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. 2020 Dec 18;2020(12):CD009599. doi: 10.1002/14651858.CD009599.pub2

3. Characteristics of included Cochrane systematic reviews: prevention, detection, and management of other morbidities.

Review title Date last searched in the review Number of studies included (number of participants in included studies) Review question/objective Study design Types of participants Interventions Relevant outcomes
(stillbirth definition used in the review) 		Overall AMSTAR score and relevant GRADE assessment
Psychosocial interventions for supporting women to stop smoking in pregnancy (Chamberlain 2017) November 2015 88 studies
> 28,000 women		 To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes RCTs, Cluster‐RCTs, Quasi‐RCT, Randomised cross‐over trials Women who are currently smoking or have recently quit smoking and are pregnant

  1. in any care setting,

  2. seeking a pre‐pregnancy consultation or

  3. health professionals in trials


Implementation strategies to support pregnant women to stop smoking

  1. Counselling (MI, CBT, psychotherapy, relaxation, problem solving facilitation, and other strategies)

  2. Health education

  3. Feedback of fetal health

  4. Incentive‐based interventions (financial incentive on smoking cessation)

  5. Social support

  6. Exercise

  7. Others

  1. Stillbirth (no definition)

  2. Perinatal mortality

  3. LBW

  4. Admission to NICU

 AMSTAR: 9
GRADE: not assessed for relevant outcomes
Pharmacological interventions for promoting smoking cessation during pregnancy (Coleman 2015) July 2015 9 studies
2210 women		 To determine the efficacy and safety of smoking cessation pharmacotherapies (including NRT), varenicline and bupropion), other medications, or ENDS when used for smoking cessation in pregnancy. RCTs Women who are pregnant and who also smoke Pharmacological treatments aimed at promoting smoking cessation including, but not exclusive to, treatments that have been proven effective in non‐pregnant adults (e.g. NRT,
bupropion, varenicline; and ENDS used to promote smoking cessation.

  1. Stillbirth (no definition)

  2. LBW

  3. Admission to NICU

 AMSTAR: 8
GRADE: not assessed
Giving women their own case notes to carry during pregnancy (Brown 2015) August 2015 4 studies
1176 women		 To evaluate the effects of giving women their own case notes to carry during pregnancy on administrative outcomes, maternal satisfaction and control, health‐related behaviours and clinical outcomes RCTs
Cluster‐RCTs		 Pregnant women from the time of their first antenatal visit to the end of the postpartum period Any intervention that involved giving women their own case notes to carry during their pregnancy from the time of their first antenatal visit through the time of hospital admission for the birth of the baby and into the postpartum period

  1. Stillbirth or neonatal death (no definition)

  2. Admission to NICU

 AMSTAR: 8
GRADE:

  1. stillbirth or neonatal death, moderate‐certainty evidence
Midwife‐led continuity models versus other models of care for childbearing women (Sandall 2016) January 2016 15 studies
17,674 women		 To compare midwife‐led models of care with other models of care for childbearing women and their infants and to determine whether the effects of midwife‐led care are influenced by:

  1. models of midwifery care that provide differing levels of continuity

  2. varying levels of obstetrical risk

 RCTs
Quasi‐RCTs Cluster‐RCTs		 Pregnant women Midwife‐led models of care compared to other or shared care on the basis of the lead professional in the antepartum and intrapartum periods

  1. Fetal loss/neonatal death (all fetal loss before and after 24 weeks plus neonatal death)

  2. LBW

  3. Admission to NICU

 AMSTAR: 9
GRADE:

  1. overall fetal loss and neonatal death, high‐certainty evidence
Traditional birth attendant training for improving health behaviours and pregnancy outcomes (Sibley 2012) June 2012 9 studies
> 32,000 women		 To assess the effects of TBA training on TBA and maternal behaviours thought to mediate positive pregnancy outcomes, as well as on maternal, perinatal, and newborn mortality and morbidity RCTs
Quasi‐RCTs, Cluster‐RCTs

