BACKGROUND: There is a lack of strong evidence on the effectiveness of the content, frequency, and timing of visits in standard antenatal-care programmes. We undertook a systematic review of randomised trials assessing the effectiveness of different models of antenatal care. The main hypothesis was that a model with a lower number of antenatal visits, with or without goal-oriented components, would be as effective as the standard antenatal-care model in terms of clinical outcomes, perceived satisfaction, and costs. METHODS: The interventions compared were the provision of a lower number of antenatal visits (new model) and a standard antenatal-visits programme. The selected outcomes were pre-eclampsia, urinary-tract infection, postpartum anaemia, maternal mortality, low birthweight, and perinatal mortality. We also selected measures of women's satisfaction with care and cost-effectiveness. This review drew on the search strategy developed for the Cochrane Pregnancy and Childbirth Group of the Cochrane Collaboration. FINDINGS: Seven eligible randomised controlled trials were identified. 57418 women participated in these studies: 30799 in the new-model groups (29870 with outcome data) and 26619 in the standard-model groups (25821 with outcome data). There was no clinically differential effect of the reduced number of antenatal visits when the results were pooled for pre-eclampsia (typical odds ratio 0.91 [95% CI 0.66-1.26]), urinary-tract infection (0.93 [0.79-1.10]). postpartum anaemia (1.01), maternal mortality (0.91 [0.55-1.51]), or low birthweight (1.04 [0.93-1.17]). The rates of perinatal mortality were similar, although the rarity of the outcome did not allow formal statistical equivalence to be attained. Some dissatisfaction with care, particularly among women in more developed countries, was observed with the new model. The cost of the new model was equal to or less than that of the standard model. INTERPRETATION: A model with a reduced number of antenatal visits, with or without goal-oriented components, could be introduced into clinical practice without risk to mother or baby, but some degree of dissatisfaction by the mother could be expected. Lower costs can be achieved.
BACKGROUND: There is a lack of strong evidence on the effectiveness of the content, frequency, and timing of visits in standard antenatal-care programmes. We undertook a systematic review of randomised trials assessing the effectiveness of different models of antenatal care. The main hypothesis was that a model with a lower number of antenatal visits, with or without goal-oriented components, would be as effective as the standard antenatal-care model in terms of clinical outcomes, perceived satisfaction, and costs. METHODS: The interventions compared were the provision of a lower number of antenatal visits (new model) and a standard antenatal-visits programme. The selected outcomes were pre-eclampsia, urinary-tract infection, postpartum anaemia, maternal mortality, low birthweight, and perinatal mortality. We also selected measures of women's satisfaction with care and cost-effectiveness. This review drew on the search strategy developed for the Cochrane Pregnancy and Childbirth Group of the Cochrane Collaboration. FINDINGS: Seven eligible randomised controlled trials were identified. 57418 women participated in these studies: 30799 in the new-model groups (29870 with outcome data) and 26619 in the standard-model groups (25821 with outcome data). There was no clinically differential effect of the reduced number of antenatal visits when the results were pooled for pre-eclampsia (typical odds ratio 0.91 [95% CI 0.66-1.26]), urinary-tract infection (0.93 [0.79-1.10]). postpartum anaemia (1.01), maternal mortality (0.91 [0.55-1.51]), or low birthweight (1.04 [0.93-1.17]). The rates of perinatal mortality were similar, although the rarity of the outcome did not allow formal statistical equivalence to be attained. Some dissatisfaction with care, particularly among women in more developed countries, was observed with the new model. The cost of the new model was equal to or less than that of the standard model. INTERPRETATION: A model with a reduced number of antenatal visits, with or without goal-oriented components, could be introduced into clinical practice without risk to mother or baby, but some degree of dissatisfaction by the mother could be expected. Lower costs can be achieved.
Authors: Jørn Olsen; Andrew Czeizel; Henrik Toft Sørensen; Gunnar Lauge Nielsen; Lolkje T W de Jong van den Berg; Lorentz M Irgens; Charlotte Olesen; Lars Pedersen; Helle Larsen; Rolv T Lie; Corinne S de Vries; Ulf Bergman Journal: Drug Saf Date: 2002 Impact factor: 5.606
Authors: A-B Kihara; A D Harries; K Bissell; W Kizito; R Van Den Berg; S Mueke; A Mwangi; J C Sitene; D Gathara; R J Kosgei; J Kiarie; P Gichangi Journal: Public Health Action Date: 2015-03-21
Authors: Fiona Milne; Chris Redman; James Walker; Philip Baker; Julian Bradley; Carol Cooper; Michael de Swiet; Gillian Fletcher; Mervi Jokinen; Deirdre Murphy; Catherine Nelson-Piercy; Vicky Osgood; Stephen Robson; Andrew Shennan; Angela Tuffnell; Sara Twaddle; Jason Waugh Journal: BMJ Date: 2005-03-12
Authors: Agustín Ciapponi; Simon Lewin; Cristian A Herrera; Newton Opiyo; Tomas Pantoja; Elizabeth Paulsen; Gabriel Rada; Charles S Wiysonge; Gabriel Bastías; Lilian Dudley; Signe Flottorp; Marie-Pierre Gagnon; Sebastian Garcia Marti; Claire Glenton; Charles I Okwundu; Blanca Peñaloza; Fatima Suleman; Andrew D Oxman Journal: Cochrane Database Syst Rev Date: 2017-09-13
Authors: George L Wehby; Jeffrey C Murray; Eduardo E Castilla; Jorge S Lopez-Camelo; Robert L Ohsfeldt Journal: Econ Hum Biol Date: 2008-10-30 Impact factor: 2.184