School of Psychology and Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
La Trobe University Library Research, La Trobe University, Bundoora, 3086, Victoria, Australia.
Women Birth. 2021 Nov;34(6):e631-e642. doi: 10.1016/j.wombi.2020.12.004. Epub 2020 Dec 25.
Poor mental health remains a significant cause of morbidity for childbearing women globally.
Group care has been shown to be effective in reducing select clinical outcomes, e.g., the rate of preterm birth, but less is known about the effect of Group Prenatal Care (GPC) on mental health outcomes of stress, depression and anxiety in pregnant women.
To conduct a systematic review of the current evidence of the effect of group pregnancy care on mental health and wellbeing outcomes (i.e., stress, depression and/or anxiety) in childbearing women.
A comprehensive search of published studies in Medline, PsychInfo, CINAHL, ProQuest databases, ClinicalTrials.gov and Google Scholar. Databases were systematically searched without publication period restriction until Feb 2020. Inclusion criteria were randomized controlled trials (including quasi-experimental) and observational studies comparing group care with standard pregnancy care. Included were studies published in English, whose primary outcome measures were stress, depression and/or anxiety.
Nine studies met the inclusion criteria, five randomized controlled trials and four observational studies, involving 1585 women (39%) in GPC and 2456 women (61%) in standard (individual) pregnancy care. Although evidence is limited, where targeted education was integrated into the group pregnancy care model, significant reductions in depressive symptoms were observed. In addition, secondary analysis across several studies identified a subset of GPC women, i.e., higher risk for psychological symptoms, who reported a decrease in their depression, stress and anxiety symptoms, postpartum. Due to the diversity of group care structure and content and the lack of outcomes measures universally reported, a comprehensive meta-analysis could not be performed.
The evidence suggests improvements in some markers of psychological health outcomes with group pregnancy care. Future research should involve larger well-designed studies encompassing cross-population data using a validated scale that is comparable across diverse childbearing populations and clinical settings to better understand the impact of group pregnancy care.
全球范围内，精神健康不良仍然是导致生育期女性发病和患病的一个主要原因。
群组护理已被证明可有效降低某些临床结局，例如早产率，但群组产前护理（GPC）对孕妇的精神健康结局（即压力、抑郁和/或焦虑）的影响知之甚少。
对群组妊娠护理对生育期妇女精神健康和福祉结局（即压力、抑郁和/或焦虑）影响的现有证据进行系统综述。
全面检索 Medline、PsychInfo、CINAHL、ProQuest 数据库、ClinicalTrials.gov 和 Google Scholar 中已发表的研究。无发表时间限制，系统检索数据库直至 2020 年 2 月。纳入标准为比较群组护理与标准妊娠护理的随机对照试验（包括准实验）和观察性研究。纳入研究为发表在英语期刊上，主要结局指标为压力、抑郁和/或焦虑。
符合纳入标准的研究有 9 项，包括 5 项随机对照试验和 4 项观察性研究，GPC 组纳入 1585 名女性（39%），标准（个体）妊娠护理组纳入 2456 名女性（61%）。虽然证据有限，但在将针对性教育纳入群组妊娠护理模式的情况下，观察到抑郁症状显著减轻。此外，对几项研究的二次分析发现，GPC 组中有一部分女性（即有更高心理症状风险的女性）产后抑郁、压力和焦虑症状有所减轻。由于群组护理结构和内容的多样性以及缺乏普遍报告的结局指标，因此无法进行全面的荟萃分析。
证据表明群组妊娠护理可改善某些心理健康结局指标。未来的研究应涉及更大规模、设计良好的研究，涵盖使用跨人群数据的研究，采用在不同生育期人群和临床环境中具有可比性的经过验证的量表，以更好地了解群组妊娠护理的影响。
