Abstract
In an era of Sustainable Development Goals, maternal, newborn, and child health still require improvement. Continuum of care is considered key to improving the health status of these populations. The continuum of care is a series of care strategies starting from pre-pregnancy to motherhood-childhood. The effectiveness of such linkage between the pregnancy, birth, and postnatal periods has been demonstrated. However, almost no study has assessed the impact of linkage that starts from pre-pregnancy to pregnancy care on maternal and child health. The present study attempts to fill this gap by assessing the effectiveness of the care linkage between pre-pregnancy and pregnancy care for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. We performed a systematic review and meta-analysis of randomized and quasi-randomized controlled trials in low- and middle-income countries. The outcome variables were neonatal, perinatal, and maternal mortality. We searched databases such as PubMed/Medline, POPLINE, EBSCO/CINAHL, and ISI Web of Science for the period 2000–2014, using broad search terms (e.g., pre-pregnancy OR adolescent OR mother), combined with search terms specific for interventions, (e.g., family planning OR contraception OR spacing). From the 1,325 retrieved articles, five studies were finally analyzed. The meta-analysis showed that interventions linking pre-pregnancy and pregnancy care effectively reduced neonatal mortality (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.71–0.89, I2 = 62%) and perinatal mortality (RR: 0.84; 95% CI: 0.75–0.94, I2 = 73%), but did not show an effect on maternal mortality. Neonatal and perinatal mortality could be reduced by linking pre-pregnancy and pregnancy care. This linkage of pre-pregnancy and pregnancy cares is an essential component of continuum of care to improve newborn health.Review RegistrationPROSPERO International prospective register of systematic reviews (CRD42015023424).
Highlights
The United Nations’ Millennium Development Goals called on countries to improve maternal, newborn, and child health
The meta-analysis showed that interventions linking pre-pregnancy and pregnancy care effectively reduced neonatal mortality and perinatal mortality (RR: 0.84; 95% confidence intervals (CI): 0.75–0.94, I2 = 73%), but did not show an effect on maternal mortality
While it is defined as a continuous care of non-curable conditions, continuum of care in maternal, newborn, and child health is a series of necessary care strategies for women and children to avoid preventable diseases
Summary
The United Nations’ Millennium Development Goals called on countries to improve maternal, newborn, and child health. Continuum of care is well known in clinical medicine in HIV care and nursing care [5] While it is defined as a continuous care of non-curable conditions, continuum of care in maternal, newborn, and child health is a series of necessary care strategies for women and children to avoid preventable diseases. It has two dimensions: a time dimension from pre-pregnancy through pregnancy, birth, the postnatal period, through to childhood, and a space dimension from community-family care to clinical care [6]. Almost no attempts have been made to assess how maternal and newborn health can be improved by interventions linking care from pre-pregnancy to pregnancy periods
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