Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy

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...

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Main Authors:	Dowswell, T., Carroli, G., Duley, L., Gates, S., Gulmezoglu, A. M., Khan-Neelofur, D., Piaggio, G. G. P.
Format:	Journal Article
Language:	EN
Published:	2012
Online Access:	http://hdl.handle.net/10986/5219

id	okr-10986-5219
recordtype	oai_dc
spelling	okr-10986-52192021-04-23T14:02:21Z Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy Dowswell, T. Carroli, G. Duley, L. Gates, S. Gulmezoglu, A. M. Khan-Neelofur, D. Piaggio, G. G. P. 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. 2012-03-30T07:31:51Z 2012-03-30T07:31:51Z 2010 Journal Article Cochrane Database Syst Rev 1469-493X http://hdl.handle.net/10986/5219 EN http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Journal Article
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	EN
relation	http://creativecommons.org/licenses/by-nc-nd/3.0/igo
description	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.
format	Journal Article
author	Dowswell, T. Carroli, G. Duley, L. Gates, S. Gulmezoglu, A. M. Khan-Neelofur, D. Piaggio, G. G. P.
spellingShingle	Dowswell, T. Carroli, G. Duley, L. Gates, S. Gulmezoglu, A. M. Khan-Neelofur, D. Piaggio, G. G. P. Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy
author_facet	Dowswell, T. Carroli, G. Duley, L. Gates, S. Gulmezoglu, A. M. Khan-Neelofur, D. Piaggio, G. G. P.
author_sort	Dowswell, T.
title	Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy
title_short	Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy
title_full	Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy
title_fullStr	Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy
title_full_unstemmed	Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy
title_sort	alternative versus standard packages of antenatal care for low-risk pregnancy
publishDate	2012
url	http://hdl.handle.net/10986/5219
_version_	1764394345076621312

Alternative Versus Standard Packages of Antenatal Care for Low-Risk Pregnancy

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