  1. Trained and untrained TBAs (reference to target intervention)

  2. Mothers and neonates cared for by trained and untrained TBAs (or those who are living in areas where such TBAs attend a majority of births ‐ a proxy for exposure of women to TBAs)

  3. Areas (or communities) having #1 and #2 (in the case of cluster‐RCTs)

 TBA training

  1. Stillbirth (number per 1000 live births)

  2. Perinatal mortality (number stillbirths + live births 0‐7 d per 1000 live births)

 AMSTAR: 9
GRADE: not assessed for relevant outcomes
Alternative versus standard packages of antenatal care for low‐risk pregnancy (Dowswell 2015) March 2015 7 studies
60,724 women		 To compare the effects of antenatal care programmes providing a reduced number of antenatal care visits for low‐risk women with programmes providing the standard schedule of visits, and to assess the views of the care providers and the women receiving antenatal care RCTs
Quasi‐RCTs		 Pregnant women attending antenatal care clinics and considered to be at low risk of developing complications during pregnancy and labour Provision of a schedule of reduced number of visits, with or without goal‐oriented antenatal care, compared with a standard schedule of visits

  1. Perinatal mortality

  2. LBW

  3. SGA

  4. Admission to NICU

 AMSTAR: 9
GRADE:

  1. perinatal mortality, moderate‐certainty evidence

  2. SGA, moderate‐certainty evidence
Group versus conventional antenatal care for women (Catling 2015) October 2014 4 studies
2350 women

  1. To compare the effects of group antenatal care vs conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.

  2. To compare the effects of group antenatal care vs conventional antenatal care on care provider satisfaction

 RCTs
Quasi‐RCTs
Cluster‐RCTs		 Pregnant women accessing antenatal care Group antenatal care compared with conventional antenatal care (1‐1 basis)

  1. Perinatal mortality (stillbirth or neonatal death)

  2. LBW

  3. SGA

  4. Admission to NICU

 AMSTAR: 10
GRADE:

  1. perinatal mortality, low‐certainty evidence

  2. LBW, moderate‐certainty evidence

  3. NICU admission, moderate‐certainty evidence
Diuretics for preventing pre‐eclampsia (Churchill 2007) May 2010 5 studies
1836 women		 To ascertain if the use of diuretics in pregnancy prevents the onset of pre‐eclampsia RCTs Pregnant women, both at high and low risk of pre‐eclampsia but without pre‐eclampsia at trial entry Prophylactic administration of diuretics of any group during pregnancy when used in order to prevent pre‐eclampsia

  1. Stillbirth (no definition)

  2. Perinatal mortality

  3. SGA

  4. Admission to NICU

 AMSTAR: 8
GRADE: not assessed
Nitric oxide for preventing pre‐eclampsia and its complications (Meher 2007) February 2012 7 studies
389 women		 To determine the effectiveness and safety of nitric oxide for preventing pre‐eclampsia and its complications RCTs Pregnant women were included, regardless of gestation at trial entry. Studies were included if they were comparisons of any nitric oxide agent with any of the following:

  1. placebo or no intervention;

  2. another nitric oxide donor or precursor;

  3. any other intervention for prevention of pre‐eclampsia

  1. Perinatal mortality (birth at or before 37 completed weeks’

  2. gestation)

  3. SGA

  4. Admission to NICU

 AMSTAR: 8
GRADE: not assessed
Progesterone for preventing pre‐eclampsia and its complications (Meher 2006) January 2011 10 studies
4659 women		 To assess the effects of progesterone, or any other progestogen, for prevention of pre‐eclampsia and its complications RCTs Pregnant women with normal blood pressure or high blood pressure without proteinuria were included, regardless of gestation at trial entry. The following comparisons were included:

  1. any progestogen vs placebo or no intervention

  2. any progestogen vs any other intervention for preventing pre‐eclampsia

  3. 1 type of progestogen vs another progestogen, during pregnancy, if appropriate

