Clinical Trial Details
— Status: Enrolling by invitation
Administrative data
NCT number |
NCT05290467 |
Other study ID # |
PUTHOGO2ORCT |
Secondary ID |
|
Status |
Enrolling by invitation |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
March 20, 2022 |
Est. completion date |
December 31, 2024 |
Study information
Verified date |
October 2021 |
Source |
Peking University Third Hospital |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Antenatal care (ANC) is a critical measure to reduce maternal and perinatal morbidity and
mortality. However, there are issues of too many visits and cumbersome procedures of ANC in
many maternity hospitals of China. In the past year, the COVID-19 pandemic has brought huge
impacts on the health systems, but also gives a valuable chance to review healthcare delivery
strategies. Reduced-visit antenatal care models combined with remote monitoring have been
recommended and implemented at most hospitals in China during the pandemic, particularly for
low-risk pregnant women. However, due to limited evaluations of the cost-effectiveness,
policymakers remain confused on how to appropriately integrate online delivery strategies
with routine models to improve ANC quality and efficiency sustainably at scale.
This is a single-blind, randomized controlled trial, conducted among low-risk pregnant women
at Peking University Third Hospital in Beijing, to evaluate the effectiveness, acceptability,
and cost of a reduced-visit ANC model combined with online monitoring compared to the routine
ANC model. Participants will be randomly assigned in a 1:1 ratio to receive 12 routine ANC
visits or the new ANC model consist of 9 outpatient visits and three online services with
remote monitoring on their weight, heart rate, blood pressure, urinary protein, blood
glucose, and fetal movement. CSOG-recommended ANC services will be provided to all
participants. According to the study objectives and hypotheses, the primary outcome is
adverse maternal and perinatal outcomes for non-inferiority analysis, and the secondary
outcomes are acceptability and cost for superiority analysis.
Description:
Main project problem Is it possible to develop a reduced-visit antenatal care model for
low-risk pregnant women, which is more convenient and lower-cost while has same protection
for maternal and fetal health compared with routine care? Goals and objectives This project
aims to evaluate the acceptability, cost and effectiveness of a reduced-visit antenatal care
model combined with online monitoring for low-risk pregnant women, so as to provide evidence
for improving antenatal care delivery strategies.
Methods Design, settings and participants A randomized controlled trial will be conducted at
the obstetric outpatient department of a tertiary hospital in Beijing between 2022 and 2024.
Pregnant women meeting the following criteria are eligible: at 20-34 years old, at <8 weeks
of gestation, being registered and scheduled for antenatal care and delivery at this
hospital, and without adverse pregnancy-related or medical conditions prior to registration.
Randomization and blinding Pregnant women who complete the first antenatal examination will
be assessed for eligibility and recruited by an obstetric nurse. After informed consent is
obtained, participants will be randomly assigned to either experimental or control groups
using a computer program by an independent statistician blinded to participants'
characteristics and health conditions. Obstetricians and nurses provide assigned antenatal
care. The outcome assessors and data statistical analysts will be blinded to antenatal care
allocation.
Intervention and control methods Participants in the control group will be scheduled for
routine 12 clinic visits for antenatal examinations. Participants in the experimental group
will be scheduled for 9 clinic visits and additional 3 times of services provided through an
online medical service platform. Home self-monitoring for weight, heart rate, blood pressure,
urinary protein, blood glucose, and fetal movement is recommended in experimental group,
according to the guideline of the Chinese Society of Obstetrics and Gynecology (CSOG) . Such
a combination is generally in line with the WHO and CSOG recommendations. Participants
developing any complications during pregnancy will be treated according to the conventional
clinical pathway, regardless of their grouping.
Data collection and evaluation Participants will be followed up until delivery. Antenatal
care time, type and practices will be recorded in detail. Effectiveness, as the primary
outcome, will be evaluated by comparing maternal and perinatal outcomes between the two
groups. The health outcomes can be extracted from medical records, including maternal, fetal,
and neonatal complications, cesarean delivery, preterm, birthweight, Apgar scores, etc. The
secondary outcomes include acceptability and cost of the new antenatal model. Acceptability
will be measured by comparing satisfaction with antenatal care and pregnancy-related stress.
We will measure pregnant women's expectations with prenatal care at 8 weeks of gestation and
measure their satisfaction with prenatal care after each visit/contact, using the Patient
Expectations and Satisfaction with Prenatal Care (PESPC) instrument. Pregnancy-related stress
will be measured at 12, 26 and 36 weeks of gestation by the Pregnancy Stress Rating Scale
(PSRS) which has been well validated and widely used (Chen, 2015). Cost of both routine and
reduced-visit antenatal care models will be measured from the perspective of both service
providers and pregnant women. For a pregnant woman during whole pregnancy, the cost of
providing routine antenatal care is calculated by multiplying the average time spent by
clinicians and nurses by their average hourly income, and the cost of obtaining antenatal
care is calculated by summing the following items: (a) Direct medical cost; (b) Direct
non-medical costs, including transportation expenses, accompanying expenses, accommodation
expenses, etc. for obtaining prenatal health care services; (c) Indirect costs, calculated by
multiplying the working hours delayed by the participants and their families due to antenatal
care throughout pregnancy by their normal average hourly income.
Sample size The sample size can be calculated based on expected effectiveness which is
considered as the most important endpoint. Given the estimated composite rate of 15% for
maternal and perinatal adverse outcomes, a sample size of 1762 patients (881 in each group)
would be required with 5% (two-sided) type I error, 80% power, and 10% attrition using a 5%
non-inferiority margin.
Statistical Analysis Both intention-to-treat and per-protocol analyses will be performed to
account for participants with protocol violations. Satisfaction with antenatal care,
pregnancy-related stress, cost, and health outcomes will be compared by arm using independent
t-test or one-way analysis of variance for continuous variables and χ2 test or Fisher's exact
test for nominal variables. If appropriate, non-inferiority tests will be used by taking a
one-sided test of 2.5%, a non-inferiority value of 5%. Multivariable adjusted analyses will
be performed to detect the differences more accurately after adjusting for baseline
characteristics.
Cost-effectiveness analysis A cost-effectiveness analysis comparing the two ANC models will
be conducted by estimating the incremental cost-effectiveness ratios (ICERs) from the
perspective of both providers and pregnant women. ICERs are computed by dividing the
incremental costs with the differences between the intervention and control groups in primary
and secondary outcomes. A sensitivity analysis will be conducted to assess the sensitivity of
the cost-effectiveness results with respect to variations in key parameters, including cost.
Expected results and products By the trial, we expect to evaluate the acceptability, cost and
effectiveness of the reduced-visit antenatal care model combined with online monitoring. The
model will be widely recommended as an alternative method to delivery antenatal care if
meeting expectation.