Use of a focussed teen prenatal clinic at a military teaching hospital: model for improved outcomes of unmarried mothers

The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review

BACKGROUND

Infant mortality has shown a steady decline in recent years but a marked socioeconomic gradient persists. Antenatal care is generally thought to be an effective method of improving pregnancy outcomes, but the effectiveness of specific antenatal care programmes as a means of reducing infant mortality in socioeconomically disadvantaged and vulnerable groups of women has not been rigorously evaluated.

METHODS

We conducted a systematic review, focusing on evidence from high income countries, to evaluate the effectiveness of alternative models of organising or delivering antenatal care to disadvantaged and vulnerable groups of women vs. standard antenatal care. We searched Medline, Embase, Cinahl, PsychINFO, HMIC, CENTRAL, DARE, MIDIRS and a number of online resources to identify relevant randomised and observational studies. We assessed effects on infant mortality and its major medical causes (preterm birth, congenital anomalies and sudden infant death syndrome (SIDS)) RESULTS: We identified 36 distinct eligible studies covering a wide range of interventions, including group antenatal care, clinic-based augmented care, teenage clinics, prenatal substance abuse programmes, home visiting programmes, maternal care coordination and nutritional programmes. Fifteen studies had adequate internal validity: of these, only one was considered to demonstrate a beneficial effect on an outcome of interest. Six interventions were considered 'promising'.

CONCLUSIONS

There was insufficient evidence of adequate quality to recommend routine implementation of any of the programmes as a means of reducing infant mortality in disadvantaged/vulnerable women. Several interventions merit further more rigorous evaluation.

Early teenage obstetrics at Waikato Hospital

New Zealand has the second highest published teenage pregnancy rate in the world. Different papers have shown adverse obstetric outcome for teenage mothers. The aim of this study was to compare the obstetric parameters, such as birth weight, gestation at birth, Apgar scores, breech delivery, caesarean sections, instrumental deliveries, incidences of birth defects, twins, and gestational hypertension/pre-eclampsia of early teenage mothers with the rest of the population. The data were obtained from the perinatal information management system (PIMS) at Waikato Hospital for the period 1994 to 1996. The data were statistically analysed. There were 306 women in the early teenage group (17 years and younger) and 206 randomly selected women in the control group who were 18 years or older. In the early teen group more than 92% of women were primiparous, whereas in the control group most women were multiparous. The analyses detected no differences in the two groups in the parameters studied except increased incidence of ventouse delivery in the early teenage group (P = 0.004). This was surprising because, older and parous women are supposed to have better outcomes. Hence there was no evidence from this study of any of obstetric risk factors associated with early teenage pregnancy. Also, race did not affect the means of birth weights, gestational age at birth and Apgar scores. Adjustment for race and parity differences did not change the conclusions apart from making the difference in incidence of ventouse delivery less significant (P = 0.067 when adjusted for parity differences).