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Approaches to information provision
Evidence review B
NICE Guideline, No. 201
National Guideline Alliance (UK).
Approaches to information provision
Review question
What approach to information giving during antenatal care is effective (including timing and mode of provision)?
Introduction
Women and their partners are receptive and keen for information in the antenatal period. Information may be provided in a number of ways: individually, at each antenatal appointment, and in antenatal classes, verbally, in leaflet/ booklet form and by signposting to digital/online sources. The aim of this review is to determine which approach to information giving works best for women and their partners.
Summary of the protocol
See Table 1 for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of this review.
Table 1
Summary of the protocol (PICO table).
For further details, see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual 2014. Methods specific to this review question are described in the review protocol in appendix A.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Clinical evidence
Included studies
Nine publications reporting 8 randomised controlled trials (RCTs) were included in this review (Andersson 2013, Brixval 2016, Björklund 2013, Chi 2016, de Leeuw 2019, Graham 2000, Koushede 2017, Svensson 2009 and Yee 2014). Brixval 2016 and Koushede 2017 reported different outcomes from the same RCT.
The included studies are summarised in Table 2.
Two studies compared group based information provision with individual information provision (Andersson 2013, Chi 2016). Three studies compared digital in addition to face to face information provision with face to face alone (Björklund 2013, de Leeuw 2019, Yee 2014). One study compared digital in addition to a leaflet with a leaflet alone (Graham 2000). One study compared an enhanced antenatal care programme, which consisted of more interactive and group based teaching, with the standard antenatal care programme, which consisted of more lecture based teaching (Svensson 2009). One study reported in 2 publications compared information provision in a small group with information provision in a large group (Brixval 2016, Koushede 2017).
One study was conducted in Australia (Svensson 2009); 1 study was conducted in Denmark (Brixval 2016, Koushede 2017); 1 study was conducted in the Netherlands (de Leeuw 2019); 2 studies were conducted in Sweden (Andersson 2013, Björklund 2013); 1 study was conducted in Taiwan (Chi 2016); 1 study was conducted in the UK (Graham 2000); 1 study was conducted in US (Yee 2014).
See the literature search strategy in appendix B and study selection flow chart in appendix C.
Excluded studies
Studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of studies included in the evidence review
Summaries of the studies that were included in this review are presented in Table 2.
Table 2
Summary of included studies.
See the full evidence tables in appendix D and forest plots in appendix E.
Quality assessment of studies included in the evidence review
See the evidence profiles in appendix F.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.
A single economic search was undertaken for all topics included in the scope of this guideline. See supplementary material 2 for details.
Excluded studies
Economic studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of studies included in the economic evidence review
No economic studies were identified which were applicable to this review question.
Economic model
No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.
Evidence statements
Clinical evidence statements
Comparison 1: Group based vs individual based information provision
Critical outcomes
Anxiety
No evidence was identified to inform this outcome.
Increase in knowledge
- High quality evidence from 1 RCT (N= 100) showed that there is an important difference between group based and individual based information provision, favouring individual based information, on an increase in knowledge at 1 month follow up (measured with mean % of correct answers; range of scores: 0-100): MD 3.63 (95% CI 3.59 to 3.67).
- High quality evidence from 1 RCT (N= 100) showed that there is an important difference between group based and individual based information provision, favouring individual based information, on an increase in knowledge at 2 months follow up (measured with mean % of correct answers; range of scores: 0-100): MD 2.43 (95% CI 2.41 to 2.45).
Satisfaction with information
- Very low quality evidence from 1 RCT (N= 407) showed that there is no important difference between group based and individual based information provision on satisfaction with information: OR 0.75 (95% CI 0.4 to 1.4).
Severe fetal morbidity
No evidence was identified to inform this outcome.
Important outcomes
Preparedness for birth
- Very low quality evidence from 1 RCT (N= 407) showed that there is no important difference between group based and individual based information provision on preparedness for birth: OR 0.73 (95% CI 0.47 to 1.13).
Satisfaction with maternity care
No evidence was identified to inform this outcome.
Self-efficacy
- Low quality evidence from 1 RCT (N= 100) showed that there is no important difference between group based and individual based information provision on self-efficacy at 1 month follow up (measured with Likert type questionnaire; range of scores: 8-40): MD 1.38 (95% CI −0.81 to 3.57).
