ArticlesWHO systematic review of randomised controlled trials of routine antenatal care
Introduction
There is a lack of strong evidence that the content, frequency, and timing of visits in currently recommended “western” programmes for routine antenatal care are effective. Observational studies have consistently shown that groups having more antenatal-care visits have lower maternal, fetal, and neonatal morbidity and mortality than those who have fewer antenatal-care visits. Conversely, randomised comparative trials of differing numbers of visits, reported in the past few years, suggest that a model with a lower number of visits is at least as effective as the standard model. We undertook a systematic review to answer the question of whether a model with a lower number of antenatal visits, with or without goal-oriented components, is at least as effective in clinical terms, satisfaction perceived by women, and costs as the standard model.
Section snippets
Methods
We considered for this review any randomised controlled trial that compared a model of a lower number of antenatal visits with the standard model. The participants in these trials were pregnant women attending antenatal care. We classified as “goal oriented” models in which the researchers explicitly gave priority to the implementation of components shown to be effective in improving clinically relevant maternal and perinatal outcomes. We selected a priori for the meta-analyses outcomes for
Results
Seven eligible randomised controlled trials were identified (table 1).4, 10, 11, 20, 21, 22, 23 Four of them took place in more developed countries.20, 21, 22, 23 Two were done in Zimbabwe.10, 11 The largest was a multicentre trial in Argentina, Cuba, Saudi Arabia, and Thailand.4 Four of the studies were individual-randomisation trials,20, 21, 22, 23 and three cluster-randomisation trials.4, 10, 11
A total of 57 418 women participated in these studies: 30 799 in models with reduced numbers of
Discussion
In this systematic review, we selected a priori several outcomes thought to be substantial health problems closely linked with antenatal care. However, the outcomes selected for the review were not in all cases the same primary outcomes as identified in the individual trials or the reported outcomes in each of the trials. Antenatal care consists of several activities and intervention procedures aimed at improving various events. Therefore, different researchers selected different variables as
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