ScHARR, The University of Sheffield, Sheffield, UK
Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK.
BMJ Open. 2022 May 13;12(5):e052576. doi: 10.1136/bmjopen-2021-052576.
Globally, 11% of babies are born preterm each year. Preterm birth (PTB) is a leading cause of neonatal death and under-five mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low/middle-income countries (LMICs) where the burden is highest.
This scoping review sought to the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis.
We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009-2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data were extracted and is described narratively.
139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low-income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies.
This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions in LIC settings.
全球每年有 11%的婴儿早产。早产（PTB）是新生儿死亡和五岁以下儿童死亡和发病的主要原因，对于存活下来的儿童来说，还会留下终身后遗症。PTB 在中低收入国家（LMICs）的影响不成比例，这些国家的负担最重。
本范围综述旨在寻找可降低 PTB 风险的干预措施的证据，重点关注来自 LMICs 的证据，并描述如何在证据综合中考虑背景。
我们进行了范围综述，以描述这个广泛的主题领域。我们搜索了五个电子数据库（2009-2020 年），并联系专家以确定减少 PTB 风险的干预措施的相关系统综述。我们纳入了已发表的系统综述，这些综述研究了干预措施的有效性及其对降低 PTB 风险的影响。提取数据并进行了叙述性描述。
综述共纳入了 139 篇已发表的系统综述。干预措施分为一级或二级。结果显示效果更大且综述结果一致的干预措施包括梅毒和阴道念珠菌病的治疗、维生素 D 补充和宫颈环扎术。纳入的 139 篇综述中有 1372 项独特的原始研究。28%的原始研究是在 LMIC 背景下进行的，只有 4.5%是在低收入国家（LIC）进行的。只有 10.8%的综述试图探索背景对结果的影响，而 19.4%的综述未报告背景或原始研究。
本范围综述强调了缺乏源自全球 PTB 负担最大的背景的研究证据。还强调了系统综述方法中在解决背景适用性方面的不严谨性。这存在在这些背景下提出不适当和不安全的实践建议的风险。它还强调了在 LIC 环境中进行初级研究、开发和测试干预措施的必要性。
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