IMPACT OF ADEQUATE ANTENATAL CARE ON THE REDUCTION OF NEONATAL INFECTIONS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv16n55-104Keywords:
Antenatal Care, Neonatal Infections, Maternal Health Services, Perinatal OutcomesAbstract
Introduction: Neonatal infections remain a leading cause of morbidity and mortality worldwide, particularly in low- and middle-income countries, and many of these events are preventable through high-quality antenatal care. Adequate antenatal follow-up creates opportunities for early identification and management of maternal comorbidities and infectious diseases, thereby interrupting vertical transmission pathways and improving neonatal outcomes.
Objective: To systematically evaluate the impact of adequate antenatal care on the reduction of neonatal infections and infection-related mortality, and to identify the specific antenatal interventions most strongly associated with improved neonatal infectious outcomes across different health system contexts.
Methods: This systematic review followed PRISMA guidelines. Searches were conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform, using controlled vocabulary and keywords related to antenatal care, maternal infections, and neonatal infections, without language restriction. Human studies published in the last five years were prioritized, with potential extension to ten years if fewer than ten eligible studies were available. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using RoB 2, ROBINS-I, and QUADAS-2 as appropriate. Certainty of evidence was graded using GRADE, and results were synthesized narratively.
Results: 22 studies met the inclusion criteria, encompassing randomized controlled trials, cohort studies, population-based analyses, and meta-analyses from diverse geographic regions. Adequate or intensified antenatal care was consistently associated with reduced neonatal mortality and infection-related complications. Targeted interventions such as timely syphilis screening and treatment, systematic Group B Streptococcus screening with intrapartum prophylaxis, and maternal pertussis vaccination showed robust reductions in congenital and early-onset infections. Antenatal corticosteroids improved survival and respiratory outcomes among preterm infants when used according to guidelines, although some large observational cohorts suggested potential increases in infection risk when used outside recommended indications. Heterogeneity in implementation fidelity, health-system capacity, and population risk profiles contributed to variability in effect magnitude.
Conclusion: Adequate antenatal care, particularly when it integrates structured infectious disease screening, maternal vaccination, and guideline-based pharmacologic interventions, plays a decisive role in reducing neonatal infections and infection-related mortality. Strengthening the coverage, quality, and continuity of antenatal services—especially in resource-limited settings—should be a central component of strategies aimed at improving neonatal survival and reducing the global burden of preventable infectious disease in early life.
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