Background
Methods
Database/information source | Inclusion criteria | Exclusion criteria |
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British Nursing Index Cochrane Database of Systematic Reviews Cochrane Central Register of Controlled Trials (CENTRAL) CINAHL Plus ClinicalTrials.gov Science Citation Index Expanded (SCI-EXPANDED) Social Sciences Citation Index (SSCI) Conference Proceedings Citation Index- Science (CPCI-S) Conference Proceedings Citation Index- Social Science & Humanities (CPCI-SSH) Database of Abstracts of Reviews of Effects (DARE) Econlit Embase Health Technology Assessment (HTA) Database International Clinical Trials Registry Platform (ICTRP) Maternity and Infant Care MEDLINE In-Process & Other Non-Indexed Citations and MEDLINE POPLINE PsycINFO NHS Economic Evaluation Database (EED) HEED: Health Economic Evaluations Database | • Study design: RCTs and reviews of RCTs, with meta-analysis • Population: pregnant women receiving antenatal care, +/- family or people delivering such care • Intervention: any model offering a defined package of antenatal care, which might be delivered by professional staff or peer/non-professional supporter • Outcome(s): maternal/infant perinatal outcomes; maternal psychosocial outcomes; organisational outcomes, including economic evaluations; maternal health behaviour outcomes | • Reviews of mixed methods studies, where the results of any RCTs were not clearly identifiable from other results and/or they did not contain a meta-analysis (and therefore did not add to original papers) • Interventions only offered during labour and/or the postnatal period • Stated outcomes were not relevant to pregnancy, birth or the period following birth (further defined as up to 2 years following birth) • The main area of interest or outcome related specifically to child abuse • An English language version was not available (due to translation and resource limitations) |
Results
Care models | Type of care/intervention | Personnel | Organisation | Location |
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Universal provision model – no restrictions on eligibility | Clustered community-focussed models | TBAs; skilled birth attendants (midwives, nurses, physicians, ‘lady health workers’ etc.), health committees; community workers; health facilitators/educators/trainers; volunteers | Task-based; participatory women’s groups; learning and action cycle; mostly group-based within community settings; Lack of continuity of carer | Home; community setting; health centre; commune |
Reduced/flexible visits | Midwives, GPs (general practitioners/family physicians), obstetricians | Task-based; individual focus; lack of continuity | Hospital; urban community; clinic | |
Hospital-based group models | Midwives | Antenatal clinic | ||
Midwifery-led models (some allowed mixed risk) | Midwives; obstetric nurses; rural practice team | Midwifery-led; Continuity of care/carer; sometimes task-based. | Antenatal clinic; teaching hospital, rural clinic | |
Restricted ‘lower risk’-based model – eligibility limited to (‘low risk’ women) | Midwifery-led models | Midwives, with medical support as required | Midwife-led; Woman-centred; Continuity of care/carer | Home/community setting and/or hospital/institutional setting; birth centre. |
Reduced/flexible visits | Midwives, obstetricians, GPs (general practitioners/family physicians); OB-GYNs (obstetrician-gynecologists); certified nurse-midwives. | Task-based; individual focus; lack of continuity; some flexibility. | Hospital clinic; GP surgery; birth centre. | |
Augmented provision model – no restrictions on eligibility but with additional care given | Supplementary antenatal care or educational input | Psychotherapists; health care professionals (physicians; nurses; midwives); home visitors; community health workers; nurse-midwives | Group or individual focus; structured health education; continuity of care; family-focussed; case-note holding | Health centre; clinic; hospital; home |
