Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial

Reproductive Health

Olufemi T Oladapo³  Gilda Piaggio¹  Pisake Lumbiganon⁴  Hassan S Baaqeel²  Guillermo Carroli⁷  Therese Dowswell⁶  A Metin Gülmezoglu⁵  João Paulo Souza⁵  Ndema Abu Habib⁵  Joshua P Vogel⁵ 

[1] Statistika Consultoria, São Paulo, Brazil, Divonne-les-Bains, France;King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, 21423, Saudi Arabia;Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, P.M.B. 2001, Nigeria;Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand;UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, CH-1211, Switzerland;Department of Women’s Health, University of Liverpool, Liverpool Women’s Hospital, Crown Street, Liverpool 8, UK;Centro Rosarino de Estudios Perinatales (CREP), Moreno 878, Rosario, 2000, Argentina

关键词: Developing country;    WHO;    Perinatal mortality;    Antenatal care;   

Others  :  811652
DOI  :  10.1186/1742-4755-10-19

 received in 2013-01-30, accepted in 2013-02-18,  发布年份 2013

【 摘 要 】

Background

In 2001, the WHO Antenatal Care Trial (WHOACT) concluded that an antenatal care package of evidence-based screening, therapeutic interventions and education across four antenatal visits for low-risk women was not inferior to standard antenatal care and may reduce cost. However, an updated Cochrane review in 2010 identified an increased risk of perinatal mortality of borderline statistical significance in three cluster-randomized trials (including the WHOACT) in developing countries. We conducted a secondary analysis of the WHOACT data to determine the relationship between the reduced visits, goal-oriented antenatal care package and perinatal mortality.

Methods

Exploratory analyses were conducted to assess the effect of baseline risk and timing of perinatal death. Women were stratified by baseline risk to assess differences between intervention and control groups. We used linear modeling and Poisson regression to determine the relative risk of fetal death, neonatal death and perinatal mortality by gestational age.

Results

12,568 women attended the 27 intervention clinics and 11,958 women attended the 26 control clinics. 6,160 women were high risk and 18,365 women were low risk. There were 161 fetal deaths (1.4%) in the intervention group compared to 119 fetal deaths in the control group (1.1%) with an increased overall adjusted relative risk of fetal death (Adjusted RR 1.27; 95% CI 1.03, 1.58). This was attributable to an increased relative risk of fetal death between 32 and 36 weeks of gestation (Adjusted RR 2.24; 95% CI 1.42, 3.53) which was statistically significant for high and low risk groups.

Conclusion

It is plausible the increased risk of fetal death between 32 and 36 weeks gestation could be due to reduced number of visits, however heterogeneity in study populations or differences in quality of care and timing of visits could also be playing a role. Monitoring maternal, fetal and neonatal outcomes when implementing antenatal care protocols is essential. Implementing reduced visit antenatal care packages demands careful monitoring of maternal and perinatal outcomes, especially fetal death.

【 授权许可】

   
2013 Vogel et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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