Table 7.3Evidence-Based Antenatal Interventions that Reduce Perinatal Morbidity and Mortality

Type of interventionMain effectsQuality of evidenceaSource of evidence
Nutritional
Folic acid
  • Reduces the risk of neural tube defects when given periconceptually
HighDe-Regil, Fernandez-Gaxiola, and others 2010
Infection prevention and treatment
Syphilis detection and treatment
  • Reduces stillbirths, neonatal deaths, and preterm birth
HighBlencowe and others 2011
IPT (malaria-endemic areas)
  • Reduces neonatal mortality and low birthweight
  • Reduces maternal anemia
HighRadeva-Petrova and others 2014
Insecticide-treated bednets (malaria)
  • Reduces fetal loss and low birthweight
HighGamble, Ekwaru, and ter Kuile 2006
Antitetanus vaccine
  • Reduces neonatal mortality from tetanus
ModerateBlencowe, Lawn, and others 2010
Intrauterine growth restriction interventions
Antithrombotic agents in pregnancies identified as high risk
  • Reduces perinatal mortality, preterm birth, and low birthweight
HighDodd and others 2013
Doppler velocimetry in high-risk pregnancies
  • Reduces perinatal mortality
ModerateAlfirevic, Stampalija, and Gyte 2013
Other interventions
Labor induction at 41+ weeks for postterm pregnancy
  • Reduces perinatal deaths and meconium aspiration
HighGülmezoglu, Crowther, and others 2012
Intensive management of gestational diabetes with optimal glucose control
  • Reduces macrosomia, perinatal morbidity, and mortality
ModerateAlwan, Tuffnell, and West 2009;
Syed and others 2011

Note: This list is not comprehensive. IPT = intermittent preventive treatment.

a.

Based on GRADE Working Group grades of evidence (Atkins and others 2004). The GRADE approach considers evidence from randomized trials to be high quality in the first instance, and downgrades the evidence to moderate, low, or very low if there are limitations in trial quality suggesting bias, inconsistency, imprecise or sparse data, uncertainty about directness, or high probability of publication bias. Evidence from observational studies is graded low quality in the first instance and upgraded to moderate (or high) if large effects are yielded in the absence of obvious bias.

From: Chapter 7, Interventions to Reduce Maternal and Newborn Morbidity and Mortality

Cover of Reproductive, Maternal, Newborn, and Child Health
Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2).
Black RE, Laxminarayan R, Temmerman M, et al., editors.
© 2016 International Bank for Reconstruction and Development / The World Bank.

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