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Journal Article•DOI•

The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review

Jennifer Hollowell1, Laura Oakley1, Jennifer J Kurinczuk1, Peter Brocklehurst1, Ron Gray1 •
University of Oxford1
11 Feb 2011-BMC Pregnancy and Childbirth (BioMed Central)-Vol. 11, Iss: 1, pp 13-13
TL;DR: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women.
Abstract: Background: Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated. Methods: We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS)). Results: We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered ‘promising’. Conclusions: There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation.

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Citations
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Journal Article•DOI•
Valid post-selection inference

[...]

Richard A. Berk1, Lawrence D. Brown1, Andreas Buja1, Kai Zhang, Linda Zhao1 •
University of Pennsylvania1
05 Jun 2013-arXiv: Statistics Theory
TL;DR: In this paper, the problem of post-selection inference is reduced to one of simultaneous inference, and the authors propose to use simultaneous inference for all linear functions that arise as coefficient estimates in all submodels.
Abstract: It is common practice in statistical data analysis to perform data-driven variable selection and derive statistical inference from the resulting model. Such inference enjoys none of the guarantees that classical statistical theory provides for tests and confidence intervals when the model has been chosen a priori. We propose to produce valid ``post-selection inference'' by reducing the problem to one of simultaneous inference and hence suitably widening conventional confidence and retention intervals. Simultaneity is required for all linear functions that arise as coefficient estimates in all submodels. By purchasing ``simultaneity insurance'' for all possible submodels, the resulting post-selection inference is rendered universally valid under all possible model selection procedures. This inference is therefore generally conservative for particular selection procedures, but it is always less conservative than full Scheffe protection. Importantly it does not depend on the truth of the selected submodel, and hence it produces valid inference even in wrong models. We describe the structure of the simultaneous inference problem and give some asymptotic results.

447 citations

Cites methods from "The effectiveness of antenatal care..."

  • ...We ordered the covariates by priority, year of birth being first because of the structure of the study, followed by gestational age in weeks (0, 33], (33, 36], (36, 38], (38, 40] and (40,∞), categories based on an estimated propensity score for the propensity to be born in Philadelphia, mother’s age in years (0, 18], (18, 34], (34,∞), mother’s education in four groups by degree....

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Journal Article•DOI•
Valid post-selection inference

[...]

Richard A. Berk1, Lawrence D. Brown1, Andreas Buja1, Kai Zhang, Linda Zhao1 •
University of Pennsylvania1
01 Apr 2013-Annals of Statistics
TL;DR: In this article, the problem of post-selection inference has been reduced to one of simultaneous inference, and the authors propose to buy simultaneous insurance for all possible submodels to ensure that the resulting inference is universally valid under all possible model selection procedures.
Abstract: It is common practice in statistical data analysis to perform data-driven variable selection and derive statistical inference from the resulting model. Such inference enjoys none of the guarantees that classical statistical theory provides for tests and confidence intervals when the model has been chosen a priori. We propose to produce valid “post-selection inference” by reducing the problem to one of simultaneous inference and hence suitably widening conventional confidence and retention intervals. Simultaneity is required for all linear functions that arise as coefficient estimates in all submodels. By purchasing “simultaneity insurance” for all possible submodels, the resulting post-selection inference is rendered universally valid under all possible model selection procedures. This inference is therefore generally conservative for particular selection procedures, but it is always less conservative than full Scheffe protection. Importantly it does not depend on the truth of the selected submodel, and hence it produces valid inference even in wrong models. We describe the structure of the simultaneous inference problem and give some asymptotic results.

