Ashman Amy M, Brown Leanne J, Collins Clare E, Rollo Megan E, Rae Kym M
J Acad Nutr Diet. 2017 Aug;117(8):1222-1253.e2. doi: 10.1016/j.jand.2017.03.012. Epub 2017 May 3.
Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously.
The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs.
Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively.
Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3).
Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols.
与非原住民群体相比，原住民在健康方面仍存在差距。针对这些群体孕期营养改善的干预措施可能会改善母亲及其婴儿的健康状况。此前尚未对现有营养干预项目的有效性进行过综述。
目的是确定针对经济合作与发展组织国家中怀孕原住民妇女改善营养相关结局的干预措施，并确定有助于项目成功的积极因素。
截至2015年10月，检索了13个电子数据库。关键词用于识别旨在改善怀孕原住民妇女营养相关结局的干预研究。两名评审员评估文章是否纳入及研究质量，并提取数据。仅纳入英文发表的研究。数据采用叙述性总结。
筛选了摘要和标题（n = 2566），并对315篇全文进行了资格审查。本综述纳入了来自澳大利亚、加拿大和美国20个干预项目的27篇文章。最常见的可测量结局是出生体重（n = 9）和母乳喂养开始/持续时间（n = 11）。在这些结局上有统计学显著结果的项目采用了以下营养活动：个体咨询/教育（n = 8）；由原住民老年妇女（n = 2）、同伴咨询师（n = 3）或其他原住民卫生工作者（n = 4）进行服务提供；社区范围的干预措施（n = 2）；媒体宣传活动（n = 2）；由非原住民卫生专业人员进行服务提供（n = 3）；以及家访（n = 3）。
纳入研究的异质性使得就项目成功做出确凿建议具有挑战性。纳入研究的作者建议在研究设计以及研究过程的各个阶段与社区合作时都应包括社区咨询。个体化咨询/教育有助于项目取得成功，使用原住民工作人员提供项目内容也有同样效果。一些研究的局限性包括干预措施缺乏细节以及使用了非随机对照组。未来的研究应包括干预组成部分的详细描述，并纳入适当的评估方案。