Behavioural or lifestyle intervention, including effect of exercise on gestational weight gain, pregnancy outcomes, breast feeding, relaxation etc. | Dieticians; fitness instructors; obstetricians; ‘interventionist’ physiotherapists; midwives | Individual counselling; exercise training; dietary advice, weight management; hypnosis; task-based | Clinic; community; hospital; home | |
Targeted ‘higher risk’-based model - for specific groups | Specific care for women with identified Clinical/Psychosocial/Socio-demographic risk factors: | Physicians and/or midwives/nurses | Task-based or woman-centred Continuity of care/carer or no continuity | Hospital/institutional setting |
Category | Description | Universal provision: Principal paper from RCT First author; year; [country of study]; * indicates sibling paper(s) – see relevant reference list; (SR1 etc. if included in a related systematic review) | Systematic Reviews associated with this category |
---|---|---|---|
Community delivered interventions (n = 14 principal papers and 1 SR) (see Additional file 1 reference list T3-1) | Interventions were mainly delivered in poor rural areas and underserved communities, typically in Asian/South Asian settings | Azad 2010 [Bangladesh] (SR1,16) Bhutta 2011 [Pakistan] Colborn 2013 [Malawi] (SR1) Darmstadt 2010 [Bangladesh] Fottrell 2013 [Bangladesh] (SR1) Jokhio 2005 [Pakistan] Lewycka 2013 [Malawi] (SR1) Manandhar 2004 [Nepal] (SR1) Midhet 2010 [Pakistan] Miller 2012 [Pakistan] More 2012 [India] (SR1) Mullany 2007 [Nepal] Pasha 2013 [India, Pakistan, Kenya, Zambia, Guatemala, Argentina] Persson 2013 [Vietnam] | 1 Prost et al. 2013 |
Midwifery-led interventions (n = 5 principal papers, and 3 SRs) (see Additional file 1 reference list T3-2) | Studies where the main focus was on the impact of antenatal care delivered by midwives, or a comparison of midwifery-led care with another mode/model of delivery | McLachlan BK 2000 [UK - England] (SR2,3) Rowley 1995 [Australia] (SR2,3,4) Tracy 2013 [Australia] Walker 2013 [Mexico] Wu 2011 [China] | 2 Devane et al. 2010 3 Sandall et al. 2013 4 Waldenstrom et al. 1998 |
Reduced/flexible visit interventions (n = 4 principal papers and 1 SR) (see Additional file 1 reference list T3-3) | Models investigating whether reduced or flexible antenatal visits had an impact on maternal/infant outcomes | Clement 1996 [UK – England] Majoko 2007 [Zimbabwe] (SR7,9,10) Munjanja 1996 [Zimbabwe] (SR5,8,9,10) Villar 2001 [Argentina, Cuba, Saudi Arabia, Thailand] (SR2,5,7,9,10) | 5 Carroli et al. 2001 |
Group-based antenatal care interventions (n = 2 principal papers, 1 sibling paper and 1 SR) (see Additional file 1 reference list T3-4) | Comparing group-based and individual antenatal care | Andersson 2013 [Sweden] (SR6) Jafari 2010 [Iran] * (SR6) | 6 Homer et al. 2012 (see Additional file 1 reference list T3-4) |
Multiple foci (n = 1 SR) (see Additional file 1 reference list T3-5) | N/A | 7 Yakoob et al. 2009 – interventions that impact on stillbirth |
Category | Description | Restricted risk-based provision: Principal paper from RCT First author; year; [country of study]; * indicates sibling paper(s) – see relevant reference list; (SR1 etc. if included in a related systematic review) | Systematic Reviews associated with this category |
---|---|---|---|
Midwifery-led interventions (n = 12 principal papers, 8 ‘sibling’ papers and 5 SRs) (see Additional file 1 reference list T4-1) | Studies where the main focus was on the impact of antenatal care delivered by midwives, or a comparison of midwifery-led care with another mode/model of delivery | Begley 2011 [Ireland] (SR2,3) Biro 2000 [Australia] * (SR2,3) Flint 1989 [UK - England] (SR2,3,4) Giles 1992 [Australia] (SR8,9) Gu 2013 [China] Harvey 2002 [Canada] (SR2) Hicks 2003 [UK - England] (SR2,3) Homer 2001 [Australia] * (SR2,3,7) McLachlan HL 2012 [Australia] (SR3) Turnbull 1996 [UK - Scotland] *** (SR2,3,4,8,9) Waldenstrom 1994 [Sweden] ** Waldenstrom 2000 [Australia] * (SR2,3) | 2 Devane et al. 2010 8 Khan-Neelofur et al. 1998 3 Sandall et al. 2013 – 9 Villar et al. 2007 4Waldenstrom et al. 1998 |
