TABLE 5.

Antenatal Care Packages

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Villar et al84Multicenter trial in Saudi Arabia, Argentina, Cuba, and Thailand; urban centers; RCTWomen (n = 24 678) received either standard antenatal care (n = 11 958) or a new model involving fewer visits incorporating scientifically evaluated and objective-oriented activities (n = 12 568); the others were given the care appropriate to any detected condition or risk factor.The maternal morbidity index (83) reached a threshold value in 14.5% of women for the new model and 16.5% for the standard model; there were no significant differences in UTI or maternal anemia rates between the 2 groups.The PMR (2% vs 1.7%), NMR (0.4% each), and LBW rates (7.2% vs 6.7%) were similar in both models.
Munjanja et al713Zimbabwe; rural setting; RCTStudy clinics had fewer visits but more objectively structured visits and fewer procedures (n = 15 994 women recruited: 9394 under the intervention program and 6138 under the standard program).There were 6 maternal deaths in study clinics versus 5 in control clinics.There were 12% fewer premature births in the study clinics (OR: 0.86; CI: 0.78–0.96); no effect was seen on LBW (OR: 0.96; CI: 0.85–1.08) or PMR (OR: 1.2; CI: 0.92–1.6; P = .18).
Srinivasan et al714India; rural setting; RCTWomen were randomized to receive 1 of 3 packages: (1) high-risk package, in which trained midwives identified high-risk pregnancies and intervened accordingly; (2) Tamil Nadu package, which included trained midwives but not high-risk pregnancy identification; and (3) a control group that received a basic package of government-approved care (n = 1145 pregnant women in the study area; 380 were in the high-risk pregnancy group, 320 were in the Tamil Nadu group, and 445 were in the control group).Higher rates of TT immunization were seen in the high-risk package and Tamil Nadu groups (98% and 95%, respectively) than in the control group (72%). Similarly, higher rates of iron-folate usage were observed in the high-risk package and Tamil Nadu groups (75% and 79%, respectively) than in the control group (13%); the proportion of women with maternal Hb <8 g/dL at 34 wk was 16.6% in the Tamil Nadu series but only 5.5% in the high-risk package series.The proportion of preventable neonatal morbidity was lower in the high-risk package series than in the Tamil Nadu series by 11% (CI: −0.8–22.8; P = .06).