TABLE 2

Review of Key Impacts of Health Interventions Delivered During Preconception and Pregnancy

Key InterventionsSummary Effects With Implications for Developmental Outcomes (Direct Developmental Effects)
Preconception diabetes care, 1 SR, HIC and LMICImproved fetal development: reduced risk of congenital malformations (RR 0.30, 95% CI 0.22 to 0.41; N = 4760 in 20 studies)
Antiplatelet agents in pregnancy for preeclampsia prevention, 1 SR, HIC and LMICImproved birth outcomes: reduced risk of preterm birth (RR 0.92, 95% CI 0.88 to 0.97; N = 31 151 in 29 studies), SGA birth (RR 0.90, 95% CI 0.83 to 0.98; N = 23 638 in 36 studies)
Fewer motor deficits in infancy: reduced risk of poor gross or fine motor function at 18 mo (RR 0.49, 95% CI 0.26 to 0.91; N = 788 in 1 study)
Nonsignificant effects: poor gross motor function at 18 mo (RR 0.82, 95% CI 0.57 to 1.17; N = 4365 in 1 study), poor language expression at 18 mo (RR 0.94, 95% CI 0.74 to1.19; N = 4365 in 1 study)
IPTp and insecticide-treated bed nets for malaria prevention, 3 SRs, LMICImproved birth weight: IPTp with sulfadoxine-pyrimethamine reduced risk of low birth weight (RR 0.81, 95% CI 0.67 to 0.99; N = 3043 in 7 studies) and IPTp combined with bed net usage reduced risk of low birth weight (RR 0.65, 95% CI 0.55 to 0.77; N = 3360 in 5 studies)
Antibiotics for premature rupture of membranes, 2 SR, HIC and LMICLonger gestation: reduced the chance of birth within 7 d of treatment (RR 0.79, 95% CI 0.71 to 0.89; N = 5965 in 7 studies)
Fewer brain injuries: reduced risk of major cerebral abnormalities on ultrasound (RR 0.81, 95% CI 0.68 to 0.98; N = 6289 in 11 studies)
Protection from infection: reduced risk of neonatal infections including pneumonia (RR 0.67, 95% CI 0.52 to 0.85; N = 1680 in 12 studies)
Lower genital tract infection screening and treatment, 1 SR, HICImproved birth outcomes: reduced risk of preterm birth (RR 0.55, 95% CI 0.41 to 0.75; N = 4155 in 1 study) and preterm and low birth weight (RR 0.48, 95% CI 0.34 to 0.66; N = 4155 in 1 study)
Antibiotics for asymptomatic bacteriuria, 1 SR, HICImproved birth outcomes: reduced risk of preterm birth (RR 0.27, 95% CI 0.11 to 0.62; N = 242 in 2 studies) and low birth weight (RR 0.64, 95% CI 0.45 to 0.93; N = 1437 in 6 studies)
Detection and treatment of syphilis, 1 SR, HIC and LMICImproved birth outcomes: reduced risk of preterm birth (RR 0.36, 95% CI 0.27 to 0.47; N = 1959 in 7 studies)
Protection from syphilis infection at birth: reduced risk of congenital syphilis (RR 0.03, 95% CI 0.02 to 0.07; N = 3460 in 3 studies)
Smoking cessation interventions, 1 SR, HIC and LMICImproved birth outcomes: reduced risk of low birth weight (RR 0.82, 95% CI 0.71 to 0.94; N = 8562 in 14 studies) and preterm birth (RR 0.82, 95% CI 0.70 to 0.96; N = 7852 in 14 studies)
Magnesium sulfate for neuroprotection in imminent preterm births, 1 SR, HIC and LMICProtection from motor disability and dysfunction: reduced risk of cerebral palsy (RR 0.68, 95% CI 0.54 to 0.87; N = 6145 in 5 studies) and gross motor dysfunction (RR 0.61, 95% CI 0.44 to 0.85; N = 5980 in 4 studies)
Nonsignificant effects: developmental delay or intellectual impairment (RR 0.99, 95% CI 0.91 to 1.09; N = 5980 in 4 studies)
Antenatal corticosteroids, 2 SRs, HIC and LMICFewer neonatal complications: reduced risk of cerebroventricular hemorrhage (RR 0.54, 95% CI 0.43 to 0.69; N = 2872 in 12 studies), respiratory distress syndrome (RR 0.66, 95% CI 0.59 to 0.73; N = 4038 in 21 studies), sepsis within 48 h (RR 0.56, 95% CI 0.38 to 0.85; N = 1319 in 4 studies), and necrotizing enterocolitis (RR 0.46, 95% CI 0.29 to 0.74; N = 1675 in 8 studies)
Improved child development: reduced risk of developmental delay in childhood (RR 0.49, 95% CI 0.24 to 1.00; N = 518 in 2 studies)
Nonsignificant effects: neurodevelopmental delay in childhood (RR 0.64, 95% CI 0.14 to 2.98; N = 988 in 1 study), intellectual impairment in childhood (RR 0.86, 95% CI 0.44 to 1.69; N = 778 in 3 studies), and behavioral and/or learning difficulties in childhood (RR 0.86, 95% CI 0.35 to 2.09; N = 90 in 1 study)
  • CI, confidence interval; HIC, high-income country; IPTp, intermittent preventive therapy in pregnancy; RR, risk ratio; SR, systematic review.