Antenatal interventions to support newborn survival: updates for the Lives Saved Tool.

Background: Antenatal care strategies encompass a series of interventions delivered to expectant mothers to optimise both their health outcomes and those of their neonate. We summarise the most recent effect estimates for maternal immunisation, screening and management of infections, pre-existing chronic diseases such as hypertension and diabetes, nutrition, psychosocial interventions for smoking cessation, pre-term pre-labour rupture of membranes, administration of corticosteroids for foetal lung maturation, and induction of post-term labour. Methods: We synthesised effect estimates for antenatal and intrapartum interventions using PubMed and CENTRAL searches (2022-2023) and in consultation with a technical advisory group to determine whether and how new meta-analysed effect estimates could be incorporated into the Lives Saved Tool (LiST) model, as well as which of these estimates should be updated and which should be retained. Results: Tetanus toxoid vaccination during the antenatal period lead to a significant reduction in neonatal mortality. Antibiotics for pre-term pre-labour rupture of membranes and administration of corticosteroids for foetal lung maturation lead to significant reductions in neonatal mortality due to sepsis and prematurity, respectively. Nutritional interventions including balanced protein and energy supplementation and multiple micronutrient supplementation reduced the risks of small-for-gestational-age babies. Insecticide-treated bed-nets for malaria, antibiotic treatment of syphilis, and post-term induction of labour demonstrated significant reductions in the risks of stillbirth. The effect estimates for preterm births contributed to the LiST model for interventions including treatment of asymptomatic bacteriuria, omega-3 fatty acid supplementation, calcium supplementation, and provision of low-dose aspirin for pre-eclampsia, which projected significant reductions in the risks of small-for-gestational-age babies. Conclusions: The evidence described here highlights the potential impact of implementing high-yield healthcare packages in context-specific settings to effectively improve neonatal survival. These estimates can be used as inputs to model the impact of antenatal care interventions using the LiST.