  1. Fetal death or neonatal death (no definition)

  2. SGA

  3. Admission to NICU

 AMSTAR: 8
GRADE: not assessed
Antioxidants for preventing pre‐eclampsia (Rumbold 2008) April 2013 13 studies
16,606 women		 To determine the effectiveness and safety of any antioxidant supplementation during pregnancy on the risk of:

  1. pre‐eclampsia

  2. SGA infants

  3. baby death

  4. maternal and neonatal morbidity

  5. long‐term development of the child

  6. side effects and adverse events

 RCTs Pregnant women considered to be at low, moderate or high risk of developing pre‐eclampsia

  1. Comparisons of any antioxidant/s (any dosage regimen) with either placebo or no antioxidant/s.

  2. Comparisons of ≥ 1 antioxidant with other antioxidant/s

  3. Comparisons of antioxidant/s with other interventions

  4. Comparisons of ≥ 1 antioxidants with other agents compared with placebo or no antioxidant/s, other antioxidants or other interventions

  1. Miscarriage or stillbirth (no definition)

  2. SGA

  3. Admission to NICU

 AMSTAR: 9
GRADE: not assessed
Altered dietary salt for
preventing pre‐eclampsia, and its complications (Duley 2005)		 October 2009 2 studies
603 women		 To assess the effects of altered dietary salt on the risk of developing pre‐eclampsia and its complications and to compare the effects of one form of alteration with another, such as restricted salt intake with increased salt intake, and to compare the effects of altered salt intake with other measures for prevention of pre‐eclampsia RCTs Women who had normal or high blood pressure without proteinuria during pregnancy were included, regardless of gestation at trial entry Any comparison of altered dietary salt intake with normal salt intake during pregnancy was included, as were comparisons of one form of alteration with another, such as restricted salt intake with increased salt intake, and comparisons of dietary salt intake with other measures for prevention of pre‐eclampsia

  1. Perinatal mortality (stillbirth or death in the first 7 d of life)

  2. SGA

  3. Admission to NICU

 AMSTAR: 7
GRADE: not assessed
Community‐based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes (Lassi 2015) May 2014 26 studies To assess the effectiveness of community‐based intervention packages in reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Community‐based trials
RCTs
Quasi‐RCTs		 Women of reproductive age group, particularly pregnant women at any period of gestation Intervention packages that included additional training of outreach workers namely, lady health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care

  1. Stillbirth fetal death after 28 weeks of gestation but before delivery of the baby’s head per all births)

  2. Perinatal mortality (stillbirths and early neonatal deaths)

 AMSTAR: 9
GRADE: not assessed
Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health (Tieu 2017) June 2017 2 studies
4523 women		 To assess the effects of screening for GDM based on different risk profiles and settings on maternal and infant
outcomes RCTs
Quasi‐RCTs		 Pregnant women, women already diagnosed with (GDM) in their current pregnancy and with pre‐existing (type 1 or 2) diabetes mellitus were excluded. Different protocols, guidelines or programmes for screening for GDM based on different risk profiles and settings, compared with the absence of screening, or compared with other protocols, guidelines or programmes for screening

  1. Stillbirth (no definition)

  2. Perinatal mortality (stillbirth and neonatal mortality)

  3. Admission to NICU

 AMSTAR: 10
GRADE:

  1. stillbirth not assessed

  2. perinatal mortality, very low‐certainty evidence
Combined diet and exercise interventions for preventing gestational diabetes mellitus (Shepherd 2017) November 2016 23 studies
8918 women and 8709 infants		 To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM, and
associated adverse health consequences for the mother and her infant/child RCTs
Cluster‐RCTs		 Pregnant women regardless of age, gestation, parity or plurality. Studies involving women with pre‐existing GDM, type 1 or type 2 diabetes were excluded. Any type of dietary advice with any type of exercise intervention (i.e. exercise advice, providing exercise sessions) compared with no intervention (i.e. standard care).