- Low quality evidence from 1 RCT (N= 100) showed that there is an important difference between group based and individual based information provision on self-efficacy at 2 months follow up, favouring individual based information (measured with Likert type questionnaire; range of scores: 8-40): MD 4.16 (95% CI 2.46 to 5.86).
Comparison 2: Digital in addition to face-to-face vs face-to-face alone information provision
Critical outcomes
Anxiety
- Moderate quality evidence from 1 RCT (N= 368) showed that there is no important difference between digital in addition to face-to-face and face-to-face alone information provision, on anxiety (measured with: Spielberger state-trait anxiety inventory- state subscale; range of scores: 20-80): MD −0.40 (95% CI −2.35 to 1.55).
- Moderate quality evidence from 1 RCT (N= 387) showed that there is no important difference between digital in addition to face-to-face and face-to-face alone information provision, on anxiety – worry about the baby (measured with adapted Cambridge worry scale; range of score: 0-5): MD −0.04 (95% CI −0.28 to 0.2).
- Moderate quality evidence from 1 RCT (N= 389) showed that there is no important difference between digital in addition to face-to-face and face-to-face alone information provision, on anxiety – worry about the birth (measured with adapted Cambridge worry scale; range of score: 0-5): MD −0.07 (95% CI −0.34 to 0.2).
Increase in knowledge
- Moderate quality evidence from 1 RCT (N= 123) showed that there is an important difference between digital in addition to face-to-face and face-to-face alone information provision, favouring digital + face-to-face, on an increase in knowledge immediately after the intervention (measured with mean % of correct answers; range of scores: 0-100): MD 23.40 (95 % CI 18.2 to 28.6).
- Low quality evidence from 1 RCT (N= 123) showed that there is an important difference between digital in addition to face-to-face and face-to-face alone information provision, favouring digital in addition to face-to-face on an increase in knowledge at 23 days follow up (measured with mean % of correct answers; range of scores: 0-100): MD 10.90 (95 % CI 4.73 to 17.07).
- Low quality evidence from 1 RCT (N= 141) showed that there is no important difference between digital in addition to face-to-face and face-to-face alone information provision, on an increase in knowledge (measured with 7 question test on the information provided; range of scores 1-7): MD 1.16 (95 % CI 0.38 to 1.94).
Satisfaction with information
- Low quality evidence from 1 RCT (N= 141) showed that there is no important difference between digital in addition to face-to-face and face-to-face alone information provision, on satisfaction with information (measured with genetic counsel satisfaction scale; range of scores 6-30): MD 0.00 (95 % CI −0.15 to 0.15).
Severe fetal morbidity
No evidence was identified to inform this outcome.
Important outcomes
Preparedness for birth
No evidence was identified to inform this outcome.
Satisfaction with maternity care
No evidence was identified to inform this outcome.
Self-efficacy
No evidence was identified to inform this outcome.
Comparison 3: Digital in addition to leaflet vs leaflet alone format of ANC information
Critical outcomes
Anxiety
- Moderate quality evidence from 1 RCT (N= 649) showed that there is no important difference between digital in addition to leaflet and leaflet alone format of ANC information, on the change in anxiety after intervention (measured with Spielberger state-trait anxiety inventory, state subscale; range of scores 20-80): MD 1.90 (95 % CI 0.56 to 3.24).
Increase in knowledge
- Moderate quality evidence from 1 RCT (N= 735) showed that there is no important difference between digital in addition to leaflet and leaflet alone format of ANC information, on number of women reporting they had knowledge of the anomaly scan: RR 0.99 (95% CI 0.96 to 1.02).
- Moderate quality evidence from 1 RCT (N= 735) showed that there is no important difference between digital in addition to leaflet and leaflet alone format of ANC information, on number of women reporting they had knowledge of the blood test: RR 1.06 (95% CI 0.98 to 1.15).
- Moderate quality evidence from 1 RCT (N= 735) showed that there is no important difference between digital in addition to leaflet and leaflet alone format of ANC information, on number of women reporting they had knowledge of amniocentesis: RR 1.05 (95% CI 0.94 to 1.16).
- Low quality evidence from 1 RCT (N= 735) showed that there is no important difference between digital in addition to leaflet and leaflet alone format of ANC information, on number of women reporting they had knowledge of chorionic villus sampling (CVS): RR 1.07 (95% CI 0.89 to 1.29).