Reduced/flexible visit interventions (n = 6 principal papers, 1 sibling paper and 4 SRs) (see Additional file 1 reference list T4-2) | Models investigating whether reduced or flexible antenatal visits had an impact on maternal/infant outcomes | Henderson 2000 [UK – England] Jewell 2000 [UK – England] McDuffie 1996 [USA] * (SR5,8,9,10) Sikorski 1996 [UK – England] (SR5,8,9,10) Tucker 1996 [UK – Scotland] (SR8,9) Walker 1997 [USA] (SR5,8,9,10) | 5 Carroli et al. 2001 10 Dowswell et al. 2010 8 Khan-Neelofur et al. 1998 9 Villar et al. 2007 |
Multiple foci (n = 1 SR) (see Additional file 1 reference list T4-3) | N/A | 7 Yakoob et al. 2009 – interventions that impact on stillbirth |
Category | Description/details | Principal paper from RCT First author; year; [country of study]; (SR1 etc. if included in a related systematic review) | Systematic Reviews associated with this category |
---|---|---|---|
Additional care interventions (n = 13 principal papers and 1 SR) (see Additional file 1 reference list T5-1) | Studies where supplementary antenatal care or educational input was given to all pregnant women (i.e. not targeted because of perceived risk status) | Au 2006 [Canada] Bergstrom 2009 [Sweden] Ekstrom 2006 [Sweden] Ekhtiari 2014 [Iran] Elbourne 1987 [UK – England] (SR11) Hajian 2012 [Iran] Hemminki 2013 [China] Jennings 2010 [Benin] Leung 2012 [Hong Kong] Nsibande 2013 [South Africa] Nuraini 2005 [Indonesia] Svensson 2009 [Australia] Tough 2006 [Canada] | 11 Brown & Smith 2004 – women carrying own notes 12 Dennis & Kingston 2008 – additional telephone support |
Behavioural interventions (n = 7 principal papers and 4 SRs) (see Additional file 1 reference list T5-2) | These focussed on behavioural or lifestyle issues for all pregnant women, including effect of exercise on gestational weight gain, pregnancy outcomes, breast feeding, relaxation etc. | Asbee 2009 [USA] Barakat 2009 [Spain] (SR13,15) Barakat 2013 [Spain] (SR13) Phelan 2011 [USA] (SR15) Rakhshani 2010 [India] Stafne 2012 [Norway] (SR13) Werner 2013 [Denmark] | 13 Domenjoz et al. 2014 – physical activity; 14 Ota et al. 2012 – dietary supplementation; 15 Ruifrok et al. 2014 – dietary and lifestyle interventions 16 Sibley et al. 2012 – the effect of TBA training on health behaviours; |
Category | Description/details | Principal paper from RCT First author; year; [country of study]; * indicates sibling paper(s) – see relevant reference list; (SR1 etc. if included in a related systematic review) | Systematic Reviews associated with this this category |
---|---|---|---|
‘Higher risk’ target groups (based on clinical/psychosocial indicators) | |||
Interventions for women with various or multiple risks (n = 9 principal papers, 3 sibling papers and 3 SRs) (see Additional file 1 reference list T6-1) | Generally involving augmented targeted care with a risk reduction focus [Higher risks not always well specified] | Brooten 2001 [USA] (SR20) Dawson 1989 [UK – Wales] * (SR20) Dawson 1999 [UK – Wales] (SR20) El Mohandes 2011 [USA] Kemp 2011 [Australia] * Klerman 2001 [USA] (SR20) Lee 2009 [USA] Turnbull 2004 [Australia] * (SR19) Villar 1992 [Argentina, Cuba, Mexico] (SR18,20) | 17 Blondel & Breart 1992 - Home visiting for pregnancy complications 18 Blondel & Breart 1995 - Social or medical care for high risk women 19 Dowswell et al. 2009 - Care for women with complicated pregnancy (antenatal day care versus hospitalisation) |
