title: 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.
abstract: 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.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK. jennifer.hollowell@npeu.ox.ac.uk
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hollowell
authors.forename: Laura
authors.initials: L
authors.lastname: Oakley
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.forename: Peter
authors.initials: P
authors.lastname: Brocklehurst
authors.forename: Ron
authors.initials: R
authors.lastname: Gray
mesh_terms: D019049:Developed Countries / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D047928:Premature Birth; D011295:Prenatal Care / Q000379:methods*; D015397:Program Evaluation; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*