WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care

Background We undertook a multicentre randomised controlled trial that comp ared the standard model of antenatal care with a new model that emphasises actions known to be effective in improving maternal or neonatal outcomes an d has fewer clinic visits. Methods Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randoml y allocated to provide either the new model (27 clinics) or the standard mo del currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further spe cific assessment or treatment were offered the basic component of the new m odel, and those deemed at higher risk received the usual care for their con ditions; however, all were included in the new-model group for the analyses , which were by intention to treat. The primary outcomes were low birthweig ht (<2500 g), pre-eclampsia/eclampsia, severe postpartum anaemia (<90 g/L h aemoglobin), and treated urinary-tract infection. There was an assessment o f quality of care and an economic evaluation. Findings Women attending clinics assigned the new model (n = 12 568) had a median of five visits compared with eight within the standard model (n = 11 958). More women in the new model than in the standard model were referred to higher levels of care (13.4% vs 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates o f low birthweight (new model 7.68% vs standard model 7.14%; stratified rate difference 0.96 [95% CI -0.01 to 1.92]), postpartum anaemia (7.59% vs 8.67 %; 0.32), and urinary-tract infection (5.95% vs 7.41%; -0.42 [-1.65 to 0.80 ]). For pre-eclampsia/eclampsia the rate was slightly higher in the new mod el (1.69% vs 1.38%; 0.21 [-0.25 to 0.67]). Adjustment by several confoundin g variables did not modify this pattern. There were negligible differences between groups for several secondary outcomes. Women and providers in both groups were, in general, satisfied with the care received, although some wo men assigned the new model expressed concern about the timing of visits. Th ere was no cost increase, and in some settings the new model decreased cost . Interpretations Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented with out major resistance from women and providers and may reduce cost.