Homer Caroline S E, Ryan Clare, Leap Nicky, Foureur Maralyn, Teate Alison, Catling-Paull Christine J
Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, Australia.
Cochrane Database Syst Rev. 2012 Nov 14;11:CD007622. doi: 10.1002/14651858.CD007622.pub2.
Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care is through a group model.
The first objective was to compare the effects of group antenatal care versus one-to-one care on outcomes for women and their babies. The primary outcomes were preterm birth (birth occurring before 37 completed gestational weeks), low birthweight (less than 2500 g), small-for-gestational age (less than the tenth percentile for gestation and gender) and perinatal mortality. Secondary outcomes included psychological measures and satisfaction as well as labour and birth and postnatal outcomes.The second objective was to compare the effects of group care versus one-to-one care on care provider satisfaction.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 March 2012), contacted experts in the field and reviewed the reference lists of retrieved studies.
All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible for inclusion but none were identified. Cross-over trials were not eligible.
Two review authors independently assessed studies for inclusion and evaluated trial quality. Two authors extracted data. Data were checked for accuracy.
We included two studies (1369 women). There were no statistically significant differences between women who received group antenatal care compared with standard one-to-one care in relation to the primary outcomes. In particular, there was no difference in the rate of preterm birth rate between the two groups (risk ratio (RR) 0.87; 95% confidence interval (CI) 0.47 to 1.60; two trials; N = 1315) and the proportion of low birthweight (less than 2500 g) babies was similar between the groups (RR 1.03; 95% CI 0.73 to 1.46; two trials; N = 1315).Satisfaction was rated highly in women who were allocated to group antenatal care but only measured in one trial. In this trial, the mean satisfaction with care in group antenatal care was almost five times higher compared with those allocated to standard care (N = 993). A number of outcomes related to stress, distress and depression were reported in one trial. There were no differences between the groups in any of these outcomes.There were no data available on the effects of group antenatal care on care provider satisfaction.
AUTHORS' CONCLUSIONS: The available evidence suggests that group antenatal care is positively viewed by women with no adverse outcomes for themselves or their babies. This review is limited owing to the small number of studies/women and the majority of the analyses are based on a single study. More research is required to determine if group antenatal care is associated with significant benefits.
产前护理是全球范围内使用的关键预防性保健服务之一。在大多数西方国家，传统的产前护理包括与护理提供者进行一对一的定期就诊。另一种提供产前护理的方式是通过小组模式。
第一个目的是比较小组产前护理与一对一护理对妇女及其婴儿结局的影响。主要结局包括早产（妊娠满37周前出生）、低出生体重（小于2500克）、小于胎龄儿（小于根据孕周和性别划分的第十百分位数）和围产期死亡率。次要结局包括心理指标、满意度以及分娩和产后结局。第二个目的是比较小组护理与一对一护理对护理提供者满意度的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2012年3月9日），联系了该领域的专家，并查阅了检索到的研究的参考文献列表。
所有已识别的比较小组产前护理与传统产前护理的已发表、未发表及正在进行的随机和半随机对照试验均被纳入。整群随机试验符合纳入标准，但未识别到相关试验。交叉试验不符合纳入标准。
两位综述作者独立评估研究是否纳入并评估试验质量。两位作者提取数据。对数据进行准确性检查。
我们纳入了两项研究（1369名妇女）。接受小组产前护理的妇女与接受标准一对一护理的妇女在主要结局方面无统计学显著差异。特别是，两组之间的早产率无差异（风险比（RR）0.87；95%置信区间（CI）0.47至1.60；两项试验；N = 1315），两组中低出生体重（小于2500克）婴儿的比例相似（RR 1.03；95%CI 0.73至1.46；两项试验；N = 1315）。分配到小组产前护理的妇女对护理的满意度评价很高，但仅在一项试验中进行了测量。在该试验中，小组产前护理的护理平均满意度比分配到标准护理的妇女高出近五倍（N = 993）。一项试验报告了一些与压力、痛苦和抑郁相关的结局。在这些结局的任何一项上，两组之间均无差异。没有关于小组产前护理对护理提供者满意度影响的数据。
现有证据表明，小组产前护理受到妇女的积极评价，对她们自己或其婴儿没有不良结局。由于研究/妇女数量较少，且大多数分析基于单一研究，本综述存在局限性。需要更多研究来确定小组产前护理是否具有显著益处。
