Who antenatal care randomised trial for the evaluation of a new model of routine antenatal care

Most of the antenatal care models currently in use around the world have not been subjected to rigorous scientific evaluation to determine their effectiveness. Despite a widespread desire to improve maternal care services, this lack of "hard" evidence has impeded the identification of effective interventions and thus the optimal allocation of resources. In developing countries, routinely recommended antenatal care programmes are often poorly implemented and clinical visits can be irregular, with long waiting times and poor feedback to the women.
To address this paucity of information, the UND1VUNFPA/WLIO/World Bank Special Programme for Research, Development and Research Training in Human Reproduction (HRP) implemented a multicenlre randomised controlled trial that compared the standard "Western" model of antenatal care with a new WHO model that limits the number of visits to the clinic and restricts the tests, clinical procedures and follow-up actions to those that have been proven by solid research evidence to improve outcomes for women and newborns.
Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new-model (27 clinics) or the standard model (26 clinics). All women presenting for antenatal care at these clinics were enrolled. Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment received the new model, and those deemed at higher risk received the usual care for their conditions.
Women attending clinics assigneu the new model (n= 12568) had a median of 5 visits compared with 8 visits within the standard model (n= 11958).
The results of this trial showed that there were no significant differences between the new and standard model in terms of severe postpartum anaemia (new model: 7.59% vs standard model: 8.67%) , pre-ec-lampsia/eclampsia (1.69% vs 1.38%), urinary-tract infections (5.95% vs 7.41%) or low-birth-weight infants (7.68% vs 7.14%). Adjustment by several confounding variables did not modify this pattern. Similarly, there were no significant differences in secondary outcomes for either women or infants, including the rates of maternal and neonatal death. Women and providers in both groups were satisfied with the care received, although some women assigned the new model expressed some concern about the timing of visits. There was no cost increase, and in some settings the new model decreased cost.
Provision of routine antenatal care by the new model seems not to affect maternal and perinatal outcomes. It could be implemented without major resistance from women and providers and may reduce cost.