388 citations

Journal Article•DOI•
Social inequality and infant health in the UK: systematic review and meta-analyses

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Alison Lesley Weightman1, Helen Elizabeth Morgan, Michael Allan Shepherd, Hilary Kitcher, Chris Roberts, Frank David John Dunstan •
Cardiff University1
01 Jan 2012-BMJ Open
TL;DR: The magnitude of effect is similar across a range of area and individual deprivation measures and birth and mortality outcomes and further research should explore the factors that are more proximal to mothers and infants.
Abstract: Objectives To determine the association between area and individual measures of social disadvantage and infant health in the UK. Design Systematic review and meta-analyses. Data sources 26 databases and websites, reference lists, experts in the field and hand-searching. Study selection 36 prospective and retrospective observational studies with socioeconomic data and health outcomes for infants in the UK, published from 1994 to May 2011. Data extraction and synthesis 2 independent reviewers assessed the methodological quality of the studies and abstracted data. Where possible, study outcomes were reported as ORs for the highest versus the lowest deprivation quintile. Results In relation to the highest versus lowest area deprivation quintiles, the odds of adverse birth outcomes were 1.81 (95% CI 1.71 to 1.92) for low birth weight, 1.67 (95% CI 1.42 to 1.96) for premature birth and 1.54 (95% CI 1.39 to 1.72) for stillbirth. For infant mortality rates, the ORs were 1.72 (95% CI 1.37 to 2.15) overall, 1.61 (95% CI 1.08 to 2.39) for neonatal and 2.31 (95% CI 2.03 to 2.64) for post-neonatal mortality. For lowest versus highest social class, the odds were 1.79 (95% CI 1.43 to 2.24) for low birth weight, 1.52 (95% CI 1.44 to 1.61) for overall infant mortality, 1.42 (95% CI 1.33 to1.51) for neonatal and 1.69 (95% CI 1.53 to 1.87) for post-neonatal mortality. There are similar patterns for other infant health outcomes with the possible exception of failure to thrive, where there is no clear association. Conclusions This review quantifies the influence of social disadvantage on infant outcomes in the UK. The magnitude of effect is similar across a range of area and individual deprivation measures and birth and mortality outcomes. Further research should explore the factors that are more proximal to mothers and infants, to help throw light on the most appropriate times to provide support and the form(s) that this support should take.

125 citations

Cites background from "The effectiveness of antenatal care..."

  • ...In a recent systematic review of 36 studies, the authors concluded that, while there is insufficient evidence to recommend any particular programme at the moment, some targeted antenatal care programmes are promising and warrant rigorous evaluation.(78) Harden et al(79) concluded that there is promise for appropriately designed early childhood interventions and youth development programmes to reduce unintended teenage pregnancy, especially if such interventions take into account the known views and emotions correlated with teenage pregnancy, such as dislike of school, low expectations of life and poor material circumstances....

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Journal Article•DOI•
The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis

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Tesfalidet Tekelab1, Catherine Chojenta1, Roger Smith1, Deborah Loxton1•
University of Newcastle1
13 Sep 2019-PLOS ONE
TL;DR: This review indicates that utilization of at least one antenatal care visit by a skilled provider during pregnancy reduces the risk of neonatal mortality by 39% in sub-Saharan African countries.
Abstract: Background Newborns are at greatest risk of dying at and shortly after the time of birth. Newborn mortality remains an urgent concern and is an important indicator of child health, development and well-being. Studies examining the effectiveness of antenatal care on maternal and newborn health outcomes have provided conflicting results. The aim of this review and meta-analysis was to determine the pooled effect of antenatal care on neonatal mortality in sub-Saharan Africa. Methods We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar from September to November 2016 and then updated our search on April 13, 2019. Two independent reviewers extracted data from eligible studies. The quality of each included study was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies (RoBANS). The results were reported based on risk ratio (RR) with 95% confidence intervals (CI) using a random-effects model. Results Eight hundred and ninety eight studies were initially identified. During screening, 23 studies were found to be relevant for data extraction. Of these, only twelve studies fulfilled the inclusion criteria and were included in the analysis. In five of the twelve studies included in the analysis, antenatal care service utilization had a significant association with neonatal mortality. The pooled risk ratio by the random-effects model was 0.61 (95% CI: 0.43, 0.86) for neonates born to women who received at least one antenatal care visit by a skilled provider as compared to neonates born to women who did not receive antenatal care. Conclusion This review indicates that utilization of at least one antenatal care visit by a skilled provider during pregnancy reduces the risk of neonatal mortality by 39% in sub-Saharan African countries. Thus, in order to accelerate progress towards the reduction of newborn deaths, all pregnant women should receive antenatal care during pregnancy.

