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Alternative versus standard packages of antenatal care for low-risk pregnancy

Overview of attention for article published in Cochrane database of systematic reviews, July 2015
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (95th percentile)
  • High Attention Score compared to outputs of the same age and source (87th percentile)

Mentioned by

news
3 news outlets
policy
1 policy source
twitter
10 tweeters
facebook
5 Facebook pages
wikipedia
3 Wikipedia pages

Citations

dimensions_citation
61 Dimensions

Readers on

mendeley
373 Mendeley
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Title
Alternative versus standard packages of antenatal care for low-risk pregnancy
Published in
Cochrane database of systematic reviews, July 2015
DOI 10.1002/14651858.cd000934.pub3
Pubmed ID
Authors

Therese Dowswell, Guillermo Carroli, Lelia Duley, Simon Gates, A Metin Gülmezoglu, Dina Khan-Neelofur, Gilda Piaggio

Abstract

The number of visits for antenatal (prenatal) care developed without evidence of how many visits are necessary. The content of each visit also needs evaluation. To compare the effects of antenatal care programmes with reduced visits for low-risk women with standard care. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 March 2015), reference lists of articles and contacted researchers in the field. Randomised trials comparing a reduced number of antenatal visits, with or without goal-oriented care, versus standard care. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. We assessed studies for risk of bias and graded the quality of the evidence. We included seven trials (more than 60,000 women): four in high-income countries with individual randomisation; three in low- and middle-income countries with cluster randomisation (clinics as the unit of randomisation). Most of the data included in the review came from the three large, well-designed cluster-randomised trials that took place in Argentina, Cuba, Saudi Arabia, Thailand and Zimbabwe. All results have been adjusted for the cluster design effect. All of the trials were at some risk of bias as blinding of women and staff was not feasible with this type of intervention. For primary outcomes, evidence was graded as being of moderate or low quality, with downgrading decisions due to risks of bias and imprecision of effects.The number of visits for standard care varied, with fewer visits in low- and middle- income country trials. In studies in high-income countries, women in the reduced visits groups, on average, attended between 8.2 and 12 times. In low- and middle- income country trials, many women in the reduced visits group attended on fewer than five occasions, although in these trials the content as well as the number of visits was changed, so as to be more 'goal-oriented'.Perinatal mortality was increased for those randomised to reduced visits rather than standard care, and this difference was borderline for statistical significance (risk ratio (RR) 1.14; 95% confidence interval (CI) 1.00 to 1.31; five trials, 56,431 babies; moderate-quality evidence). In the subgroup analysis, for high-income countries the number of deaths was small (32/5108), and there was no clear difference between the groups (RR 0.90; 95% CI 0.45 to 1.80, two trials); for low- and middle-income countries perinatal mortality was significantly higher in the reduced visits group (RR 1.15; 95% CI 1.01 to 1.32, three trials).There was no clear difference between groups for our other primary outcomes: maternal death (RR 1.13, 95%CI 0.50 to 2.57, three cluster-randomised trials, 51,504 women, low-quality evidence); hypertensive disorders of pregnancy (various definitions including pre-eclampsia) (RR 0.95, 95% CI 0.80 to 1.12, six studies, 54,108 women, low-quality evidence); preterm birth (RR 1.02, 95% CI 0.94 to 1.11; seven studies, 53,661 women, moderate-quality evidence); and small-for-gestational age (RR 0.99, 95% CI 0.91 to 1.09, four studies 43,045 babies, moderate-quality evidence).Reduced visits were associated with a reduction in admission to neonatal intensive care that was borderline for significance (RR 0.89; 95% CI 0.79 to 1.02, five studies, 43,048 babies, moderate quality evidence). There were no clear differences between the groups for the other secondary clinical outcomes.Women in all settings were less satisfied with the reduced visits schedule and perceived the gap between visits as too long. Reduced visits may be associated with lower costs. In settings with limited resources where the number of visits is already low, reduced visits programmes of antenatal care are associated with an increase in perinatal mortality compared to standard care, although admission to neonatal intensive care may be reduced. Women prefer the standard visits schedule. Where the standard number of visits is low, visits should not be reduced without close monitoring of fetal and neonatal outcome.

Twitter Demographics

The data shown below were collected from the profiles of 10 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 373 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Ethiopia 1 <1%
South Africa 1 <1%
Australia 1 <1%
Unknown 369 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 76 20%
Student > Bachelor 50 13%
Student > Ph. D. Student 50 13%
Researcher 44 12%
Student > Postgraduate 26 7%
Other 72 19%
Unknown 55 15%
Readers by discipline Count As %
Medicine and Dentistry 139 37%
Nursing and Health Professions 73 20%
Social Sciences 29 8%
Psychology 13 3%
Economics, Econometrics and Finance 10 3%
Other 42 11%
Unknown 67 18%

Attention Score in Context

This research output has an Altmetric Attention Score of 41. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 February 2020.
All research outputs
#501,662
of 15,124,181 outputs
Outputs from Cochrane database of systematic reviews
#1,368
of 11,111 outputs
Outputs of similar age
#7,834
of 185,835 outputs
Outputs of similar age from Cochrane database of systematic reviews
#33
of 255 outputs
Altmetric has tracked 15,124,181 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,111 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 22.7. This one has done well, scoring higher than 87% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 185,835 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 95% of its contemporaries.
We're also able to compare this research output to 255 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 87% of its contemporaries.