Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1QU, UK.
Department of Pharmacy and Pharmacology, University of Bath, Bath, BA2 7AY, UK.
BMC Pregnancy Childbirth. 2023 Mar 2;23(1):135. doi: 10.1186/s12884-022-05218-5.
Sub-optimal medication adherence in pregnant women with chronic disease and pregnancy-related indications has the potential to adversely affect maternal and perinatal outcomes. Adherence to appropriate medications is advocated during and when planning pregnancy to reduce risk of adverse perinatal outcomes relating to chronic disease and pregnancy-related indications. We aimed to systematically identify effective interventions to promote medication adherence in women who are pregnant or planning to conceive and impact on perinatal, maternal disease-related and adherence outcomes.
Six bibliographic databases and two trial registries were searched from inception to 28th April 2022. We included quantitative studies evaluating medication adherence interventions in pregnant women and women planning pregnancy. Two reviewers selected studies and extracted data on study characteristics, outcomes, effectiveness, intervention description (TIDieR) and risk of bias (EPOC). Narrative synthesis was performed due to study population, intervention and outcome heterogeneity.
Of 5614 citations, 13 were included. Five were RCTs, and eight non-randomised comparative studies. Participants had asthma (n = 2), HIV (n = 6), inflammatory bowel disease (IBD; n = 2), diabetes (n = 2) and risk of pre-eclampsia (n = 1). Interventions included education +/- counselling, financial incentives, text messaging, action plans, structured discussion and psychosocial support. One RCT found an effect of the tested intervention on self-reported antiretroviral adherence but not objective adherence. Clinical outcomes were not evaluated. Seven non-randomised comparative studies found an association between the tested intervention and at least one outcome of interest: four found an association between receiving the intervention and both improved clinical or perinatal outcomes and adherence in women with IBD, gestational diabetes mellitus (GDM), and asthma. One study in women with IBD reported an association between receiving the intervention and maternal outcomes but not for self-reported adherence. Two studies measured only adherence outcomes and reported an association between receiving the intervention and self-reported and/or objective adherence in women with HIV and risk of pre-eclampsia. All studies had high or unclear risk of bias. Intervention reporting was adequate for replication in two studies according to the TIDieR checklist.
There is a need for high-quality RCTs reporting replicable interventions to evaluate medication adherence interventions in pregnant women and those planning pregnancy. These should assess both clinical and adherence outcomes.
患有慢性病和与妊娠相关疾病的孕妇药物治疗依从性不理想，可能会对母婴围产期结局产生不良影响。提倡在妊娠期间和计划妊娠时使用适当的药物，以降低与慢性病和与妊娠相关的疾病相关的不良围产期结局的风险。我们旨在系统地确定有效的干预措施，以促进怀孕或计划怀孕的妇女遵守药物治疗，并对围产期、母亲疾病相关和药物治疗依从性结果产生影响。
从建库到 2022 年 4 月 28 日，我们检索了 6 个文献数据库和 2 个试验注册处。我们纳入了评估妊娠妇女和计划妊娠妇女药物治疗依从性干预措施的定量研究。两名审查员选择了研究，并提取了研究特征、结局、有效性、干预描述（TIDieR）和偏倚风险（EPOC）的数据。由于研究人群、干预措施和结局存在异质性，因此采用叙述性综合方法进行分析。
在 5614 条引文，有 13 条被纳入。其中 5 项为 RCT，8 项为非随机对照研究。参与者患有哮喘（n=2）、艾滋病毒（n=6）、炎症性肠病（IBD；n=2）、糖尿病（n=2）和子痫前期风险（n=1）。干预措施包括教育+/-咨询、经济奖励、短信、行动计划、结构化讨论和心理社会支持。一项 RCT 发现，经测试的干预措施对自我报告的抗逆转录病毒药物治疗依从性有影响，但对客观依从性没有影响。没有评估临床结局。7 项非随机对照研究发现，所测试的干预措施与至少一个感兴趣的结局之间存在关联：4 项研究发现，在 IBD、妊娠糖尿病（GDM）和哮喘患者中，接受干预措施与改善临床或围产期结局以及药物治疗依从性之间存在关联。一项针对 IBD 患者的研究报告称，接受干预措施与母婴结局之间存在关联，但与自我报告的药物治疗依从性无关。两项仅测量药物治疗依从性结局的研究报告称，在艾滋病毒和子痫前期风险患者中，接受干预措施与自我报告和/或客观药物治疗依从性之间存在关联。所有研究的偏倚风险均较高或不明确。根据 TIDieR 清单，有两项研究的干预措施报告充分，可进行复制。
需要高质量的 RCT 报告可复制的干预措施，以评估妊娠妇女和计划妊娠妇女的药物治疗依从性干预措施。这些研究应评估临床和药物治疗依从性结局。