Interventions for women at risk of preterm birth or having a low birthweight (LBW) baby (n = 10 principal papers, 1 sibling paper and 1 SR) (see Additional file 1 reference list T6-2) | Interventions aimed at prevention of preterm birth or lbw baby | Bryce 1991 [Australia] (SR18) Depp 1993 [USA] Heins 1990 [USA] (SR20) Langer 1993 [Latin America] * Lutenbacher 2014 [USA] Mueller-Heubach 1989 [USA] Muender 2000 [USA] Norbeck 1996 [USA] (SR12,20) Oakley 1990 [UK – England] (SR12,18,20) Ross 1994 [USA] | 20 Hodnett et al. 2010 - support for women at risk of LBW baby |
Interventions for women who smoke (n = 9 principal papers and 1 sibling paper) (see Additional file 1 reference list T6-3) | Various approaches (individualised social support; group evening class; computer-delivered; telephone support; health practice population screening) aimed at encouraging smoking cessation | Bullock 2009 [USA] O’Connor 1992 [[Canada] Ondersma 2012 [USA] Parker 2007 [USA] Pbert 2004 [USA] Petersen 1992 [USA] Ruger 2009 [USA] Secker-Walker 1998 [USA] * Tappin 2000 [UK – Scotland]] | N/A |
Interventions for women with anxiety or mental health issues (n = 9 principal papers) (see Additional file 1 reference list T6-4) | Studies involving additional support (e.g. home visits, relaxation classes, cognitive behavioural interventions) | Bastani 2006 [Iran] Brugha 2000 [UK - England] Guardino 2014 [USA] Ortiz Collado 2014 [Spain, France] Petrou 2006 [UK - England] Rahman 2008 [Pakistan] Richter 2012 [Germany] Saisto 2001 [Finland] Webster 2003 [Australia] | N/A |
Interventions for overweight/obese women and/or women at risk of Gestational Diabetes Mellitus (n = 5 principal papers) (see Additional file 1 reference list T6-5) | Interventions to assist lifestyle behaviour change (e.g. exercise, telemedicine) | Harrison 2013 [Australia] Oostdam 2012 [Netherlands] (SR13) Perez Ferre 2010 [Spain] Poston 2013 [UK – Scotland & England] Quinlivan 2011 [Australia] (SR15) | N/A |
Other ‘higher risk’ clinical/psychosocial target groups (see Additional file 1 Reference list T6-6) | |||
Interventions for women/babies at risk of abuse (n = 3 principal papers) | Interventions for those at risk of abuse | Barlow 2007 [UK – England] McIntosh 2009 [UK – England] Taft 2011 [Australia] | |
Interventions for women with alcohol risk (n = 2 principal papers and 1 SR) | Brief alcohol counselling interventions for women identified as having a previous or current alcohol risk | O’Connor 2007 [USA] Osterman 2012 [USA] | 21 Turnbull et al. 2012 |
Interventions for women with history of previous caesarean (n = 1 principal paper) | Antenatal education and support relating to vaginal birth. | Fraser 1997 [Canada, USA] | N/A |
Interventions for women with HIV (n = 1 principal paper) | Telephone support intervention for pregnant women with HIV-positive status | Ross 2013 [Thailand] | N/A |
Interventions for women with twin pregnancy (n = 1 principal paper and 1 sibling paper) | Preparation for twin birth programme | Sen 2006 [UK – England] * | N/A |
‘Higher risk’ socio-demographic target groups (see Additional file 1 Reference list T6-7) | |||
Interventions for adolescent/younger age women (n = 8 principal papers and 2 sibling papers) | Additional support (e.g. home visits, education) to improve outcomes for ‘at risk’ group | Aracena 2009 [Chile] Barlow A 2006 [USA] Barlow A 2013 [USA] Barlow J 2007 [USA] Barnet 2002 [USA] Barnet 2007 [USA] Ford 2002 [USA] Ickovics 2007 [USA] ** (SR6) | 22 Barlow J et al. 2011 |
Interventions for low income women (n = 6 principal papers and 5 sibling papers) | Community support interventions | Edwards 2013 [USA] McLachlan 1992 [USA] (SR20) Olds 1986 [USA] **** (SR18,20) Polley 2002 [USA] (SR15) Roman 2009 [USA] * Wen 2011 [Australia] | N/A |
Interventions for women in the military/Military wives (n = 3 principal papers) | Interventions for military women or partners of military personnel to support adaptation to motherhood | Fausett 2014 [USA] Kennedy 2011 [USA] (SR6) Weis 2012 [USA] | N/A |