Aslam Rabeea'h W, Hendry Maggie, Booth Andrew, Carter Ben, Charles Joanna M, Craine Noel, Edwards Rhiannon Tudor, Noyes Jane, Ntambwe Lupetu Ives, Pasterfield Diana, Rycroft-Malone Jo, Williams Nefyn, Whitaker Rhiannon
Department of Biostaistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
North Wales Centre for Primary Care Research School of Healthcare Sciences, Bangor University, Bangor, UK.
BMC Med. 2017 Aug 15;15(1):155. doi: 10.1186/s12916-017-0904-7.
Unintended repeat conceptions can result in emotional, psychological and educational harm to young women, often with enduring implications for their life chances. This study aimed to identify which young women are at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what are the barriers to and facilitators for the uptake of these interventions.
We conducted a mixed-methods systematic review which included meta-analysis, framework synthesis and application of realist principles, with stakeholder input and service user feedback to address this. We searched 20 electronic databases, including MEDLINE, Excerpta Medica database, Applied Social Sciences Index and Abstracts and Research Papers in Economics, to cover a broad range of health, social science, health economics and grey literature sources. Searches were conducted between May 2013 and June 2014 and updated in August 2015.
Twelve randomised controlled trials (RCTs), two quasi-RCTs, 10 qualitative studies and 53 other quantitative studies were identified. The RCTs evaluated psychosocial interventions and an emergency contraception programme. The primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control group, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78-1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with an RR of 0.60 (95% CI 0.39-0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations and negligible opportunities. Qualitative and realist evidence highlighted the importance of context, motivation, future planning and giving young women a central and active role in the development of new interventions.
Little or no evidence for the effectiveness or cost-effectiveness of any of the interventions to reduce repeat pregnancy in young women was found. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce unintended repeat pregnancy in young women.
PROSPERO, CRD42012003168 . Cochrane registration number: i = fertility/0068.
意外再次怀孕会对年轻女性造成情感、心理和教育方面的伤害，往往会对她们的人生机遇产生持久影响。本研究旨在确定哪些年轻女性再次意外怀孕的风险最高；哪些干预措施有效且具有成本效益；以及采用这些干预措施的障碍和促进因素是什么。
我们进行了一项混合方法的系统评价，包括荟萃分析、框架综合以及现实主义原则的应用，并纳入了利益相关者的意见和服务使用者的反馈来解决这个问题。我们检索了20个电子数据库，包括MEDLINE、医学文摘数据库、应用社会科学索引与摘要以及经济学研究论文数据库，以涵盖广泛的健康、社会科学、卫生经济学和灰色文献来源。检索在2013年5月至2014年6月期间进行，并于2015年8月更新。
共识别出12项随机对照试验（RCT）、2项半随机对照试验、10项定性研究和53项其他定量研究。RCT评估了心理社会干预措施和一项紧急避孕计划。主要结局是再次怀孕率：干预组308例中有132例（43%）发生该事件，对照组289例中有140例（48%）发生，风险比（RR）为0.92，无统计学意义[95%置信区间（CI）0.78 - 1.08]。四项研究报告了后续出生率：干预组237例中有29例（12%）发生该事件，对照组224例中有46例（21%）发生，RR为0.60（95% CI 0.39 - 0.93）。许多再次怀孕发生在贫困、期望和抱负较低以及机会微乎其微的背景下。定性和现实主义证据强调了背景、动机、未来规划的重要性，以及让年轻女性在新干预措施的制定中发挥核心和积极作用。
未发现有任何干预措施在减少年轻女性再次怀孕方面有效或具有成本效益的证据。定性和现实主义证据有助于解释干预设计中应解决的差距。需要制定更多基于理论且经过严格评估的项目，以减少年轻女性意外再次怀孕的情况。
PROSPERO，CRD42012003168。Cochrane注册号：i = 生育/0068。
