title: The effect of antenatal education in small classes on obstetric and psycho-social outcomes - a systematic review.
abstract: BACKGROUND
  The aims of antenatal education are broad and encompass outcomes related to pregnancy, birth, and parenthood. Both form and content of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes.
  
  
  METHODS
  Bibliographic databases (Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO) were searched. We included randomized and quasi-randomized trials irrespective of language, publication year, publication type, and publication status. Only trials carried out in the Western world were considered in this review. Studies were assessed for bias using the Cochrane risk of bias tool. Results are presented as structured summaries of the included trials and as forest plots.
  
  
  RESULTS
  We identified 5,708 records. Of these, 17 studies met inclusion criteria. Studies varied greatly in content of the experimental and control condition. All outcomes were only reported in a single or a few trials, leading to limited or uncertain confidence in effect estimates. Given the heterogeneity in interventions and outcomes and also the high risk of bias of studies, we are unable to draw definitive conclusions as to the impact of small group antenatal education on obstetric and psycho-social outcomes.
  
  
  CONCLUSIONS
  Insufficient evidence exists as to whether antenatal education in small classes is effective in regard to obstetric and psycho-social outcomes. We recommend updating this review following the emergence of well-conducted randomized controlled trials with a low risk of bias.
  
  
  BACKGROUND
  PROSPERO CRD42013004319.
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. cabr@niph.dk.
authors: Carina Sjöberg
authors: CS
authors: Brixval
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. sgla@niph.dk.
authors: Solveig Forberg
authors: SF
authors: Axelsen
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. sgla@niph.dk.
authors: Stine Glenstrup
authors: SG
authors: Lauemøller
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. skan@niph.dk.
authors: Stig Krøger
authors: SK
authors: Andersen
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. pdu@niph.dk.
authors: Pernille
authors: P
authors: Due
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. vibe@niph.dk.
authors: Vibeke
authors: V
authors: Koushede
mesh_terms: D005260:Female; D006126:Group Processes; D006801:Humans; D008297:Male; D016487:Parenting; D011247:Pregnancy; D011248:Pregnancy Complications; D064186:Prenatal Education