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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Antenatal care packages with reduced visits and perinatal mortality: A secondary analysis of the WHO Antenatal Care Trial
Reproductive Health, Volume 10, No. 1, Article 19, Year 2013
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Description
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. © 2013 Vogel et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Vogel, Joshua P.
Australia, Perth
The University of Western Australia
Switzerland, Geneva
Organisation Mondiale de la Santé
Habib, Ndema Abu
Switzerland, Geneva
Organisation Mondiale de la Santé
Souza, Joao Paulo
Switzerland, Geneva
Organisation Mondiale de la Santé
Gülmezoglu, Ahmet Metin
Switzerland, Geneva
Organisation Mondiale de la Santé
Dowswell, Therese
United Kingdom, Liverpool
University of Liverpool
Carroli, Guillermo
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Baaqeel, Hassan S.
Saudi Arabia, Jeddah
College of Medicine-jeddah
Lumbiganon, Pisake
Thailand, Khon Kaen
Faculty of Medicine, Khon Kaen University
Piaggio, Gilda Gp
Brazil, Sao Paulo
Statistika Consultoria
Oladapo, Olufemi Taiwo
Nigeria, Ago-iwoye
Olabisi Onabanjo University
Statistics
Citations: 118
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1186/1742-4755-10-19
e-ISSN:
17424755
Research Areas
Genetics And Genomics
Maternal And Child Health
Study Design
Randomised Control Trial
Exploratory Study
Participants Gender
Female