Alternative versus standard packages of antenatal care for low-risk pregnancy

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 methods 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.

Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

“…Moreover, it is possible that some hospital admissions resulted from reasons other than antenatal care such as prescription or maternal anxiety. Furthermore, a systematic review including a total of over 60,000 women compared the effects of reduced antenatal care visits (4-9 visits) with standard care (13-14 visits) (19). In that study, the reduced visit model was not associated with significant increases in postpartum anemia (Relative risk=0.88, 95% CI=0.75-1.03) (19).…”

“…Furthermore, a systematic review including a total of over 60,000 women compared the effects of reduced antenatal care visits (4-9 visits) with standard care (13-14 visits) (19). In that study, the reduced visit model was not associated with significant increases in postpartum anemia (Relative risk=0.88, 95% CI=0.75-1.03) (19). Similarly, we think that the impact of antenatal visit number on maternal anemia in our study mainly resulted from the gestational age at the initiation of antenatal care.…”

Acceptability of focused antenatal care by antenatal clinic attendees in Obio Cottage Hospital, Port Harcourt, Nigeria

“…Where it is implemented, women have been generally satisfied with focused antenatal care, although women in developed countries have expressed dissatisfaction with their care. Concerns [9,[31][32][33] have been raised by women and service providers about fewer visits and spacing of visits. Secondary analysis of the WHO 2001 randomized control trial of focused antenatal care showed excess of foetal deaths in those who had fewer visits [34].…”

The interconnections between maternal and newborn health – evidence and implications for policy

“…Impact analysis: A Cochrane review by Dowswell et al [138] showed a significant increase in the number of maternal deaths (RR 1.13; 95% CI: 0.5 to 2.57) with reduced number of antenatal visits as compared to standard ANC visits. However, availability of ANC services leads to an increase in the detection of anemia (from 26.3% pre-intervention to 41.3% post-intervention, p ¼ 0.001) [139] and pregnancy-induced hypertension (PIH) (11% in women attending one of the care programs versus 5.1% women not attending the program, P 0.03) [139].…”