Satisfaction with information
No evidence was identified to inform this outcome.
Severe fetal morbidity
No evidence was identified to inform this outcome.
Important outcomes
Preparedness for birth
No evidence was identified to inform this outcome.
Satisfaction with maternity care
No evidence was identified to inform this outcome.
Self-efficacy
No evidence was identified to inform this outcome.
Comparison 4: Enhanced ANC programme (interactive group based teaching and life skills) vs standard ANC programme (lecture based learning)
Critical outcomes
Anxiety
- Moderate quality evidence from 1 RCT (N= 170) showed that there is no important difference between an enhanced ANC programme and a standard ANC programme on anxiety (assessed with Cambridge worry scale; range of scores 0-50): MD −0.10 (95% CI −0.85 to 0.65).
Increase in knowledge
- Moderate quality evidence from 1 RCT (N= 170) showed that there is no important difference between an enhanced ANC programme and a standard ANC programme on an increase in knowledge pre-birth (measured with assessment developed by researchers; range of scores 0-55): MD 0.72 (95% CI 0.06 to 1.38).
- High quality evidence from 1 RCT (N= 170) showed that there is no important difference between an enhanced ANC programme and a standard ANC programme on an increase in knowledge 8 weeks’ post-partum (measured with assessment developed by researchers; range of scores 0-55): MD 0.82 (95% CI −0.31 to 1.95).
Satisfaction with information
No evidence was identified to inform this outcome.
Severe fetal morbidity
No evidence was identified to inform this outcome.
Important outcomes
Preparedness for birth
No evidence was identified to inform this outcome.
Satisfaction with maternity care
No evidence was identified to inform this outcome.
Self-efficacy
- Low quality evidence from 1 RCT (N= 170) showed that there is an important difference between an enhanced ANC programme and a standard ANC programme on self-efficacy, favouring an enhanced ANC programme (measured with parents’ expectations survey; range of scores 0-250): MD 16.00 (95% CI 9.46 to 22.54).
Comparison 5: Small group vs large group information provision for ANC
Critical outcomes
Anxiety
- Low quality evidence from 1 RCT (N= 1766) showed that there is no important difference between small group and large group information provision on anxiety at 9 weeks’ post-partum (measured with perceived stress scale; range of scores 0-40): MD −0.06 (95% CI −0.15 to 0.03).
- Low quality evidence from 1 RCT (N= 1766) showed that there is no important difference between small group and large group information provision on anxiety at 6 months’ post-partum (measured with perceived stress scale; range of scores 0-40): MD −0.10 (95% CI −0.2 to 0.00).
Increase in knowledge
No evidence was identified to inform this outcome.
Satisfaction with information
No evidence was identified to inform this outcome
Severe fetal morbidity
No evidence was identified to inform this outcome.
Important outcomes
Preparedness for birth
No evidence was identified to inform this outcome.
Satisfaction with maternity care
No evidence was identified to inform this outcome.
Self-efficacy
- Moderate quality evidence from 1 RCT (N= 1335) showed that there is no important difference between small group and large group information provision on self-efficacy to handle the birth process: RR 1.02 (95% CI 0.94 to 1.09).
- Moderate quality evidence from 1 RCT (N= 1337) showed that there is no important difference between small group and large group information provision on self-efficacy to make delivery a positive experience: RR 1.02 (95% CI 0.99 to 1.06).
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
The committee considered anxiety, increase in knowledge and satisfaction with information or support as the critical outcomes. Anxiety in particular was chosen as a critical outcome as mental health and wellbeing is vital for women as they build a solid foundation in pregnancy, for their child to grow. The outcomes identified as important were preparedness for labour, birth and parenthood, satisfaction with maternity care and self-efficacy.
The quality of the evidence
The quality of the evidence for establishing which approach for information giving in antenatal care is effective, ranged from very low to high, with most of the evidence of low or moderate quality. The main issues were due to imprecision around the estimate of effects in many outcomes. Some outcomes (such as anxiety) were also downgraded for risk of bias as they were subjective. Other reasons for downgrading were high risk of bias in the randomisation process for some outcomes, and also risk of bias due to deviations from the intended interventions. Anxiety, when measured by the perceived stress scale, was downgraded for indirectness as the scale is not a direct measure of anxiety.