92 citations

Journal Article•DOI•
An investigation of the relationship between the caseload model of midwifery for socially disadvantaged women and childbirth outcomes using routine data – A retrospective, observational study

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Hannah Rayment-Jones1, Trevor Murrells1, Jane Sandall2•
King's College London1, St Thomas' Hospital2
01 Apr 2015-Midwifery
TL;DR: caseload midwifery care appeared to confer increased benefit and reduced harmful outcomes, suggesting caseload care may affect women in different ways depending on their individual needs.

74 citations

Cites background or result from "The effectiveness of antenatal care..."

  • ...However findings from a large cohort study (Hollowell et al., 2011) cannot be directly compared to findings in this study due to the differences in population....

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  • ...However, a recent systematic review found insufficient evidence of adequate quality to recommend routine implementation of any programme reviewed as a means of reducing infant mortality in disadvantaged populations-caseload care was not considered (Hollowell et al., 2011)....

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  • ...Place of birth is well documented in terms of improving birth outcomes with birth outside of an obstetric unit decreasing rates of intervention (NICE, 2010; Hollowell et al., 2011), this is demonstrated in the findings....

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  • ...Hollowell et al. (2011) only studied the pregnancy outcomes of women who were medically low risk and the outcomes were analysed according to where the participants had planned to give birth, not where the birth occurred....

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References
More filters
Journal Article•DOI•
Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources

[...]

Trisha Greenhalgh1, Richard Peacock•
University College London1
03 Nov 2005-BMJ
TL;DR: Systematic reviews of complex evidence cannot rely solely on protocol-driven search strategies, and primary sources must be identified by “snowballing” or by personal knowledge or personal contacts.
Abstract: Objective To describe where papers come from in a systematic review of complex evidence. Method Audit of how the 495 primary sources for the review were originally identified. Results Only 30% of sources were obtained from the protocol defined at the outset of the study (that is, from the database and hand searches). Fifty one per cent were identified by “snowballing” (such as pursuing references of references), and 24% by personal knowledge or personal contacts. Conclusion Systematic reviews of complex evidence cannot rely solely on protocol-driven search strategies.

1,480 citations

"The effectiveness of antenatal care..." refers methods in this paper

  • ...We took some additional steps to increase ascertainment of relevant material, including using an adapted version of an ‘equity filter’ (developed by the EPPI-Centre to identify material relating to health inequalities) in our searches, and ‘snowballing’ [58]....

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Journal Article•DOI•
Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing : a randomized controlled trial

