Impact of group antenatal care on fetal and maternal outcomes, systematic literature review and meta-analysis of recent randomized clinical trials

Abstract

Background: Antenatal care is a priority form of preventive medicine for the wellbeing of the mother and baby, it is traditionally provided on one-to-one basis. Emerging evidence suggest beneficial impact of group antenatal care.Methods: Systematic literature review and meta-analysis of recent (as of 2015) randomized controlled trials, investigating impact of group antenatal care compared to individual antenatal care, on objective fetal and maternal outcomes, namely: preterm labor, low birth weight, caesarean section rates, initiation of breastfeeding, and postpartum depression. Comparisons between group and individual ANC were reported as relative risk and mean differences for binary and continuous outcomes respectively, using random effects model.Results: Systematic PUBMED and EMBASE search resulted in inclusion of seven articles. Meta-analyses showed no statistically significant differences in the outcomes of preterm labor (4 studies), low birth weight [2 studies), caesarean section rates [2 studies), and mean Edinburgh Postpartum Depression Score [2 studies). A significantly higher chance of breast-feeding initiation was observed in the meta-analysis including 2 studies (RR = 1.13 [95% CI: 1.03-1.24]; p = 0.01).Conclusion: Group antenatal care resulted in higher chance of breastfeeding initiation with a low grade certainty of evidence, but had no effect on preterm birth, low birth weight, caesarean section rates, and postpartum depression. Group antenatal care was not harmful, but further investigations are needed to establish its benefits.