No evidence was identified for severe fetal morbidity.
Benefits and harms
There were 2 studies that compared group based with individual based antenatal care information provision. The evidence showed an important difference favouring individual based information provision on an increase in knowledge at 1 and 2 months follow up. There was also an important difference favouring individual based information provision on self-efficacy at 2 months, though no difference for this outcome at 1 month. There was also no important difference for any of the other outcomes identified (satisfaction with information, preparedness for birth). One study compared information provision in small groups to large groups. The evidence showed that there were no important differences between the two groups for any of the outcomes identified (self-efficacy, anxiety).
Three studies compared digital and face to face information provision with face to face information provision alone for ANC. The evidence showed an important difference favouring digital information provision on an increase in knowledge in one study immediately after the intervention and at 23 days follow up, although there was no difference in this outcome in one other study. There were no important differences for any of the other outcomes identified (anxiety, satisfaction with information). One studies compared digital and leaflet information provision to a leaflet alone. The evidence showed that were no important differences for any outcomes between the two groups for any of the outcomes identified (anxiety, increase in knowledge).
One study compared an enhanced ANC programme consisting of interactive group based teaching and life skills with a standard ANC programme consisting of lecture based learning. The evidence showed that was an important difference, favouring the enhanced programme, on self-efficacy. There were no important differences between the two groups for any of the other outcomes (anxiety, increase in knowledge).
Overall the evidence suggests that information provided to individuals, supplemented with digital approaches and generally with a more interactive focus may have some benefits in terms of knowledge and self-efficacy although this does not necessarily translate into outcomes around anxiety or satisfaction.
The committee agreed that there were two broad aspects of information provision that healthcare professionals needed to take into account. First information provision in formats that meet a woman’s needs (for example in the correct language) which absolutely must be covered by services and are discussed in detail in the NICE adults experience guideline. Second there are then options in information provision which may suit certain women, services or categories of information better, for example format of written materials (digital or printed, or both), or individual or group formats. The committee agreed based on their experience and the evidence in this review that each of these options may have some benefits in certain situations, however, information provision should be based on one-to-one discussions (sometimes including the partner) but supplemented by other formats, including group discussions (which could be either women only or together with partners), and different format of written information (digital, printed leaflets). Ideally healthcare services would be able to offer every approach to information provision for every woman in every situation, however this would have significant resource impacts and is not currently supported by the strength of evidence on the efficacy of any of the approaches to provision. On balance the committee recommended that one-to-one discussions could be supplemented by with alternative approaches as described above.
The committee noted that one possible harm of group based information provision is that it cannot be tailored specifically to any one woman. This may cause problems if, for example, some women attending groups have partners and others do not and much of the information is heavily focused on partner interactions. The committee therefore agreed it was important to recommend that when information is provided in a group format, such as in antenatal classes, it is done in a way so as to make all women feel welcome.
There was no evidence identified to inform the timing of information, but the committee felt it was important to have a staged approach and cover topics relevant to each stage of pregnancy, throughout the pregnancy.
The committee also agreed that it is important for healthcare professionals providing antenatal care to check with the woman (and her partner) that they have understood the information they have been given and how it relates to their situation. Enough time should be provided for them to ask questions and to discuss concerns. Pregnancy and antenatal care brings a lot of new information to parents, particularly first-time parents to process and healthcare professionals should support that this information is understood.
The committee discussed the benefits of signposting to additional sources of information. They recognised that women, their partners and families often look for information in various sources and felt it was essential that information given to women and their partners was evidence-based and consistent. The committee also agreed based on experience that it would be beneficial to recommend that women are given information on how to get in touch with services specific to their needs and to the local area. They discussed that this information can come from sources such as local support groups in the community, or various national charities. The committee discussed that there are groups of women, such as those with complex social factors, who may also benefit from additional support, and felt it was important to reference the NICE guidance on pregnancy and complex social factors which give guidance on caring for pregnant women who have substance use problems; who are recent migrants, asylum seekers or refugees, or women who have difficulty reading or speaking English; young women aged under 20; and women who experience domestic abuse.
The committee discussed that there are sometimes differences in the information given to partners and women. They agreed it was important to recommend that the same general information related to antenatal care and pregnancy which is provided to women is also made available for the partners.