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Harriet Kitzman1, David L. Olds, Charles R. Henderson, Carole Hanks, Robert Cole, Robert Tatelbaum, Kenneth M. McConnochie, Kimberly Sidora, Dennis W. Luckey, David Shaver, Kay Engelhardt, David C. James, Kathryn Barnard •
University of Rochester1
27 Aug 1997-JAMA
TL;DR: This program of home visitation by nurses can reduce pregnancy-induced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.
Abstract: Context. —Interest in home-visitation services as a way of improving maternal and child outcomes has grown out of the favorable results of a trial in semirural New York. The findings have not been replicated in other populations. Objective. —To test the effect of prenatal and infancy home visits by nurses on pregnancy-induced hypertension, preterm delivery, and low birth weight; on children's injuries, immunizations, mental development, and behavioral problems; and on maternal life course. Design. —Randomized controlled trial. Setting. —Public system of obstetric care in Memphis, Tenn. Participants. —A total of 1139 primarily African-American women at less than 29 weeks' gestation, with no previous live births, and with at least 2 sociodemographic risk characteristics (unmarried, Intervention. —Nurses made an average of 7 (range, 0-18) home visits during pregnancy and 26 (range, 0-71) visits from birth to the children's second birthdays. Main Outcome Measures. —Pregnancy-induced hypertension, preterm delivery, low birth weight, children's injuries, ingestions, and immunizations abstracted from medical records; mothers' reports of children's behavioral problems; tests of children's mental development; mothers' reports of subsequent pregnancy, educational achievement, and labor-force participation; and use of welfare derived from state records. Main Results. —In contrast to counterparts assigned to the comparison condition, fewer women visited by nurses during pregnancy had pregnancy-induced hypertension (13% vs 20%; P =.009). During the first 2 years after delivery, women visited by nurses during pregnancy and the first 2 years of the child's life had fewer health care encounters for children in which injuries or ingestions were detected (0.43 vs 0.55; P =.05); days that children were hospitalized with injuries or ingestions (0.03 vs 0.16; P P =.006). There were no program effects on preterm delivery or low birth weight; children's immunization rates, mental development, or behavioral problems; or mothers' education and employment. Conclusion. —This program of home visitation by nurses can reduce pregnancyinduced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.

702 citations

"The effectiveness of antenatal care..." refers background in this paper

  • ...Overall, fifteen of the studies (14 primary studies [23,41-43,46-55] and one secondary report providing supplementary data[38]) were considered to have ‘adequate’ internal validity....

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  • ...Adjusted % PTB ( 37 weeks): 9.8% vs. 13.8%, p = .045 Adjusted odds ratio (95% CI) for PTB: 0.67 (0.44-0.98) N/A Yes/Yes N/A Temple Infant and Parent Support Services (TIPPS) programme Reece, 2002 380 women enrolled in the Temple Infant and Parent Support Services (TIPPS) vs. 437 women (not randomised) receiving usual care (matched for age, parity, ethnicity, health insurance and smoking) % PTB* ( 37 weeks): 4.3% vs. 12.0%, p 0.005 N/A Yes/ Possibly N/A Tennessee Medicaid Managed Care programme (TennCare) Conover, 2001 Before and after study with an adjacent geographical area as a control group....

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  • ...Adjusted Odds Ratio (95% CI) for PTB ( 37 weeks): Adjusted Odds Ratios (95% CI) for neonatal death ( 28 days): No conclusion stated/No No/No IB = Intervention area, ’before’ IA = Intervention area, ’after’ CB = Comparator area, ’before’ CA = Comparator area, ’after’ TN = Tennessee NC = North Carolina Sample size (births): IB: 69329 IA:70045 CB: 94012 CA: 94910 Not randomised....

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  • ...Tennessee Medicaid Managed Care programme (TennCare) Conover, 2001/USA Antenatal services for Medicaid eligible women in Tennessee and North Carolina....

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  • ...Hollowell et al. BMC Pregnancy and Childbirth 2011, 11:13 http://www.biomedcentral.com/1471-2393/11/13 Page 4 of 20 One study, a before and after study with a contemporaneous comparison group, evaluated a ‘managed care’ model of delivering antenatal care (the Tennessee Medicaid Managed Care programme (TennCare)) in one US state (Tennessee) against a standard antenatal care model in an adjacent state (North Carolina) [47]....

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BMC Pregnancy and Childbirth

[...]

