Pedersen Johanne Frøsig, Kallesøe Sarah Boutrup, Langergaard Sofie, Overgaard Charlotte
Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark.
Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg Øst, Denmark.
Midwifery. 2021 Sep;100:103018. doi: 10.1016/j.midw.2021.103018. Epub 2021 Apr 20.
Pregnant women with psychosocial vulnerability factors face a higher risk of preterm birth, a heavier burden of perinatal morbidity and mortality and less social health equity. Prevention of preterm birth in this group has proved difficult, and more knowledge is needed to ensure evidence-based care and improve prevention. This study aimed to determine the effectiveness of preventive interventions to reduce preterm birth among pregnant women with psychosocial vulnerability factors.
A systematic review of preventive interventions was conducted, searching the databases Cinahl, Cochrane Library, Embase, ProQuest, PsycInfo, PubMed and Scopus to identify RCT's. The search was completed on October 14, 2019. Using the Cochrane Collaboration tools, quality assessments were made, and independent single-data extraction was conducted. Due to heterogeneity in, e.g., participant characteristics, intervention content and duration, the data were synthesised qualitatively. Included studies were ranked in evidence-based hierarchical order, elucidating the risk of bias of each individual study, all of which were ranked as having a medium or low level of evidence.
We identified 1,562 articles, of which five focused on prevention of preterm birth, met our predefined criteria for inclusion and quality assessment, and were therefore included. Interventions consisted of home visits in two studies, group meetings in one study, phone calls in one study, and physical massage in the last study. Four transverse themes arose: intervention intensity, initiation, continuity of care, and the healthcare professionals' educational background.
The evidence base for interventions aiming to prevent preterm birth among pregnant women with psychosocial vulnerabilities is limited. Interventions based on ten antenatal group meetings initiated during the second trimester and facilitated by the same midwife have the greatest likelihood of being effective. Continuity in intervention delivery and healthcare professional's educational background may positively impact the efficiency of the intervention. Further research is needed to address questions about the impact of intervention initiation and intensity and its degree of continuity and mode of delivery.
具有社会心理脆弱因素的孕妇面临更高的早产风险、围产期发病和死亡负担更重以及社会健康公平性更低的问题。事实证明，预防该群体的早产很困难，需要更多知识来确保循证护理并改进预防措施。本研究旨在确定预防性干预措施对降低具有社会心理脆弱因素的孕妇早产率的有效性。
对预防性干预措施进行了系统评价，检索了CINAHL、Cochrane图书馆、Embase、ProQuest、PsycInfo、PubMed和Scopus数据库以识别随机对照试验。检索于2019年10月14日完成。使用Cochrane协作工具进行质量评估，并进行独立的单数据提取。由于参与者特征、干预内容和持续时间等方面存在异质性，因此对数据进行了定性综合分析。纳入的研究按照循证等级顺序排列，阐明了每项个体研究的偏倚风险，所有这些研究均被列为证据水平为中或低。
我们识别出1562篇文章，其中5篇关注早产预防，符合我们预先定义的纳入和质量评估标准，因此被纳入。干预措施包括两项研究中的家访、一项研究中的小组会议、一项研究中的电话干预以及最后一项研究中的身体按摩。出现了四个横向主题：干预强度、开始时间、护理连续性以及医护人员的教育背景。
旨在预防具有社会心理脆弱性的孕妇早产的干预措施的证据基础有限。基于孕中期开始并由同一名助产士协助进行的十次产前小组会议的干预措施最有可能有效。干预实施的连续性和医护人员的教育背景可能会对干预效率产生积极影响。需要进一步研究以解决有关干预开始时间和强度及其连续性程度和实施方式的影响的问题。