The committee recognised that references to a partner may not be inclusive for all women. They also acknowledged that different women have different circumstances and discussions in antenatal care can bring up sensitive issues. Therefore, they felt it was necessary to highlight in the recommendations that information provided should be supportive and respectful so that all women, regardless of their circumstances felt welcome and cared for.
Cost effectiveness and resource use
A systematic review of the economic literature was conducted but no relevant studies were identified which were applicable to this review question.
Detailed information giving will already be taking place in all centres providing antenatal care. These recommendations will reinforce best practice and improve consistency of care. It is not anticipated there will be any resource impact arising from these recommendations.
References
Andersson 2013
Andersson, E., Christensson, K., Hildingsson, I., Mothers’ satisfaction with group antenatal care versus individual antenatal care--a clinical trial. Sexual & reproductive healthcare, 4, 113–120, 2013 [PubMed: 24041732]Björklund 2013
Björklund, U., Marsk, A., Ohman, S. G., Does an information film about prenatal testing in early pregnancy affect women’s anxiety and worries?Journal of psychosomatic obstetrics and gynaecology, 34, 9–14, 2013 [PubMed: 23394408]Brixval 2016
Brixval, C. S., Axelsen, S. F., Thygesen, L. C., Due, P., Koushede, V., Antenatal education in small classes may increase childbirth self-efficacy: Results from a Danish randomised trial. Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives, 10, 32–34, 2016 [PubMed: 27938870]Chi 2016
Chi, Y. C., Sha, F., Yip, P. S., Chen, J. L., Chen, Y. Y., Randomized comparison of group versus individual educational interventions for pregnant women to reduce their second hand smoke exposure. Medicine (Baltimore), 95, e5072, 2016 [PMC free article: PMC5059081] [PubMed: 27749578]de Leeuw 2019
de Leeuw, R. A., van der Horst, S. F. B., de Soet, A. M., van Hensbergen, J. P., Bakker, Pcam, Westerman, M., de Groot, C. J. M., Scheele, F., Digital vs face-to-face information provision in patient counselling for prenatal screening: a noninferiority randomized controlled trial. Prenatal Diagnosis, 39, 456–463, 2019 [PMC free article: PMC6593435] [PubMed: 30995693]Graham 2000
Graham, W., Smith, P., Kamal, A., Fitzmaurice, A., Smith, N., Hamilton, N., Randomised controlled trial comparing effectiveness of touch screen system with leaflet for providing women with information on prenatal tests. British Medical Journal, 320, 155–160, 2000 [PMC free article: PMC27263] [PubMed: 10634736]Koushede 2017
Koushede, V., Brixval, C. S., Thygesen, L. C., Axelsen, S. F., Winkel, P., Lindschou, J., Gluud, C., Due, P., Antenatal small-class education versus auditorium-based lectures to promote positive transitioning to parenthood - A randomised trial. PLoS ONE [Electronic Resource], 12, e0176819, 2017 [PMC free article: PMC5413036] [PubMed: 28464006]Svensson 2009
Svensson,J., Barclay,L., Cooke,M., Randomised-controlled trial of two antenatal education programmes. Midwifery, 25, 114–125, 2009 [PubMed: 17459542]Yee 2014
Yee, L. M., Wolf, M., Mullen, R., Bergeron, A. R., Cooper Bailey, S., Levine, R., Grobman, W. A., A randomized trial of a prenatal genetic testing interactive computerized information aid. Prenatal Diagnosis34, 552–557, 2014 [PMC free article: PMC4043849] [PubMed: 24578289]
Appendices
Appendix A. Review protocol
Appendix B. Literature search strategies
Appendix C. Clinical evidence study selection
Appendix D. Clinical evidence tables
Appendix E. Forest plots
Forest plots for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
No meta-analysis was conducted for this review question and so there are no forest plots.
Appendix F. GRADE tables
Appendix G. Economic evidence study selection
Economic evidence study selection for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
A single economic search was undertaken for all topics included in the scope of this guideline. No economic studies were identified which were applicable to this review question. See supplementary material 2 for details.
No economic evidence was identified which was applicable to this review question.
Appendix H. Economic evidence tables
Economic evidence tables for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
No economic evidence was identified which was applicable to this review question.
