This review compiles updated effect estimates for a range of antenatal and intrapartum interventions with demonstrated relevance to neonatal survival and related outcomes. The primary objective was to synthesise recent evidence and determine which meta-analysed estimates should be updated or retained as inputs for the Lives Saved Tool (LiST), a modelling platform used to project intervention impacts on maternal, newborn, and child health.
The authors conducted systematic searches of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) covering 2022–2023. A technical advisory group was convened to guide decisions on whether and how new meta-analysed effect estimates could be incorporated into the LiST model. The process identified antenatal strategies across domains including immunisation, infection screening and management, chronic disease management, nutrition, psychosocial interventions, and peripartum clinical practices.
The review highlights that antenatal tetanus toxoid vaccination was associated with a significant reduction in neonatal mortality. This finding supports the continued inclusion of maternal tetanus vaccination as a high-impact antenatal intervention for improving newborn survival in modelling and programmatic planning.
Screening and timely treatment of maternal infections were assessed across several conditions. The review reports that antibiotic treatment of maternal syphilis during pregnancy reduced the risk of stillbirth. Treatment of certain maternal infections was also considered for their downstream effects on preterm birth and neonatal sepsis, with some interventions contributing to LiST inputs where evidence supported quantifiable impact.
For pregnancies complicated by PPROM, administration of antibiotics during the antenatal period was associated with reductions in neonatal mortality attributable to sepsis. The review supports the role of antibiotic therapy in the management pathway for PPROM as an intervention that can reduce infection-related neonatal deaths.
Administration of antenatal corticosteroids to promote fetal lung maturation was found to reduce neonatal mortality caused by prematurity. The review therefore reinforces corticosteroid therapy as an evidence-based antenatal intervention to lower prematurity-related neonatal deaths and supports its representation in LiST modelling.
Nutritional support during pregnancy was examined with respect to fetal growth outcomes. Interventions including balanced protein-energy supplementation and multiple micronutrient supplementation were associated with reduced risks of babies born small-for-gestational-age (SGA). These nutrition-related effects were considered relevant for LiST inputs addressing growth-related neonatal vulnerability.
Several antenatal and intrapartum interventions were identified as reducing stillbirth risk. These include use of insecticide-treated bed nets for malaria prevention in pregnancy, effective antibiotic therapy for maternal syphilis, and post-term induction of labour. The evidence for these interventions supports their consideration when modelling reductions in stillbirths and related perinatal outcomes.
The authors reviewed interventions that affect preterm birth and related growth outcomes. Evidence for interventions such as treatment of asymptomatic bacteriuria, omega-3 fatty acid supplementation, calcium supplementation, and provision of low-dose aspirin for prevention of pre-eclampsia contributed to LiST model inputs; the projections from these inputs indicated significant reductions in SGA risk. These interventions were therefore incorporated where pooled estimates supported their impact on preterm birth or fetal growth outcomes.
The updated effect estimates identified through literature synthesis and technical consultation were evaluated for incorporation into LiST. Where meta-analysed data demonstrated consistent, quantifiable effects on outcomes such as neonatal mortality, stillbirth, prematurity-related deaths, neonatal sepsis, or SGA, the estimates were recommended for use as LiST inputs. The review emphasizes the role of LiST as a platform to model the potential impact of implementing context-specific antenatal care packages that combine high-yield interventions.
The review concludes that a suite of antenatal and intrapartum interventions — including maternal tetanus vaccination, antibiotics for PPROM, antenatal corticosteroids, targeted nutritional supplementation, malaria prevention with insecticide-treated nets, treatment of maternal syphilis, and post-term induction — have evidence supporting reductions in neonatal mortality, stillbirth, prematurity-related death, or small-for-gestational-age births. Updated effect estimates can be applied within the Lives Saved Tool to model projected impacts and support context-specific planning.
Note: The review methods, specific pooled effect sizes, and detailed meta-analysis results were not reproduced in full in the source abstract; those numerical details were not reported in the provided source content.