Whitworth Melissa, Dowswell Therese
St Mary's Hospital, Central Manchester and Manchester Children's University Hospitals NHS Trust, Hathersage Road, Manchester, UK, M13 0JH.
Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD007536. doi: 10.1002/14651858.CD007536.pub2.
A number of potentially modifiable risk factors are known to be associated with poor pregnancy outcomes. These include smoking, drinking excess alcohol, and poor nutrition. Routine health promotion (encompassing education, advice and general health assessment) in the pre-pregnancy period has been proposed for improving pregnancy outcomes by encouraging behavioural change, or allowing early identification of risk factors. While results from observational studies have been encouraging, this review examines evidence from randomised controlled trials of preconception health promotion.
To assess the effectiveness of routine pre-pregnancy health promotion for improving pregnancy outcomes when compared with no pre-pregnancy care or usual care.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009).
Randomised and quasi-randomised trials examining health promotion interventions which aim to identify and modify risk factors before pregnancy. The review focuses on all women of childbearing age rather than those in high-risk groups. We have excluded trials where interventions are aimed specifically at women with established medical, obstetric or genetic risks or already receiving treatment as part of programmes for high-risk groups.
Two review authors independently assessed eligibility and carried out data extraction.
Four trials (2300 women) are included. The interventions ranged from brief advice through to education on health and lifestyle over several sessions. For most outcomes, data were only available from individual studies. Only one study followed up through pregnancy and there was no strong evidence of a difference between groups for preterm birth, congenital anomalies or weight for gestational age; only one finding (mean birthweight) reached statistical significance (mean difference -97.00, 95% confidence interval (CI) -168.05 to -25.95). This finding needs to be interpreted with caution as pregnancy outcome data were available for only half of the women randomised. There was some evidence that health promotion interventions were associated with positive maternal behavioural change including lower rates of binge drinking (risk ratio 1.24, 95% CI 1.06 to 1.44). Overall, there has been little research in this area and there is a lack of evidence on the effects of pre-pregnancy health promotion on pregnancy outcomes.
AUTHORS' CONCLUSIONS: There is little evidence on the effects of pre-pregnancy health promotion and much more research is needed in this area. There is currently insufficient evidence to recommend the widespread implementation of routine pre-pregnancy health promotion for women of childbearing age, either in the general population or between pregnancies.
已知一些潜在的可改变风险因素与不良妊娠结局相关。这些因素包括吸烟、过量饮酒和营养不良。有人提议在孕前进行常规健康促进（包括教育、建议和一般健康评估），以通过鼓励行为改变或尽早识别风险因素来改善妊娠结局。虽然观察性研究的结果令人鼓舞，但本综述考察了孕前健康促进随机对照试验的证据。
评估与未进行孕前护理或常规护理相比，常规孕前健康促进对改善妊娠结局的有效性。
我们检索了Cochrane妊娠与分娩组试验注册库（2009年2月）。
考察旨在孕前识别和改变风险因素的健康促进干预措施的随机和半随机试验。本综述关注所有育龄妇女，而非高危人群中的妇女。我们排除了干预措施专门针对患有既定医学、产科或遗传风险的妇女或已作为高危人群项目一部分接受治疗的妇女的试验。
两位综述作者独立评估入选资格并进行数据提取。
纳入了四项试验（2300名妇女）。干预措施从简短建议到多次关于健康和生活方式的教育不等。对于大多数结局，数据仅来自个别研究。只有一项研究随访至妊娠结束，且在早产、先天性异常或出生体重方面，两组之间没有有力证据表明存在差异；只有一个结果（平均出生体重）达到统计学显著性（平均差异 -97.00，95%置信区间（CI）-168.05至-25.95）。由于仅随机分组妇女中的一半有妊娠结局数据，这一结果需谨慎解读。有一些证据表明健康促进干预与产妇积极的行为改变相关，包括暴饮率较低（风险比1.24，95%CI 1.06至1.44）。总体而言，该领域研究较少，缺乏关于孕前健康促进对妊娠结局影响的证据。
关于孕前健康促进的影响几乎没有证据，该领域需要更多研究。目前没有足够证据推荐在一般人群或两次妊娠之间为育龄妇女广泛实施常规孕前健康促进。
