Kim Sun-Hee, Park Jin-Hwa, Jung Sun-Young, De Gagne Jennie C
College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, Daegu, Republic of Korea.
School of Nursing, Duke University, Durham, NC, United States.
JMIR Pediatr Parent. 2024 Apr 2;7:e54788. doi: 10.2196/54788.
Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation.
This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women.
A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted.
This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied.
Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions' effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes.
PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847.
全球早产率略有上升，因此预防早产对短期和长期健康结果都至关重要。针对早产的多方面风险因素，已开发出各种干预措施，包括基于互联网的项目。这些项目具有可及性并能增强参与度；然而，它们在预防早产方面的总体效果需要进行全面评估。
本系统评价旨在确定研究设计，并评估基于互联网的干预措施对预防孕妇早产的有效性。
对MEDLINE、Embase、CINAHL和Cochrane图书馆数据库进行全面检索，以识别评估基于互联网的孕妇早产预防干预措施的随机试验和准实验研究。检索范围广泛，不受语言或地理位置限制，以提供全面的全球视角。纳入研究的时间范围截至2023年2月。按照PRISMA（系统评价和Meta分析优先报告项目）指南，由3位作者两两配对，使用修订后的Cochrane偏倚风险工具（RoB 2）对每项研究的偏倚风险进行独立评估。由于人群、测量方法和干预措施存在异质性，未进行Meta分析。
本评价纳入了26篇文章，包括12项意向性分析研究和14项符合方案分析研究。大多数意向性分析研究的总体偏倚风险较高，大多数符合方案分析研究的偏倚风险值得关注。目标人群各不相同，包括非特定孕妇、患有妊娠期糖尿病（GDM）或有GDM风险的孕妇、焦虑或抑郁患者以及有早产迹象的孕妇。对心理社会、生理和健康结局进行了评估。基于互联网的干预措施有效地减轻了非特定孕妇的压力/痛苦，但对有早产迹象的孕妇无效。其在减轻焦虑和抑郁方面的效果各不相同，不同组的结果不一致。在患有GDM或有GDM风险的孕妇中，干预措施成功地控制了空腹血糖和餐后2小时血糖水平，但糖化血红蛋白水平的管理并不一致。这些干预措施并未降低所研究的不同人群的早产发生率。这些基于互联网的干预措施在解决药物或酒精滥用及失眠问题方面的效果也各不相同。
基于互联网的干预措施在改善心理社会健康和控制血糖以预防早产方面显示出前景，突出了不同风险因素下效果的差异。包括临床试验在内的进一步研究对于开发、评估和推广有效、安全的基于互联网的干预措施至关重要。建立标准化测量工具和严格的评估过程对于提高这些干预措施在临床实践中的有效性和可靠性至关重要，这将极大地有助于预防早产并改善孕产妇健康结局。
PROSPERO CRD42021278847；https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847