Appendix I. Economic evidence profiles
Economic evidence profiles for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
No economic evidence was identified which was applicable to this review question.
Appendix J. Economic analysis
Economic analysis for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
No economic analysis was conducted for this review question.
Appendix K. Excluded studies
Excluded studies for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
Clinical studies
Table 10Excluded studies and reasons for their exclusion
| Study | Reason for exclusion |
|---|---|
| Abdel-Aziz, S. B., Hegazy, I. S., Mohamed, D. A., Abu El Kasem, M. M. A., Hagag, S. S., Effect of dietary counseling on preventing excessive weight gain during pregnancy, Public health, 154, 172–181, 2018 [PubMed: 29248827] | Study conducted in low or middle income country |
| Ackerman, Ilana N., Ngian, Gene-Siew, Van Doornum, Sharon, Briggs, Andrew M., A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis, Clinical rheumatology, 35, 33–41, 2016 [PubMed: 26638162] | There are no relevant studies in this systematic review. |
| Aveyard, P., Lawrence, T., Evans, O., Cheng, K. K., The influence of in-pregnancy smoking cessation programmes on partner quitting and women’s social support mobilization: a randomized controlled trial, BMC public health, 5, 80, 2005 [PMC free article: PMC1201148] [PubMed: 16053527] | No relevant outcomes that fit the protocol |
| Aveyard,P., Lawrence,T., Croghan,E., Evans,O., Cheng,K.K., Is advice to stop smoking from a midwife stressful for pregnant women who smoke? Data from a randomized controlled trial, Preventive Medicine, 40, 575–582, 2005 [PubMed: 15749141] | No relevant outcomes. |
| Ayling, Laura, Henry, Amanda, Tracy, Sally, Donkin, Chris, Kasparian, Nadine A., Welsh, Alec W., How well do women understand and remember information in labour versus in late pregnancy? A pilot randomised study, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 39, 913–921, 2019 [PubMed: 31064263] | No usable outcomes reported due to high attrition |
| Bergström, M., Kieler, H., Waldenström, U., A randomised controlled multicentre trial of women’s and men’s satisfaction with two models of antenatal education, Midwifery, 27, e195–200, 2011 [PubMed: 20863604] | Content of information investigated rather than timing or mode. No relevant outcomes. |
| Bergström, M., Kieler, H., Waldenström, U., Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial, BJOG: An International Journal of Obstetrics & Gynaecology, 116, 1167–1176, 2009 [PMC free article: PMC2759981] [PubMed: 19538406] | Content of training is different between the two intervention. Does not match this review’s study protocol. |
| Bergström, M., Rudman, A., Waldenström, U., Kieler, H., Fear of childbirth in expectant fathers, subsequent childbirth experience and impact of antenatal education: subanalysis of results from a randomized controlled trial, Acta Obstetricia et Gynecologica Scandinavica, 92, 967–973, 2013 [PubMed: 23590647] | Looking at the content of antenatal care training and not about how it is provided or the format |
| Choi, JiWon, Lee, Ji hyeon, Vittinghoff, Eric, Fukuoka, Yoshimi, Bandura, Craig Davies Evenson Evenson Evenson Fjeldsoe Fjeldsoe Fox Fukuoka Fukuoka Harris Marcus Marcus Mudd Mutrie Noah Pearce Radloff Sallis Symons-Downs Taylor-Piliae Wallace Weiss, mHealth physical activity intervention: A randomized pilot study in physically inactive pregnant women, Maternal and child health journal, 20, 1091–1101, 2016 | Does not explore information valued by pregnant women. |
| Cooper,M., Warland,J., Improving women’s knowledge of prostaglandin induction of labour through the use of information brochures: A quasi-experimental study, Women and Birth, 24, 156–164, 2011 [PubMed: 21075695] | Does not explore information valued by pregnant women. |
| Dodd, J. M., Dietary and lifestyle advice for pregnant women who are overweight or obese: the LIMIT randomized trial, Annals of Nutrition & Metabolism, 64, 197–202, 2014 [PubMed: 25300260] | Does not explore information valued by pregnant women. |
