Bick Debra, Beake Sarah, Chappell Lucy, Ismail Khaled M, McCance David R, Green James S A, Taylor Cath
King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
Women's Health Academic Centre, Guys and St Thomas' NHS Foundation Trust, 10th floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
BMC Pregnancy Childbirth. 2014 Dec 20;14:428. doi: 10.1186/s12884-014-0428-5.
More women with an increased risk of poor pregnancy outcome due to pre-existing medical conditions are becoming pregnant. Although clinical care provided through multi-disciplinary team (MDT) working is recommended, little is known about the structure or working practices of different MDT models, their impact on maternal and infant outcomes or healthcare resources. The objectives of this review were to consider relevant international evidence to determine the most appropriate MDT models of care to manage complex medical conditions during and after pregnancy, with a specific focus on pre-existing diabetes or cardiac disease in high income country settings.
Quantitative and qualitative evidence of MDT models of care for the management of pregnant/postnatal women with pre-existing diabetes and cardiac disease was considered. A search of the literature published between January 2002 - January 2014 was undertaken. Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Given limited primary and secondary research evidence, guidelines and opinion papers were included. Two independent reviewers conducted critical appraisal of included papers.
Nineteen papers were included from UK, Canada, USA, the Netherlands and Singapore. No studies were found which had compared MDT models for pregnant/postnatal women with pre-existing diabetes or cardiac disease. Two small retrospective studies reported better outcomes for women with cardiac disease if an MDT approach was used, although evidence to support this was limited. Due to study heterogeneity it was not possible to meta-analyse data. No evidence was identified of MDT management in the postnatal period or impacts of MDT working on healthcare resources.
Despite widespread promotion of MDT models of care for pregnant and postnatal women with pre-existing diabetes or cardiac disease, there is a dearth of primary evidence to inform structure or working practices or beneficial impact on maternal and infant outcomes or healthcare resources. Primary research into if or how MDT models of care improve outcomes for women with complex pregnancies is urgently needed.
越来越多因孕前存在的健康问题而面临不良妊娠结局风险增加的女性怀孕。尽管建议通过多学科团队（MDT）协作提供临床护理，但对于不同MDT模式的结构或工作实践、其对母婴结局或医疗资源的影响知之甚少。本综述的目的是考虑相关国际证据，以确定在孕期及产后管理复杂健康问题时最合适的MDT护理模式，特别关注高收入国家环境中孕前存在的糖尿病或心脏病。
考虑了关于管理患有孕前糖尿病和心脏病的孕妇/产后妇女的MDT护理模式的定量和定性证据。检索了2002年1月至2014年1月发表的文献。使用乔安娜·布里格斯研究所制定的清单评估方法学质量。鉴于初级和二级研究证据有限，纳入了指南和意见书。两名独立评审员对纳入的论文进行了批判性评价。
纳入了来自英国、加拿大、美国、荷兰和新加坡的19篇论文。未发现比较患有孕前糖尿病或心脏病的孕妇/产后妇女的MDT模式的研究。两项小型回顾性研究报告称，采用MDT方法的心脏病女性结局更好，尽管支持这一点的证据有限。由于研究的异质性，无法对数据进行荟萃分析。未发现产后MDT管理的证据或MDT工作对医疗资源的影响。
尽管广泛推广针对患有孕前糖尿病或心脏病的孕妇和产后妇女的MDT护理模式，但缺乏关于其结构或工作实践、对母婴结局或医疗资源的有益影响的主要证据。迫切需要对MDT护理模式是否以及如何改善复杂妊娠女性的结局进行初步研究。
