Dowswell, Therese, Carroli, Guillermo, Duley, Lelia, Gates, Simon, Gulmezoglu, A. Metin, Khan-Neelofur, Dina and Piaggio, Gilda G. P. (2010) Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database of Systematic Reviews (Number 10). Article number CD000934. ISSN 1469-493X

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Abstract

Background

The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation.

Objectives

To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2010), reference lists of articles and contacted researchers in the field.

Selection criteria

Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, with standard care.

Data collection and analysis

Two authors assessed trial quality and extracted data independently.

Main results

We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low-and middle-income countries with cluster randomisation (clinics as the unit of randomisation). The number of visits for standard care varied, with fewer visits in low-and middle-income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low-and middle-income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more 'goal oriented'.

Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (five trials; risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (2 trials; RR 0.90; 95% CI 0.45 to 1.80); for low-and middle-income countries perinatal mortality was significantly higher in the reduced visits group (3 trials RR 1.15; 95% CI 1.01 to 1.32). Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02). There were no clear differences between the groups for the other reported clinical outcomes.

Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs.

Authors' conclusions

In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.

Item Type:	Journal Item
Subjects:	R Medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Prenatal care, Newborn infants -- Medical care
Journal or Publication Title:	Cochrane Database of Systematic Reviews
Publisher:	John Wiley & Sons Ltd.
ISSN:	1469-493X
Official Date:	6 October 2010
Dates:	Date Event 6 October 2010 Published
Number:	Number 10
Number of Pages:	68
Article Number:	Article number CD000934
Identification Number:	10.1002/14651858.CD000934.pub2
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	World Health Organization (WHO), University of Leeds, University of Liverpool, National Institute for Health Research (Great Britain) (NIHR)
Grant number:	CPGS02
URI:	http://wrap.warwick.ac.uk/id/eprint/5105

Data sourced from Thomson Reuters' Web of Knowledge

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