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Cited by 435Global Maternal and Child HealthMaternal and Neonatal HealthcareMaternal and Perinatal Health Interventions

WHO systematic review of randomised controlled trials of routine antenatal care

Carroli, Guillermo, Villar, José, Piaggio, Gilda, Khan-Neelofur, Dina, Gülmezoglu, Metin, Mugford, Miranda, Lumbiganon, Pisake, Farnot, Ubaldo +1 more·2001·The Lancet
DOI 10.1016/s0140-6736(00)04723-1
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Abstract

Background There is a lack of strong evidence on the effectiveness of the content, frequency, and timing of visits in standard antenatal-care programmes. We undertook a systematic review of randomised trials assessing the effectiveness of different models of antenatal care. The main hypothesis was that a model with a lower number of antenatal visits, with or without goal-oriented components, would be as effective as the standard antenatal-care model in terms of clinical outcomes, perceived satisfaction, and costs.Methods The interventions compared were the provision of a lower number of antenatal visits (new model) and a standard antenatal-visits programme. The selected outcomes were pre-eclampsia, urinary-tract infection, postpartum anaemia, maternal mortality, low birthweight, and perinatal mortality. We also selected measures of women's satisfaction with care and cost-effectiveness. This review drew on the search strategy developed for the Cochrane Pregnancy and Childbirth Group of the Cochrane Collaboration.Findings Seven eligible randomised controlled trials were identified. 57418 women participated in these studies: 30799 in the new-model groups (29870 with outcome data) and 26619 in the standard-model groups (25821 with outcome data). There was no clinically differential effect of the reduced number of antenatal visits when the results were pooled for pre-eclampsia (typical odds ratio 0.91 [95% CI 0.66-1.26]), urinary-tract infection (0.93 [0.79-1.10]). postpartum anaemia (1.01), maternal mortality (0.91 [0.55-1.51]), or low birthweight (1.04 [0.93-1.17]). The rates of perinatal mortality were similar, although the rarity of the outcome did not allow formal statistical equivalence to be attained. Some dissatisfaction with care, particularly among women in more developed countries, was observed with the new model. The cost of the new model was equal to or less than that of the standard model.Interpretation A model with a reduced number of antenatal visits, with or without goal-oriented components, could be introduced into clinical practice without risk to mother or baby, but some degree of dissatisfaction by the mother could be expected. Lower costs can be achieved.

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Authors
Carroli, G., Villar, J., Piaggio, G., Khan-Neelofur, D., Gülmezoglu, M., Mugford, M., Lumbiganon, P., Farnot, U., & Bersgjø, P.
Affiliations
  • Centro Rosarino de Estudios Perinatales (AR)
  • World Health Organization (CH)
  • University of East Anglia (GB)
  • Khon Kaen University (TH)
  • University of Bergen (NO)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2001-05
Volume
357
Issue
9268
Pages
1565-1570
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(00)04723-1
OpenAlex
W2114168327
Cited by
435
References
29
Citations by year
2026: 7 · 2025: 5 · 2024: 13 · 2023: 15 · 2022: 18 · 2021: 23 · 2020: 21 · 2019: 20 · 2018: 18 · 2017: 28 · 2016: 17 · 2015: 34 · 2014: 25 · 2013: 20 · 2012: 18
FWCI
3.02
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
preeclampsia, urinary tract infection, postpartum anemia, maternal mortality, low birth weight, perinatal mortality, patient satisfaction, cost-effectiveness, obstetric care
MeSH terms
Adult, Female, Humans, Infant, Newborn, Infant, Premature, Maternal Mortality, Maternal Welfare, Office Visits, Patient Compliance, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prenatal Care, Sensitivity and Specificity, World Health Organization, Confidence Intervals, Odds Ratio, Randomized Controlled Trials as Topic

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