Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON; Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON.
Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON; MD Program, Faculty of Medicine, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2020 Aug;42(8):1001-1011. doi: 10.1016/j.jogc.2019.09.011. Epub 2020 Jan 25.
The purpose of this study was to determine the clinical and non-clinical outcomes that pregnant women with obesity value as pertaining to their health and that of their babies. In this systematic review of the qualitative literature, a search of four databases was conducted for studies using qualitative methods in pregnant women with obesity. From the included studies, the review synthesized relevant themes representing the voiced concerns and perceived benefits of and barriers to the uptake of interventions, to yield patient-reported outcomes (PROs). PROs were categorized into domains according to the published taxonomy of outcomes in medical research. Of the 89 identified studies, 27 were included, none of which were primarily intended to elicit PROs. A total of 256 PROs and 7 distinct themes were identified. Only 13% of PROs represented physiological or clinical outcomes, whereas 21% represented the core area of emotional functioning or well-being, and 15% represented the area of delivery of care. The most frequently voiced concern was inadequate health care provider support (60%), and women considered intervention-specific challenges to be the greatest barriers to the uptake of interventions (34%). This study synthesized the qualitative evidence of concerns that pregnant women with obesity have regarding their pregnancy and postpartum care, as well as specific barriers they perceive to the uptake of interventions. In addition, this study revealed that clinical outcomes, which are most often reported in clinical trials, comprise only a minority of outcomes considered important by these women. A core outcome set that adequately incorporates PROs is required to inform the conduct of future trials in pregnant women with obesity.
本研究旨在确定肥胖孕妇重视的与自身和婴儿健康相关的临床和非临床结局。本系统综述对定性文献进行了检索，在四个数据库中搜索了使用定性方法研究肥胖孕妇的研究。从纳入的研究中，综述综合了与干预措施的采用相关的问题和获益，以及障碍的主题，以产生患者报告的结局（PROs）。PROs 根据医学研究中发表的结局分类法进行了分类。在 89 项已确定的研究中，有 27 项被纳入，其中没有一项主要旨在引出 PROs。共确定了 256 个 PROs 和 7 个不同的主题。只有 13%的 PROs 代表生理或临床结局，而 21%代表情感功能或幸福感的核心领域，15%代表护理的提供。最常表达的担忧是医疗保健提供者支持不足（60%），女性认为干预特定的挑战是采用干预措施的最大障碍（34%）。本研究综合了肥胖孕妇对妊娠和产后护理的担忧的定性证据，以及她们对采用干预措施的具体障碍的看法。此外，本研究表明，临床试验中最常报告的临床结局仅占这些女性认为重要的结局的少数。需要制定一个充分纳入 PROs 的核心结局集，以指导未来肥胖孕妇的临床试验。
