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A Systematic Review of Antenatal Risk Scoring Systems in India to Predict Adverse Neonatal Outcomes



The purpose of antenatal care (ANC) is to identify ‘at-risk’ pregnant women, to provide quality care for all, and maximize the allocation of resources for those who need them the most. To address the synergistic effect of risk factors, clinicians across the globe developed antenatal scoring systems.


This review aims to investigate various antenatal risk scoring systems developed and used in India to predict adverse neonatal outcome.


We reviewed articles published between January 2000 and April 2020, which have either developed a scoring system or used a scoring system, among the Indian population. This systematic review is reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Prediction model study Risk Of Bias Assessment Tool (PROBAST) was employed for the assessment of the quality of included studies. Data sources such as Embase, MEDLINE/Pubmed, APA PsycExtra, PsycINFO, CINHAL Plus, Cochrane Library, IndMED, LILACS, Scopus, WHO Reproductive Health Library and Web of science were searched.


An initial search retrieved a total of 6246 articles. This systematic review identified six studies, of which one study developed an antenatal scoring system and the other five studies used two antenatal systems for predicting adverse neonatal outcome. The study which developed a risk scoring system had a high risk of bias (ROB) and concern for applicability. The overall sensitivity of the antenatal scoring system was high (77.4%), but the specificity was low (45%). Similarly, the positive predictive value is low (15.3%), and the negative predictive value is high (94.2%). A meta-analysis was not conducted due to the heterogeneity of the studies and insufficient data.


There is a need for a systematically developed antenatal scoring system for India. Such scoring systems can be promising in public health, proposing a paradigm shift in the implementation of effective mother and child health programmes locally as well as nationally.

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The authors would like to acknowledge the steering committee members for their valuable inputs and suggestions.


This systematic review did not receive any funding.

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Authors and Affiliations



All the authors conceived and designed the study. DRP, SK and SKK developed the search strategy. DRP and SKK conducted the search strategy. DRP and SK independently assessed titles and abstracts for eligibility and extracted relevant data. VBB was the third reviewer to resolve any disagreements. DRP and VBB drafted the manuscript. All the authors reviewed, gave feedback and approved the final version of the manuscript.

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Correspondence to Dinesh Raj Pallepogula.

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The systematic review was registered with International Prospective Registering of Systematic Reviews–PROSPERO (CRD42019108083).

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Pallepogula, D.R., Bethou, A., Ballambatu, V.B. et al. A Systematic Review of Antenatal Risk Scoring Systems in India to Predict Adverse Neonatal Outcomes. J Obstet Gynecol India 72, 181–191 (2022).

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  • Antenatal risk scoring
  • Risk score development
  • High-risk pregnancy
  • Systematic review
  • India