Models of antenatal care to reduce and prevent preterm birth: a systematic review and meta-analysis

Abstract

ObjectiveTo assess the effectiveness of models of antenatal care designed to prevent and reduce preterm birth (PTB) in pregnant women.MethodsWe conducted a search of seven electronic databases and reference lists of retrieved studies to identify trials from inception up to July 2014 where pregnant women, regardless of risk factors for pregnancy complications, were randomly allocated to receive an alternative model of antenatal care or routine care. We pooled risks of PTB to determine the effect of alternative care models in all pregnant women. We also assessed secondary maternal and infant outcomes, women's satisfaction and economic outcomes.Results15 trials involving 22 437 women were included. Pregnant women in alternative care models were less likely to experience PTB (risk ratio 0.84, 95% CI 0.74 to 0.96). The subgroup of women randomised to midwife-led continuity models of antenatal care were less likely to experience PTB (0.78, 0.66 to 0.91) but there was no significant difference between this group and women allocated to specialised care (0.92, 0.76 to 1.12) (interaction test for subgroup differences p=0.20). Overall low-risk women in alternative care models were less likely to have PTB (0.74, 0.59 to 0.93), but this effect was not significantly different from that in mixed-risk populations (0.91, 0.79 to 1.05) (subgroup p=0.13).ConclusionsAlternative models of antenatal care for all pregnant women are effective in reducing PTB compared with routine care, but no firm conclusions could be drawn regarding the relative benefits of the two models. Future research should evaluate the impact of antenatal care models which include more recent interventions and predictive tests, and which also offer continuity of care by midwives throughout pregnancy.PROSPERO registration numberCRD42014007116.

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study

“…Fernandez Turienzo et al (2016), in their systematic review and meta-analysis of models of antenatal care designed to reduce and prevent preterm birth, found that while "alternative" models of care (i.e. midwife-led continuity of care and specialised care) reduce preterm birth compared to standard care, conclusions on the relative benefits of the two models could not be drawn.…”

How optimal caseload midwifery can modify predictors for preterm birth in young women: Integrated findings from a mixed methods study

“…Modifying the risk and protective factors inherent in adolescents daily lives, especially for those who are most socio-economically disadvantaged, can improve health outcomes (Viner et al, 2012). Indeed, programmes targeted to improve the circumstances of socially disadvantaged women can reduce PTB (Fernandez Turienzo et al, 2016;Hollowell et al, 2011). While there is some evidence that single interventions including smoking cessation, improved diet for under-nourished women, and antenatal lower genital tract screening are effective in reducing PTB rates (Piso et al, 2014); the effect of model of care is a PTB research priority (Duley et al, 2014).…”

“…Antenatal care is generally thought to improve pregnancy outcomes including preterm birth (Fernandez Turienzo et al, 2016;Hollowell et al, 2011). Receiving less than five visits, compared to five or more visits, has been associated with an eightfold increase in preterm birth, after adjusting for known confounders (Raatikainen et al, 2007).…”

A protocol for a pilot cluster randomized control trial of e-vouchers and mobile phone application to enhance access to maternal health services in Cameroon

“…The sample size calculation assumed and estimated that 20% of the individuals in the poorest quintile do not receive more than two antenatal care visits and are less likely to deliver by a skilled birth attendant in Cameroon [2][3][4][5][6][7][8]. Previous studies reported an approximately 10-15% increase in the use of antenatal care and a 10% increase in the use of skilled delivery [18][19][20][21][22][23][24][25][26]. Thus, the study assumes a 15% difference compared with the control assuming an inter-cluster coefficient of 0.001 [26,45,46], with four clusters.…”

“…In Africa, most women are unable to seek health care due to high out-of-pocket costs [1][2][3][4][5][6][7][8][9][10][11][12]. Systematic reviews on voucher interventions in addressing maternal mortality have shown that vouchers can be effective in improving access to and utilization of maternal health services, especially in poor and underserved communities [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Vouchers typically grant purchasing power to low-income individuals who may otherwise be ignored in the market due to their lack of funds or knowledge of goods and services [18,19].…”