PMID- 23577700
OWN - NLM
STAT- MEDLINE
DCOM- 20150330
LR  - 20220330
IS  - 1742-4755 (Electronic)
IS  - 1742-4755 (Linking)
VI  - 10
DP  - 2013 Apr 12
TI  - Antenatal care packages with reduced visits and perinatal mortality: a secondary 
      analysis of the WHO Antenatal Care Trial.
PG  - 19
LID - 10.1186/1742-4755-10-19 [doi]
AB  - 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.
FAU - Vogel, Joshua P
AU  - Vogel JP
FAU - Habib, Ndema Abu
AU  - Habib NA
FAU - Souza, Joao Paulo
AU  - Souza JP
FAU - Gulmezoglu, A Metin
AU  - Gulmezoglu AM
FAU - Dowswell, Therese
AU  - Dowswell T
FAU - Carroli, Guillermo
AU  - Carroli G
FAU - Baaqeel, Hassan S
AU  - Baaqeel HS
FAU - Lumbiganon, Pisake
AU  - Lumbiganon P
FAU - Piaggio, Gilda
AU  - Piaggio G
FAU - Oladapo, Olufemi T
AU  - Oladapo OT
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20130412
PL  - England
TA  - Reprod Health
JT  - Reproductive health
JID - 101224380
SB  - IM
MH  - Adult
MH  - Female
MH  - Gestational Age
MH  - Humans
MH  - Infant, Newborn
MH  - Office Visits/*statistics & numerical data
MH  - *Perinatal Mortality
MH  - Pregnancy
MH  - Pregnancy Outcome
MH  - Prenatal Care/*standards/*statistics & numerical data
MH  - Program Evaluation
MH  - World Health Organization
PMC - PMC3637102
EDAT- 2013/04/13 06:00
MHDA- 2015/03/31 06:00
PMCR- 2013/04/12
CRDT- 2013/04/13 06:00
PHST- 2013/01/30 00:00 [received]
PHST- 2013/02/18 00:00 [accepted]
PHST- 2013/04/13 06:00 [entrez]
PHST- 2013/04/13 06:00 [pubmed]
PHST- 2015/03/31 06:00 [medline]
PHST- 2013/04/12 00:00 [pmc-release]
AID - 1742-4755-10-19 [pii]
AID - 10.1186/1742-4755-10-19 [doi]
PST - epublish
SO  - Reprod Health. 2013 Apr 12;10:19. doi: 10.1186/1742-4755-10-19.