  1. Stillbirth (> 20 weeks)

  2. Perinatal mortality (stillbirth or neonatal mortality)

  3. SGA

  4. Admission to NICU

 AMSTAR: 10
GRADE:

  1. perinatal mortality, low‐certainty evidence
Screening and subsequent management for thyroid dysfunction pre‐pregnancy and during pregnancy for improving maternal and infant health (Spencer 2015) July 2015 2 studies 26,408 women To assess the effects of different screening methods (and subsequent management) for thyroid dysfunction pre‐pregnancy and during pregnancy on maternal and infant outcomes. RCTs Women, either pre‐pregnancy or during pregnancy (including both singleton and multiple pregnancies). Women with a pre‐existing diagnosis of thyroid dysfunction were excluded.

  1. Any screening method (e.g. tool, program, guideline or protocol) for detecting thyroid dysfunction (including hypothyroidism, hyperthyroidism, and/or thyroid autoimmunity) pre‐pregnancy or during pregnancy compared with no screening

  2. Comparison of ≥ 2 methods of screening (e.g. case finding vs universal screening).

  1. Fetal and neonatal death

  2. LBW

  3. Admission to NICU

 AMSTAR: 10
GRADE:

  1. fetal and neonatal death, moderate‐certainty evidence
Treating periodontal disease for preventing adverse birth outcomes in pregnant women (Iheozor‐Ejiofor 2017) October 2016 15 studies
7161 women		 To assess the effects of treating periodontal disease in pregnant women in order to prevent or reduce perinatal and maternal morbidity and mortality RCTs Pregnant women considered to have periodontal disease (diagnoses of gingivitis and periodontitis) after dental examination Treatment for periodontal disease, performed by a dentist, dental hygienist or therapist, either singly or in combination with counselling on oral hygiene, antiseptic oral agents, topical or systemic antimicrobial therapies compared with either placebo (for adjunctive treatment), no treatment or alternative treatments

  1. Perinatal mortality (including fetal and neonatal deaths up to the first 28 d after birth)

  2. LBW

  3. SGA

 AMSTAR: 11
GRADE:

  1. periodontal treatment vs no treatment:

    1. perinatal mortality, very low‐certainty evidence

    2. LBW, low‐certainty evidence

    3. SGA, low‐certainty evidence;

  2. Periodontal treatment vs no treatment:

    1. perinatal mortality, low‐certainty evidence

    2. LBW, very low‐certainty evidence
Use of biochemical tests of placental function for improving pregnancy outcome (Heazell 2015) July 2015 3 studies
740 women		 To assess whether clinicians' knowledge of the results of biochemical tests of placental function is associated with improvement in fetal or maternal outcome of pregnancy RCTs
Quasi‐RCTs		 All pregnant women, regardless of whether deemed to be high risk or low risk for pregnancy complications, or unselected participants by the study investigators. Women who had pregnancies complicated by chromosomal or structural anomaly were excluded. Comparison of women who had placental function tests (biochemical test of placental function carried out using the woman's maternal biofluid, either alone or in combination with other placental function test/s) and the results were available to their clinicians with women who either did not have the tests, or the tests were done but the results were not available to the clinicians

  1. Stillbirth (no definition)

  2. SGA

  3. Admission to NICU

 AMSTAR: 10
GRADE:

  1. stillbirth very low‐certainty evidence

  2. SGA, low‐certainty evidence
AMSTAR: A Measurement Tool to Assess Reviews; CBT: cognitive behavioural therapy; ENDS: electronic nicotine delivery systems; GDM: gestational diabetes mellitus; LBW: low birthweight; MI: motivational interviewing; NICU: neonatal intensive care unit; NRT: nicotine replacement therapy; RCT: randomised controlled trial; SGA: small‐for‐gestational age; TBA: traditional birth attendant