.8% Unadjusted % very preterm (<34 weeks): 2.3% vs. 5.1% Adjusted Odds Ratio (95% CI) for PTB (<37 weeks): 0.59 (0.45 - 0.78), p < = 0.001 Adjusted Odds Ratio (95% CI) for very preterm birth (<34 weeks) 0.53 (0.35 - 0.81), p < = 0.001 Odds ratios also reported for subsamples-pregravid weight <50 kg; pregravid weight 50 kg or more; 13-17 yrs; 18-19 yrs. N/A Yes/Possibly N/A