How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence

This is an overview of evidence of the effectiveness of antenatal care in r elation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mo rtality, and traces their antecedent morbidities and risk factors in pregna ncy. It also includes interventions aimed at preventing, detecting or treat ing any stage along this pathway during pregnancy. This is an updated and e xpanded version of a review first published by the World Health Organizatio n (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation a re considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in c onditions that can lead to maternal mortality or serious morbidity is prese nted. Interventions for which there is some promising evidence, short of pr oof, of effectiveness are explored, and the outstanding questions formulate d. These are presented in a series of tables with suggestions about the typ es of study needed to answer them.