| Dodd, J. M., Louise, J., Cramp, C., Grivell, R. M., Moran, L. J., Deussen, A. R., Evaluation of a smartphone nutrition and physical activity application to provide lifestyle advice to pregnant women: the SNAPP randomised trial, Maternal & Child Nutrition, 14, 2018 [PMC free article: PMC6866107] [PubMed: 28836373] | Does not explore information valued by pregnant women. |
| Doyle, O., McGlanaghy, E., Palamaro-Munsell, E., McAuliffe, F. M., Home based educational intervention to improve perinatal outcomes for a disadvantaged community: A randomised control trial, European Journal of Obstetrics & Gynecology and Reproductive Biology, 180, 162–167, 2014 [PubMed: 25027267] | No relevant outcomes. |
| Franzon, A. C. A., Oliveira-Ciabati, L., Bonifacio, L. P., Vieira, E. M., Andrade, M. S., Sanchez, J. A. C., Braga, G. C., Nogueira-Pileggi, V., Fernandes, M., Souza, J. P., A communication and information strategy in health and preparation for childbirth: a randomized cluster trial (PRENACEL), Cadernos de Saude PublicaCad Saude Publica, 35, e00111218, 2019 [PubMed: 31618382] | Study conducted in a low or middle income country. |
| Goodman, K., Mossad, S. B., Taksler, G. B., Emery, J., Schramm, S., Rothberg, M. B., Impact of Video Education on Influenza Vaccination in Pregnancy, Journal of reproductive medicine, 60, 471–479, 2015 [PMC free article: PMC4827704] [PubMed: 26775454] | No relevant outcomes. |
| Hall, J., Women’s and men’s satisfaction with two models of antenatal education, Practising Midwife, 15, 35–7, 2012 [PubMed: 22662539] | Article unavailable. |
| Kuppermann, M., Pena, S., Bishop, J. T., Nakagawa, S., Gregorich, S. E., Sit, A., Vargas, J., Caughey, A. B., Sykes, S., Pierce, L., et al.,, Effect of enhanced information, values clarification, and removal of financial barriers on use of prenatal genetic testing: a randomized clinical trial, JAMA, 312, 1210–1217, 2014 [PMC free article: PMC4445462] [PubMed: 25247517] | Does not explore information valued by pregnant women. |
| Lindgren, Peter, Stadin, Magdalena, Blomberg, Inger, Nordin, Karin, Sahlgren, Hanna, Ingvoldstad Malmgren, Charlotta, Information about first-trimester screening and self-reported distress among pregnant women and partners - comparing two methods of information giving in Sweden, Acta obstetricia ET gynecologica scandinavica, 96, 1243–1250, 2017 [PubMed: 28742930] | This study is not a RCT. |
| Lonnberg, G., Jonas, W., Unternaehrer, E., Branstrom, R., Nissen, E., Niemi, M., Effects of a mindfulness based childbirth and parenting program on pregnant women’s perceived stress and risk of perinatal depression Results from a randomized controlled trial, Journal of Affective Disorders, 262, 133–142, 2020 [PubMed: 31733457] | Irrelevant intervention. |
| Loughnan, S. A., Sie, A., Hobbs, M. J., Joubert, A. E., Smith, J., Haskelberg, H., Mahoney, A. E. J., Kladnitski, N., Holt, C. J., Milgrom, J., et al.,, A randomized controlled trial of ‘MUMentum Pregnancy’: internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression, Journal of Affective Disorders, 243, 381–390, 2019 [PubMed: 30266030] | Does not explore information valued by pregnant women. |
| Lumley,J., Donohue,L., Aiming to increase birth weight: a randomised trial of pre-pregnancy information, advice and counselling in inner-urban Melbourne, BMC Public Health, 6, 299-, 2006 [PMC free article: PMC1712341] [PubMed: 17156466] | No relevant outcomes. |
| McCarthy, E. A., Walker, S. P., Ugoni, A., Lappas, M., Leong, O., Shub, A., Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial, BJOG: An International Journal of Obstetrics & Gynaecology, 123, 965–73, 2016 [PubMed: 26875586] | Does not explore information valued by pregnant women. |
| Moran, L. J., Fraser, L. M., Sundernathan, T., Deussen, A. R., Louise, J., Yelland, L. N., Grivell, R. M., Macpherson, A., Gillman, M. W., Robinson, J. S., et al.,, The effect of an antenatal lifestyle intervention in overweight and obese women on circulating cardiometabolic and inflammatory biomarkers: secondary analyses from the LIMIT randomised trial, BMC Medicine, 15, 32, 2017 [PMC free article: PMC5307888] [PubMed: 28193219] | No relevant outcomes. |