Joy E Lawn, Mohammad Yawar Yakoob, Rachel A Haws, Tanya Soomro, Gary L. Darmstadt, Zulfiqar A Bhutta, Afsah Zulfiqar Bhutta, L Darmstadt 
01 Jan 2009
TL;DR: This first paper in the series outlines issues in stillbirth data availability and quality, the global epidemiology of stillbirths, and describes the methodology and framework used for the review of interventions and strategies.
Abstract: More than 3.2 million stillbirths occur globally each year, yet stillbirths are largely invisible in global data tracking, policy dialogue and programme implementation. This mismatch of burden to action is due to a number of factors that keep stillbirths hidden, notably a lack of data and a lack of consensus on priority interventions, but also to social taboos that reduce the visibility of stillbirths and the associated family mourning. Whilst there are estimates of the numbers of stillbirths, to date there has been no systematic global analysis of the causes of stillbirths. The multiple classifications systems in use are often complex and are primarily focused on high-income countries. We review available data and propose a programmatic classification that is feasible and comparable across settings. We undertook a comprehensive global review of available information on stillbirths in order to 1) identify studies that evaluated risk factors and interventions to reduce stillbirths, 2) evaluate the level of evidence for interventions, 3) place the available evidence for interventions in a health systems context to guide programme implementation, and 4) elucidate key implementation, monitoring, and research gaps. This first paper in the series outlines issues in stillbirth data availability and quality, the global epidemiology of stillbirths, and describes the methodology and framework used for the review of interventions and strategies.

664 citations

Journal Article•DOI•
Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation

[...]

David L. Olds, Charles R. Henderson, Robert Tatelbaum, Robert W. Chamberlin
01 Jan 1986-Pediatrics
TL;DR: The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status.
Abstract: We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)

577 citations

"The effectiveness of antenatal care..." refers background in this paper

  • ...Olds DL, Henderson CR Jr, Tatelbaum R, Chamberlin R: Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation....

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  • ...One review from the early 1990 s evaluated ‘prenatal care packages’ [21] but found only five studies of adequate quality which evaluated the effect of the programme on gestational age at birth and/or infant mortality, two of which (Nurse Home Visitation [22]; and case management [23]) were found to have a positive effect on the relevant outcome measure....

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  • ...A well-designed RCT to evaluate the antenatal home visiting component of the Prenatal and Early Childhood Nurse Home Visitation Program in multi-disadvantaged, black, low-income women in Tennessee [51], found no evidence of a beneficial effect on PTB (11% PTB in the intervention group vs. 13% in the comparator group; adjusted odds ratio 0.8 (95% CI 0.6-1.2))....

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Journal Article•DOI•
The contribution of preterm birth to infant mortality rates in the United States.

[...]

William M. Callaghan1, Marian F. MacDorman1, Sonja A. Rasmussen1, Cheng Qin1, Eve M. Lackritz1 •
Centers for Disease Control and Prevention1
01 Oct 2006-Pediatrics
TL;DR: The extreme prematurity of most of the infants and their short survival indicate that reducing infant mortality rates requires a comprehensive agenda to identify, to test, and to implement effective strategies for the prevention of preterm birth.
Abstract: OBJECTIVE. Although two thirds of infant deaths in the United States occur among infants born preterm ( METHODS. We identified the top 20 leading causes of infant death in 2002 in the US linked birth/infant death file. The role of preterm birth for each cause was assessed by determining the proportion of infants who were born preterm for each cause of death and by considering the biological connection between preterm birth and the specific cause of death. RESULTS. Of 27970 records in the linked birth/infant death file for 2002, the 20 leading causes accounted for 22273 deaths (80% of all infant deaths). Among infant deaths attributable to the 20 leading causes, we classified 9596 infant deaths (34.3% of all infant deaths) as attributable to preterm birth. Ninety-five percent of those deaths occurred among infants who were born at CONCLUSIONS. On the basis of this evaluation, preterm birth is the most frequent cause of infant death in the United States, accounting for at least one third of infant deaths in 2002. The extreme prematurity of most of the infants and their short survival indicate that reducing infant mortality rates requires a comprehensive agenda to identify, to test, and to implement effective strategies for the prevention of preterm birth.

513 citations

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