Yasin Rahima, Azhar Maha, Allahuddin Zoha, Das Jai K, Bhutta Zulfiqar A
Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.
Neonatology. 2025;122(Suppl 1):13-31. doi: 10.1159/000542702. Epub 2024 Nov 23.
Antenatal care strategies (ANC) play a pivotal role in ensuring a healthy gestational period for expectant mothers and promote optimal outcomes for their babies. Implementing these interventions can contribute to a supportive environment for pregnant women, resulting in positive perinatal and neonatal outcomes.
We summarize evidence for a total of twenty-seven interventions pertaining to ANC from Every Newborn Series published in The Lancet 2014 by identifying the most recent systematic reviews, extracting data from each review, and conducting a subgroup analysis for low-income and lower-middle-income countries (LMICs) for outcomes relevant to maternal and neonatal health. Findings from our paper suggest a paucity in evidence from LMICs, and consolidated efforts are required to narrow this gap to build on more inclusive evidence on ANC.
Evidence from LMICs suggests that antenatal multiple micronutrient supplementation when compared to iron and folic acid had a significant effect on stillbirth, small for gestational age, and low birthweight (LBW). Vitamin D supplementation reduced the risks of preterm birth and LBW. High-dose calcium supplementation, when compared to placebo in pregnancy, lowered the likelihood of developing high blood pressure, preeclampsia, and preterm birth. Antihypertensives significantly reduced the probability of developing severe hypertension, proteinuria/preeclampsia, and severe preeclampsia. Metformin for GDM reduced the risk of neonatal death or serious morbidity composite. Cervical cerclage had no effect on stillbirth, preterm birth, or perinatal and neonatal mortality. Data for anti-D administration for rhesus alloimmunization were limited to HICs.
Antenatal care strategies (ANC) play a pivotal role in ensuring a healthy gestational period for expectant mothers and promote optimal outcomes for their babies. Implementing these interventions can contribute to a supportive environment for pregnant women, resulting in positive perinatal and neonatal outcomes.
We summarize evidence for a total of twenty-seven interventions pertaining to ANC from Every Newborn Series published in The Lancet 2014 by identifying the most recent systematic reviews, extracting data from each review, and conducting a subgroup analysis for low-income and lower-middle-income countries (LMICs) for outcomes relevant to maternal and neonatal health. Findings from our paper suggest a paucity in evidence from LMICs, and consolidated efforts are required to narrow this gap to build on more inclusive evidence on ANC.
Evidence from LMICs suggests that antenatal multiple micronutrient supplementation when compared to iron and folic acid had a significant effect on stillbirth, small for gestational age, and low birthweight (LBW). Vitamin D supplementation reduced the risks of preterm birth and LBW. High-dose calcium supplementation, when compared to placebo in pregnancy, lowered the likelihood of developing high blood pressure, preeclampsia, and preterm birth. Antihypertensives significantly reduced the probability of developing severe hypertension, proteinuria/preeclampsia, and severe preeclampsia. Metformin for GDM reduced the risk of neonatal death or serious morbidity composite. Cervical cerclage had no effect on stillbirth, preterm birth, or perinatal and neonatal mortality. Data for anti-D administration for rhesus alloimmunization were limited to HICs.
产前护理策略在确保准妈妈孕期健康以及促进其宝宝获得最佳结局方面发挥着关键作用。实施这些干预措施有助于为孕妇营造一个支持性环境，从而带来积极的围产期和新生儿结局。
我们通过识别最新的系统评价、从每项评价中提取数据，并对低收入和中低收入国家（LMICs）进行亚组分析以获取与孕产妇和新生儿健康相关的结局，总结了《柳叶刀》2014年发表的《每一个新生儿系列》中总共27项与产前护理相关的干预措施的证据。我们论文的研究结果表明，LMICs的证据不足，需要共同努力缩小这一差距，以便在更具包容性的产前护理证据基础上开展工作。
来自LMICs的证据表明，与铁和叶酸相比，产前补充多种微量营养素对死产、小于胎龄儿和低出生体重（LBW）有显著影响。补充维生素D可降低早产和低出生体重的风险。与孕期安慰剂相比，高剂量补钙可降低患高血压、先兆子痫和早产的可能性。使用抗高血压药物可显著降低发生严重高血压、蛋白尿/先兆子痫和重度先兆子痫的概率。用于妊娠期糖尿病（GDM）的二甲双胍可降低新生儿死亡或严重并发症综合发生的风险。宫颈环扎术对死产、早产或围产期及新生儿死亡率没有影响。关于恒河猴同种免疫的抗D治疗的数据仅限于高收入国家（HICs）。
产前护理策略在确保准妈妈孕期健康以及促进其宝宝获得最佳结局方面发挥着关键作用。实施这些干预措施有助于为孕妇营造一个支持性环境，从而带来积极的围产期和新生儿结局。
我们通过识别最新的系统评价、从每项评价中提取数据，并对低收入和中低收入国家（LMICs）进行亚组分析以获取与孕产妇和新生儿健康相关的结局，总结了《柳叶刀》2014年发表的《每一个新生儿系列》中总共27项与产前护理相关的干预措施的证据。我们论文的研究结果表明，LMICs的证据不足，需要共同努力缩小这一差距，以便在更具包容性的产前护理证据基础上开展工作。
来自LMICs的证据表明，与铁和叶酸相比，产前补充多种微量营养素对死产、小于胎龄儿和低出生体重（LBW）有显著影响。补充维生素D可降低早产和低出生体重的风险。与孕期安慰剂相比，高剂量补钙可降低患高血压、先兆子痫和早产的可能性。使用抗高血压药物可显著降低发生严重高血压、蛋白尿/先兆子痫和重度先兆子痫的概率。用于妊娠期糖尿病（GDM）的二甲双胍可降低新生儿死亡或严重并发症综合发生的风险。宫颈环扎术对死产、早产或围产期及新生儿死亡率没有影响。关于恒河猴同种免疫的抗D治疗的数据仅限于高收入国家（HICs）。
