| Methods |
Randomised trial. |
| Participants |
2764 low‐risk women aged 18‐39 years booking at any of the participating sites before 13 completed weeks' gestation.
Excluded if past or current high‐risk obstetric condition, current medical condition, non‐English speaking or planning to change insurance carriers during pregnancy. |
| Interventions |
Reduced visits: 9 visits (at 8, 12, 16, 24, 28, 32, 36, 38 and 40 weeks). For parous women a telephone call was scheduled at 12 weeks instead of a visit.
Standard ANC: 14 visits (visits every 4 weeks from 8 to 28 weeks, every 2 weeks until 36 weeks, and weekly thereafter). |
| Outcomes |
Women: mild and severe pre‐eclampsia, caesarean section, preterm labour, preterm premature rupture of membranes, gestational diabetes, chorioamnionitis (clinical), abruptio placentae, placenta previa, and PPH (> 750 mL for vaginal delivery and > 1500 mL for caesarean delivery).
Babies: stillbirth (> 20 weeks), preterm birth (< 37 weeks), and low birthweight (< 2500 g), gestation at birth, birthweight, small‐for‐gestational age (< 10th percentile), very low birthweight (< 1500 g), Apgar score < 7 at 5 minutes, and stillbirth.
Women's satisfaction: with prenatal care, education during prenatal visits and educational material. |
| Notes |
Mean number of visits in the reduced visits group was 12.0 (SD 4.2) and in standard ANC group 14.7 (SD 4.2). |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Random sequence generation (selection bias) |
Low risk |
Random number tables. |
| Allocation concealment (selection bias) |
Low risk |
Concealment of allocation: sealed, opaque envelopes contained details of group allocation. |
| Blinding of participants and personnel (performance bias)
All outcomes |
High risk |
Blinding not feasible with this type of intervention. It was stated that women and staff providing care were not blinded to treatment allocation or study hypotheses. |
| Blinding of outcome assessment (detection bias)
All outcomes |
High risk |
Outcomes were recorded by staff aware of group allocation and data were extracted from case notes. |
| Incomplete outcome data (attrition bias)
All outcomes |
Unclear risk |
Loss to follow‐up: 217/1382 (15.7%) in the reduced visits group and 219/1382 (15.8%) in the standard ANC group. |
| Selective reporting (reporting bias) |
Unclear risk |
Assessment from published study report. |
| Other bias |
Low risk |
Other bias not apparent. |
