Effectiveness evaluation of an antenatal care intervention addressing disparities to improve perinatal outcomes in Denmark: a nationwide register-based analysis of a cluster randomized controlled trial (MAMAACT)
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Effectiveness evaluation of an antenatal care intervention addressing disparities to improve perinatal outcomes in Denmark : a nationwide register-based analysis of a cluster randomized controlled trial (MAMAACT). / Damsted Rasmussen, T; Villadsen, S F; Hansen, A Vinkel; Mortensen, L. H.; Ekstrøm, C. T.; Jervelund, S. S.; Andersen, A. M. Nybo.
I: BJOG : an international journal of obstetrics and gynaecology, Bind 130, Nr. 7, 2023, s. 759-769.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Effectiveness evaluation of an antenatal care intervention addressing disparities to improve perinatal outcomes in Denmark
T2 - a nationwide register-based analysis of a cluster randomized controlled trial (MAMAACT)
AU - Damsted Rasmussen, T
AU - Villadsen, S F
AU - Hansen, A Vinkel
AU - Mortensen, L. H.
AU - Ekstrøm, C. T.
AU - Jervelund, S. S.
AU - Andersen, A. M. Nybo
N1 - This article is protected by copyright. All rights reserved.
PY - 2023
Y1 - 2023
N2 - OBJECTIVE: To evaluate whether MAMAACT, an antenatal care (ANC) intervention, aiming at reducing ethnic and social disparities in perinatal mortality, affected perinatal health outcomes.DESIGN: Cluster randomized controlled trial.SETTING: 19 out of 20 maternity wards in Denmark.POPULATION: All newborn children within a pre-implementation period (2014-2017) or the implementation period (2018-2019) (N=188 658).INTERVENTION: A six-hour training session for midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials for pregnant women on warning signs of pregnancy complications ꟷ in six languages.METHODS: Nationwide register-based analysis of the MAMAACT cluster randomized controlled trial. Mixed-effects logistic regression models were used to estimate the change in outcomes from pre- to post-implementation in the intervention group relative to the control group. Results were obtained for the overall study population and for children born to immigrants from low-middle income countries, separately. Models were adjusted for a priori selected confounders.OUTCOME MEASURE: A composite perinatal mortality and morbidity outcome, including stillbirths, neonatal deaths, Apgar score <7, umbilical arterial pH <7.0, admissions to a neonatal intensive care unit (NICU) >48 hours, and NICU admissions for mechanical ventilation. Additional outcomes were the individual measures.RESULTS: The intervention increased the risk of the composite outcome (aOR 1.16, 95% CI: 0.99-1.34), mainly driven by differences in NICU admission risk (composite outcome excl. NICU, aOR 0.98, 95% CI: 0.84-1.14). The intervention slightly increased the risk of low Apgar score and decreased the risk of low arterial pH, however, reflecting small differences in absolute numbers. Other outcomes were unchanged.CONCLUSIONS: Overall, the MAMAACT intervention did not improve the composite perinatal mortality and morbidity outcome (when excluding NICU admissions). . The lack of effects may be due to contextual factors including organizational barriers in ANC hindering the midwives from changing practices.
AB - OBJECTIVE: To evaluate whether MAMAACT, an antenatal care (ANC) intervention, aiming at reducing ethnic and social disparities in perinatal mortality, affected perinatal health outcomes.DESIGN: Cluster randomized controlled trial.SETTING: 19 out of 20 maternity wards in Denmark.POPULATION: All newborn children within a pre-implementation period (2014-2017) or the implementation period (2018-2019) (N=188 658).INTERVENTION: A six-hour training session for midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials for pregnant women on warning signs of pregnancy complications ꟷ in six languages.METHODS: Nationwide register-based analysis of the MAMAACT cluster randomized controlled trial. Mixed-effects logistic regression models were used to estimate the change in outcomes from pre- to post-implementation in the intervention group relative to the control group. Results were obtained for the overall study population and for children born to immigrants from low-middle income countries, separately. Models were adjusted for a priori selected confounders.OUTCOME MEASURE: A composite perinatal mortality and morbidity outcome, including stillbirths, neonatal deaths, Apgar score <7, umbilical arterial pH <7.0, admissions to a neonatal intensive care unit (NICU) >48 hours, and NICU admissions for mechanical ventilation. Additional outcomes were the individual measures.RESULTS: The intervention increased the risk of the composite outcome (aOR 1.16, 95% CI: 0.99-1.34), mainly driven by differences in NICU admission risk (composite outcome excl. NICU, aOR 0.98, 95% CI: 0.84-1.14). The intervention slightly increased the risk of low Apgar score and decreased the risk of low arterial pH, however, reflecting small differences in absolute numbers. Other outcomes were unchanged.CONCLUSIONS: Overall, the MAMAACT intervention did not improve the composite perinatal mortality and morbidity outcome (when excluding NICU admissions). . The lack of effects may be due to contextual factors including organizational barriers in ANC hindering the midwives from changing practices.
U2 - 10.1111/1471-0528.17404
DO - 10.1111/1471-0528.17404
M3 - Journal article
C2 - 36655509
VL - 130
SP - 759
EP - 769
JO - British Journal of Obstetrics and Gynaecology, Supplement
JF - British Journal of Obstetrics and Gynaecology, Supplement
SN - 0140-7686
IS - 7
ER -
ID: 333690382