A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations

Abstract

BackgroundAlthough this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support.MethodsIn this narrative review, we included relevant Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies.ResultsIn the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to ¼ of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 25–30%. Behavioral interventions targeting practices at birth and in the hours that follow can have substantial impact in settings where many births happen at home: in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20%; good thermal care practices can reduce mortality risk by a similar order of magnitude.ConclusionsSimple interventions delivered during pregnancy have considerable potential impact on important mortality outcomes. More programmatic effort is warranted to ensure high effective coverage.

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 Demographic and Health Survey

“…Antenatal, delivery, and postnatal care are part of the continuum of care for maternal and child survival [28][29][30][31][32][33][34][35][36]. Antenatal care can prevent maternal mortality and morbidity, directly or indirectly.…”

Evidence-Based Practices During Pregnancy and Midwifery Approach

“…(2016)'nın basit ve etkili müdahalelerin sonuçlarını incelemek amacıyla kanıta dayalı olarak derledikleri makalelerinde, demir preparatları için anemiyi tedavi ettiğine dair yeterli kanıt olmadığını belirtmişlerdir. 42 Ancak antenatal dönemde yapılan demir desteğinin anemi oluşma-dan önce başlandığı takdirde, aneminin önlenme-sinde etkili olduğunu vurgulamışlardır. 42 Ayrıca antenatal demir desteğinin yenidoğan bebeklerin yararına olduğunu destekleyen kanıtların da sınırlı olduğunu belirtmişlerdir.…”

“…42 Ancak antenatal dönemde yapılan demir desteğinin anemi oluşma-dan önce başlandığı takdirde, aneminin önlenme-sinde etkili olduğunu vurgulamışlardır. 42 Ayrıca antenatal demir desteğinin yenidoğan bebeklerin yararına olduğunu destekleyen kanıtların da sınırlı olduğunu belirtmişlerdir. 42 DSÖ (2016) doğum yapan annede anemi, puerperal sepsis, düşük doğum ağırlığı ve preterm doğumun önlenmesi için gebelikte 30 mg -60 mg elemental demir ve 400 μg (0.4 mg) folik asit içeren günlük oral demir ve folik asit takviyesini gebeliğin başından itibaren önermektedir.…”

An effectiveness-implementation hybrid type 1 trial assessing the impact of group versus individual antenatal care on maternal and infant outcomes in Malawi

“…Antenatal care provides an opportunity for life-saving monitoring, health promotion, and health system linkages through early detection and timely intervention [7][8][9]. In sub-Saharan Africa, however, provider shortages, resource stockouts, and disrespectful care translate into long wait times and short antenatal care visits at which there is inconsistent provisioning of essential services and health promotion [10][11][12]. Providers' failure to deliver essential services along with low attendance after the intake visit combine to reduce opportunities for early detection and timely intervention [13,14].…”