Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland.
Am J Clin Nutr. 2023 Jun;117 Suppl 2:S148-S159. doi: 10.1016/j.ajcnut.2022.11.028.
Risk factors related to the harmful behaviors, psychosocial wellbeing, and socio-economic circumstances in the lives of pregnant women can lead to adverse birth outcomes, including low birth weight (LBW).
This systematic search and review aims to provide a comparative evidence synthesis on the effect of eleven antenatal interventions targeted to address psychosocial risk factors on adverse birth outcomes.
We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and CINAHL Complete between March 2020 and May 2020. We included randomized controlled trials (RCTs) and reviews of RCTs of eleven antenatal interventions for pregnant females reporting LBW, preterm birth (PTB), small-for-gestational-age or stillbirth as outcomes. For interventions where randomization was either not feasible or unethical, we accepted non-randomized controlled studies.
Seven records contributed data to the quantitative estimates of the effect sizes and 23 contributed to narrative analysis. Psychosocial interventions for reducing smoking in pregnancy likely reduced the risk of LBW, and professionally provided psychosocial support for at-risk women possibly reduced the risk of PTB. Financial incentives or nicotine replacement therapy as smoking cessation aids, or virtually delivered psychosocial support did not appear to reduce the risk of adverse birth outcomes. The available evidence on these interventions was primarily from high-income countries. For other reviewed interventions (psychosocial interventions to reduce alcohol use, group based psychosocial support programs, intimate partner violence prevention interventions, antidepressant medication, and cash transfers) there was little evidence in any direction regarding the efficacy or the data was conflicting.
Professionally provided psychosocial support during pregnancy in general and specifically as a means to reduce smoking can potentially contribute to improved newborn health. The gaps in the investments for research and implementation of psychosocial interventions should be addressed to better meet the global targets in LBW reduction.
与孕妇有害行为、心理社会健康和社会经济状况相关的风险因素可导致不良生育结局，包括低出生体重（LBW）。
本系统搜索和综述旨在提供关于十一种针对解决心理社会风险因素的产前干预措施对不良生育结局影响的比较证据综合评价。
我们检索了 MEDLINE、Embase、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库和 CINAHL Complete，检索时间为 2020 年 3 月至 2020 年 5 月。我们纳入了针对报告 LBW、早产（PTB）、小于胎龄儿或死产结局的孕妇的十一种产前干预措施的随机对照试验（RCT）和 RCT 综述。对于无法进行随机分组或不道德的干预措施，我们接受了非随机对照研究。
有七个记录为效应大小的定量估计提供了数据，有二十三个记录为叙述性分析提供了数据。减少孕期吸烟的心理社会干预措施可能降低 LBW 的风险，为高危孕妇提供专业的心理社会支持可能降低 PTB 的风险。作为戒烟辅助手段的经济激励或尼古丁替代疗法，或虚拟提供的心理社会支持，似乎并不能降低不良生育结局的风险。这些干预措施的现有证据主要来自高收入国家。对于其他审查的干预措施（减少饮酒的心理社会干预、基于群体的心理社会支持计划、预防亲密伴侣暴力干预措施、抗抑郁药物和现金转移），关于这些干预措施的疗效的证据很少，或者数据相互矛盾。
一般来说，怀孕期间专业提供的心理社会支持，特别是作为减少吸烟的一种手段，可能有助于改善新生儿健康。应解决对心理社会干预措施的研究和实施的投资差距，以更好地实现降低 LBW 的全球目标。
