Table 3 Charting of the included studies

Austin, 2011 [53]

Dietetic referral for pregnant women with high/low BMI^*at booking. Personalised dietary and exercise advice from dietetic service every 4–6 weeks throughout pregnancy

Pregnant women with BMI^*at booking <18.5 or >30

None

Potential confounds: participant descriptive statistics not presented, no information on SES variables, education.

Primary outcomes: Birth outcomes and frequency of dietetic interventions taken

Primary measures: 2 or more interventions with dietetic services showed improved birth outcomes (less infant mortality and no low birth weight). (n = 219; 7 adverse outcomes reported[LBW = 4, stillbirth = 3])

Initial results suggest that early dietetic intervention may improve birth outcomes in Newham.

Individual multiple risk of adverse birth outcome not shown

Secondary outcomes: Qualitative satisfaction questionnaire

Secondary outcomes: 86 % of attendees rated the advice as “very good” or “good”.

More research is required.

Dormandy et al., 2010 [54]

Universal SCT¹Antenatal Screening in primary care (at first booking) 3 methods tested.

Attendance at participatory surgeries, planned to continue pregnancy, pregnancy gestation <19 weeks and 6 days when first seen in primary care, there was no written record of SCT status and gestational age based on definite LMP date.

3 groups compared for effectiveness, feasibility and acceptability

Potential demand characteristics –only 62 % of health care professionals attended training to deliver the SCT screening invitation intervention, indicating 38 % of staff did not receive training and this may have impacted on the uptake, both positively and negatively.

Primary outcomes: timing of screening, (proportion of women screened before 10 weeks (70 days). Date calculated from LMP²

Proportion of women screened within 10 weeks was 2 % (9/441 in standard care, 24 % (161/677) primary care with parallel testing and 28 % (167/590) in primary care.

Research is needed to understand the impact of gestational age on screening uptake and subsequent reproductive decision making.

Group 1: primary care testing with simultaneous offer of father testing

Secondary outcomes: rates of informed choice and awareness of fathers carrier status at 11 weeks gestation

The number of women screened by 70 days (10 weeks) 3 % (3/90) standard care; 47 % (321/677) in primary care with parallel testing and 48 % (281/590) in primary care using sequential testing.

More research is required to understand why women failed to have SCT screening.

2. In primary care with offer of follow up father testing if mother a carrier

The percentage of women screened within 26 weeks was reported to be similar in all 3 groups; 73 % standard care; 84 % in primary care with parallel testing and 82 % in primary care with sequential testing

Limited uptake of father testing results in unclear carrier status and reproductive decisions are not considered.

3. In secondary care with follow up father testing, if mother a carrier.

Other models of screening may facilitate an improved uptake and these need to be explored.

This study suggests that antenatal screening for SCT is not negatively impacting on emotional wellbeing, however this needs more research

Wiggins et al., 2004 [55]

Levels of Social Support post-natal

Women who gave birth in Camden & Islington between 01/01/99 – 30/09/99.

“usual care” of routine health visitor support (1× home visit) at infant age 10–15 days. Other home visits are only made if a risk is determined; otherwise contact is made at primary care clinic.

HV were recruited and trained for the RCT

Child injury, Maternal smoking status and maternal wellbeing at 12 and 18 months with follow up self-report questionnaire or interviews.

Both intervention groups were demographically well matched.

The SHV intervention was found to be popular and showed some improvement in secondary outcomes. This suggests that increase social support from health visitors may improve maternal and family wellbeing but further research is needed.

To improve infant and maternal outcomes. 2 arms.

(exclusion if baby died, mother moved away, baby or mother unwell or interpreter unavailable)

Uptake between the 2 groups was imbalanced; 94 % SHV vs 19 % CGS

Secondary outcomes included access to healthcare services and financial services, maternal and child health and the self-reported experiences of feeding and motherhood, assessed using self-report questionnaire or interviews

Response rates were 90 and 82 % at 12 and 18 months respectively.

There is a need to develop and test more culturally specific interventions

1, SHV³12 months of monthly supportive and listening visits from 10 weeks old. SHCV attention on maternal needs

CGS Assignment based on preference, SHV assignment based on geographic proximity to HV base clinic. This may result in bias in the results.

In the SHV group, there was a reduction of GP visits but an increase in use of SHV and social worker services at 12 month follow up.

Research is needed to explore the evidence in delay in subsequent pregnancy found in the study.

2, CGS⁴ allocation to one of 8 community groups, with drop in sessions, home visits and telephone support for 12 months post- delivery.

A “dose effect” may be evident with increasing contact with support group, regardless of randomisation group

By 18 month follow up, less mothers were pregnant in both SHV and CGS groups compared to “usual care” and SHV mothers were less concerned regards their child’s health.

Self- reported measures; there is a risk of under reporting of medical visits and inadequate account of children in receipt of regular medication regimes

Littler, 2010 [58]

Multi-Agency teenage pregnancy intervention

Not directly specified

Comparisons are made to earlier year’s teenage pregnancy cohorts in the local area and audit data of contraceptive plans.

Possible dose effects from intervention, but frequency and uptake is not reported.

A number of outcomes were reported:

The results were reported:

The intervention was considered successful (through the broad outcome measures) although there is a lack of formal evidence reporting of this intervention, which should attend more closely to the demographic profile of attendees of the service, to ensure that it reaches all sectors of the community, including BAME.

Contraceptive plans are as intended and not a measure of actual behaviour

C-Section rates, breast feeding uptake, Number of contraceptive plans in place; subsequent pregnancy rates; use of services by teenagers; Referral for social problems; uptake of continued or further education.

C-Section rates decreased (2008 – 2009), Increased breast feeding (33.1–44 %), increased numbers of contraceptive plans in place, reduction in subsequent pregnancy rates (15–8.2 %), increased use of services by teenagers, early referral for social problems 54 % mothers reported to be in education or training following birth of baby.

The redesigning of original services allowed the new service to be developed with no new investment.

Service users gave positive evaluations.

Khan, 2008 [56]

‘Haamla Service’ befriending, advocacy and support service for vulernable and hard to reach women in West Yorkshire

Not clearly defined;

none

Highly likely – this intervention has no comparison or control group.

Attendance rates in different Haamlaserice sectors (GP surgeries, hospital ward visits, attendance by electoral ward data, ethnicity data (hospital ward, antenatal groups)

Various attendance rates and service activity presented as percentages and frequencies.

A comprehensive service evaluation is required to determine the return on investment in real terms including length of admission, frequencies of admissions and late booking complications leading to adverse outcomes.

Vulernable (migrants, asylum seekers, refugee’s); Hard to reach (including BAME women).

There is no uniform service and no measurable service outcomes.

% of origins of referrals, gestation period at time of access,

Total women accessed service in 2006 = 286

Reliability and validity cannot be established due to lack of methodological rigor.

The majority (66 %) of service involved information giving, several ethnic groups were reported (Pakistani, Bengali, Indian, Black African, Black Caribean, Black other, Chinese, White, Other, Not known) with Pakistani representing the largest number of attendees for hospital ward support in 2006, 2007, 57 % of women seen in GP surgeries were of Pakistani origin, the majority of referrals came from community midwives (32 %) and generated by internal referrals through the hospital (21 %)