WHO systematic review of randomised controlled trials of routine antenatalcare

Background There is a lack of strong evidence on the effectiveness of the c ontent, frequency, and timing of visits in standard antenatal-care programm es. We undertook a systematic review of randomised trials assessing the eff ectiveness of different models of antenatal care. The main hypothesis was t hat a model with a lower number of antenatal visits, with or without goal-o riented components, would be as effective as the standard antenatal-care mo del in terms of clinical outcomes, perceived satisfaction, and costs. Methods The interventions compared were the provision of a lower number of antenatal visits (new model) and a standard antenatal-visits programme. The selected outcomes were preeclampsia, urinary-tract infection, postpartum a naemia, maternal mortality, low birthweight, and perinatal mortality. We al so selected measures of women's satisfaction with care and cost-effectivene ss. This review drew on the search strategy developed for the Cochrane Preg nancy and Childbirth Group of the Cochrane Collaboration. Findings Seven eligible randomised controlled trials were identified. 57 41 8 women participated in these studies: 30 799 in the new-model groups (29 8 70 with outcome data) and 26 619 in the standard-model groups (25 821 with outcome data). There was no clinically differential effect of the reduced n umber of antenatal visits when the results were pooled for pre-eclampsia (t ypical odds ratio 0.91 [95% CI 0.66-1.26]), urinary-tract infection (0.93 [ 0.79-1.10]). postpartum anaemia (1.01), maternal mortality (0.91 [0.55-1.51 ]), or low birthweight (1.04 [0.93-1.17]). The rates of perinatal mortality were similar, although the rarity of the outcome did not allow formal stat istical equivalence to be attained. Some dissatisfaction with care, particu larly among women in more developed countries, was observed with the new mo del. The cost of the new model was equal to or less than that of the standa rd model. Interpretation A model with a reduced number of antenatal visits, with or w ithout goal-oriented components, could be introduced into clinical practice without risk to mother or baby, but some degree of dissatisfaction by the mother could be expected. Lower costs can be achieved.