The WHO antenatal care model has been reassessed…
The past decade has seen significant changes in the pattern of antenatal visits offered to women. These changes began as a result of the World Health Organization Antenatal Care Trial (WHOACT) (Villar et al 2001), but this trial’s findings were thrown into question by a Cochrane review (Dowswell et al 2010) and prompted a reanalysis of the original WHO trial, which was one of three cluster-randomised trials included in the Cochrane review. The full text of the secondary analysis of the data by Vogel et al (2013) can be seen by clicking HERE.
Although there is an association between fewer antenatal visits and an increase in fetal death it is not clear why this figure is higher, and other factors may be affecting results. Research author, Dr Joshua P Vogel from the World Health Organization speculated that it ‘may be due to differences in settings, content and quality of care. The timing and quality of visits is also important — reduced numbers of visits may miss important windows when fetuses are still at risk’.
Professor Justus Hofmeyr from the University of the Witwatersrand in South Africa stated, ‘An increased number of routine visits may detect asymptomatic conditions such as pre-eclampsia, fetal growth restriction or reduced fetal movements earlier, allowing more timely intervention. The importance of the content and quality of routine antenatal care should not be lost to policymakers when decisions about numbers of visits with the available resources are being made’.
The uncertainty thrown up by this secondary analysis of the WHO antenatal care trials highlights one of the difficulties of cluster-randomised controlled trials which, although an efficient way to evaluate certain interventions, can lead to difficulties in identifying confounding factors and it often becomes more difficult to ensure that a like-for-like comparison is achieved. It may be that lumping together varied settings and different patient groups as ‘developing countries’ is not helpful in this case, and a more tailored approach is required.
Dowswell T, Carroli G, Duley L et al (2010). Alternative versus standard packages of antenatal care for low-risk pregnancy. Cochrane Database of Systematic Reviews, Issue 10.
Villar J, Ba’aqeel H, Piaggio G et al (2001). The WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 357(9268):1551-64.
Vogel JP, Habib NA, Souza JP et al (2013). Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Reproductive Health 10(19). http://tinyurl.com/cwmt9k3 [Accessed 30 April 2013].