title: A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations.
abstract: BACKGROUND
  Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support.
  
  
  METHODS
  In this narrative review, we included relevant Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies.
  
  
  RESULTS
  In the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to ¼ of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 25-30%. Behavioral interventions targeting practices at birth and in the hours that follow can have substantial impact in settings where many births happen at home: in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20%; good thermal care practices can reduce mortality risk by a similar order of magnitude.
  
  
  CONCLUSIONS
  Simple interventions delivered during pregnancy have considerable potential impact on important mortality outcomes. More programmatic effort is warranted to ensure high effective coverage.
authors.affiliation: Saving Newborn Lives, Save the Children/ US, Washington, D.C., United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hodgins
authors.affiliation: Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America.
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.affiliation: Saving Newborn Lives, Save the Children/ US, Washington, D.C., United States of America.
authors.forename: Kristen
authors.initials: K
authors.lastname: Rankin
authors.affiliation: Department of Life Sciences, Brunel University London, London, United Kingdom.
authors.forename: Amber
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Human Care Systems, Boston, Massachusetts, United States of America.
authors.forename: Annie
authors.initials: A
authors.lastname: Kearns
authors.affiliation: T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Caglia
mesh_terms: D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000517:prevention & control; D014943:Global Health; D006801:Humans; D007223:Infant; D066088:Infant Death / Q000517:prevention & control; D007231:Infant, Newborn; D008428:Maternal Mortality; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000517:prevention & control; D011203:Poverty; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control; D011295:Prenatal Care / Q000379:methods*; D012307:Risk Factors