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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