| Sanaati, F., Mohammad-Alizadeh Charandabi, S., Farrokh Eslamlo, H., Mirghafourvand, M., Alizadeh Sharajabad, F., The effect of lifestyle-based education to women and their husbands on the anxiety and depression during pregnancy: a randomized controlled trial, Journal of Maternal-Fetal & Neonatal Medicine, 30, 870–876, 2017 [PubMed: 27186630] | Study in Iran |
| Suto, Maiko, Takehara, Kenji, Yamane, Yumina, Ota, Erika, Effects of prenatal childbirth education for partners of pregnant women on paternal postnatal mental health and couple relationship: A systematic review, Journal of Affective Disorders, 210, 115–121, 2017 [PubMed: 28024222] | No relevant outcomes. |
| Szmeja, M. A., Cramp, C., Grivell, R. M., Deussen, A. R., Yelland, L. N., Dodd, J. M., Use of a DVD to provide dietary and lifestyle information to pregnant women who are overweight or obese: a nested randomised trial, BMC Pregnancy & Childbirth, 14, 409, 2014 [PMC free article: PMC4280000] [PubMed: 25495459] | Does not explore information valued by pregnant women. |
| Wilkinson,S.A., McIntyre,H.D., Evaluation of the ‘healthy start to pregnancy’ early antenatal health promotion workshop: a randomized controlled trial, BMC Pregnancy and Childbirth, 12, 131-, 2012 [PMC free article: PMC3520859] [PubMed: 23157894] | No relevant outcomes. |
Economic studies
A single economic search was undertaken for all topics included in the scope of this guideline. No economic studies were identified which were applicable to this review question. See supplementary material 2 for details.
Appendix L. Research recommendations
Research recommendations for review question: What approach to information giving during antenatal care is effective (including timing and mode of provision)?
No research recommendations were made for this review question.
Final
Evidence reviews underpinning recommendations 1.1.9, 1.1.16, 1.3.4, 1.3.6, 1.3.8 and 1.3.21
These evidence reviews were developed by the National Guideline Alliance, which is a part of the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
- An evaluation of pregnant women's knowledge and attitudes about newborn bloodspot screening.[Midwifery. 2017]An evaluation of pregnant women's knowledge and attitudes about newborn bloodspot screening.Fitzgerald C, Heery E, Conneally N, Linnane B, George S, Fitzpatrick P. Midwifery. 2017 Feb; 45:21-27. Epub 2016 Nov 21.
- The Complementary Therapies for Labour and Birth Study making sense of labour and birth - Experiences of women, partners and midwives of a complementary medicine antenatal education course.[Midwifery. 2016]The Complementary Therapies for Labour and Birth Study making sense of labour and birth - Experiences of women, partners and midwives of a complementary medicine antenatal education course.Levett KM, Smith CA, Bensoussan A, Dahlen HG. Midwifery. 2016 Sep; 40:124-31. Epub 2016 Jun 9.
- Women's attitudes toward their partners' involvement in antenatal care and prevention of mother-to-child transmission of HIV in Cameroon, Africa.[J Midwifery Womens Health. 2013]Women's attitudes toward their partners' involvement in antenatal care and prevention of mother-to-child transmission of HIV in Cameroon, Africa.Nkuoh GN, Meyer DJ, Nshom EM. J Midwifery Womens Health. 2013 Jan-Feb; 58(1):83-91.
- Review Improving antenatal engagement for Aboriginal women in Australia: A scoping review.[Midwifery. 2020]Review Improving antenatal engagement for Aboriginal women in Australia: A scoping review.Simpson N, Wepa D, Bria K. Midwifery. 2020 Dec; 91:102825. Epub 2020 Aug 31.
- Review Antenatal perineal massage for reducing perineal trauma.[Cochrane Database Syst Rev. 2013]Review Antenatal perineal massage for reducing perineal trauma.Beckmann MM, Stock OM. Cochrane Database Syst Rev. 2013 Apr 30; (4):CD005123. Epub 2013 Apr 30.
- Approaches to information provisionApproaches to information provision
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