Article type
Abstract
Introduction: Antenatal care strategies play a pivotal role in ensuring a safe and healthy gestational period for expectant mothers and promote optimal outcomes for their babies. Implementing these interventions can contribute to a supportive environment for pregnant women, resulting in positive perinatal outcomes.
Methods: With a focus on low- and middle-income countries (LMICs), this publication is a part of a supplement that builds on the evidence described in the ‘Lancet Every Newborn’ series. An umbrella of different antenatal care interventions was identified and included antenatal maternal nutrition interventions, management of hypertensive disorders, prevention and management of gestational diabetes mellitus (GDM), optimization of mental health during pregnancy, screening and management of placental insufficiency, prophylactic cervical cerclage and anti-D administration for Rhesus alloimmunization. A review for all existing systematic reviews was conducted and relevant information including estimates extracted. The existing systematic reviews were updated where the evidence was not recent.
Results: Evidence from LMICs suggests that antenatal vitamin D supplementation reduced the risks of preterm birth (PTB) [RR 0.54 (0.30-0.96)] and low birthweight (LBW) [RR 0.54 (0.35-0.79)]. Multiple micronutrient supplementation when compared to iron and folic acid, had a significant effect on stillbirth [RR 0.91 (0.85-0.98)], PTB [RR 0.96 (0.94-0.99)], small-for-gestational-age [RR 0.97 (0.95-0.99)] and LBW [RR 0.88 (0.85-0.90)]. High-dose calcium supplementation, when compared to placebo in pregnancy, lowered the likelihood of developing high blood pressure [RR 0.41 (0.25-0.69)] and pre-eclampsia [RR 0.30 (0.18-0.50)].
Antihypertensives significantly reduced the probability of developing severe hypertension [RR 0.27 (0.15-0.51)], proteinuria/pre-eclampsia [RR 0.43 (0.22-0.86)] and severe pre-eclampsia [RR 0.30 (0.10-0.89)]. Metformin for GDM reduced the risk of neonatal death or serious morbidity composite [RR 0.54 (0.31-0.94)]. Additional psychosocial support had no effect on cesarean birth, preterm birth, stillbirth or LBW. Cervical cerclage had no effect on stillbirth, preterm birth, or perinatal and neonatal mortality. Data for anti-D administration for rhesus alloimmunization was limited to HICs.
Conclusion: There is paucity in evidence from LMICs. Consolidated efforts are required to narrow this gap to build on more inclusive evidence on antenatal care strategies to get context-specific evidence to inform policy for optimizing maternal and neonatal outcomes.
Methods: With a focus on low- and middle-income countries (LMICs), this publication is a part of a supplement that builds on the evidence described in the ‘Lancet Every Newborn’ series. An umbrella of different antenatal care interventions was identified and included antenatal maternal nutrition interventions, management of hypertensive disorders, prevention and management of gestational diabetes mellitus (GDM), optimization of mental health during pregnancy, screening and management of placental insufficiency, prophylactic cervical cerclage and anti-D administration for Rhesus alloimmunization. A review for all existing systematic reviews was conducted and relevant information including estimates extracted. The existing systematic reviews were updated where the evidence was not recent.
Results: Evidence from LMICs suggests that antenatal vitamin D supplementation reduced the risks of preterm birth (PTB) [RR 0.54 (0.30-0.96)] and low birthweight (LBW) [RR 0.54 (0.35-0.79)]. Multiple micronutrient supplementation when compared to iron and folic acid, had a significant effect on stillbirth [RR 0.91 (0.85-0.98)], PTB [RR 0.96 (0.94-0.99)], small-for-gestational-age [RR 0.97 (0.95-0.99)] and LBW [RR 0.88 (0.85-0.90)]. High-dose calcium supplementation, when compared to placebo in pregnancy, lowered the likelihood of developing high blood pressure [RR 0.41 (0.25-0.69)] and pre-eclampsia [RR 0.30 (0.18-0.50)].
Antihypertensives significantly reduced the probability of developing severe hypertension [RR 0.27 (0.15-0.51)], proteinuria/pre-eclampsia [RR 0.43 (0.22-0.86)] and severe pre-eclampsia [RR 0.30 (0.10-0.89)]. Metformin for GDM reduced the risk of neonatal death or serious morbidity composite [RR 0.54 (0.31-0.94)]. Additional psychosocial support had no effect on cesarean birth, preterm birth, stillbirth or LBW. Cervical cerclage had no effect on stillbirth, preterm birth, or perinatal and neonatal mortality. Data for anti-D administration for rhesus alloimmunization was limited to HICs.
Conclusion: There is paucity in evidence from LMICs. Consolidated efforts are required to narrow this gap to build on more inclusive evidence on antenatal care strategies to get context-specific evidence to inform policy for optimizing maternal and neonatal outcomes.