Center for Healthier Children, Families and Communities, University of California, Los Angeles (UCLA), Los Angeles, CA, United States of America.
Department of Pediatrics, Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America.
PLoS One. 2024 Oct 24;19(10):e0307441. doi: 10.1371/journal.pone.0307441. eCollection 2024.
Preventing Adverse Childhood Experiences (ACEs) is a public health priority, and the perinatal period is a sensitive life stage when preventive interventions could be particularly effective. Protecting and buffering pregnant persons and infants from exposure to adversity can optimize children's development and health trajectories, reduce future morbidity and mortality, and even break intergenerational cycles of adversity, but no study has synthesized experimental evidence on effectiveness of interventions to address ACEs in the perinatal period.
To (1) identify perinatal ACE prevention interventions, tested in high quality randomized control trials, with a dyadic perspective examining outcomes for mother and child; (2) describe their (a) place on the public health prevention continuum and (b) incorporation of life course characteristics that aim to optimize life health trajectories; and (3) determine which interventions show evidence of effectiveness.
We undertook a scoping review, using a modified PRISMA-Sc approach, of articles published in English between January 2000 and November 2023 identified through Psych info and PubMed using search terms for a broad range of adversities, with additional capture of articles from relevant reference lists. Interventions were included if they targeted an identified ACEs exposure or risk; were tested in randomized controlled trials (RCTs); reported outcome measures for both mother and child and were initiated during pregnancy. Interventions were further analyzed using the public health prevention continuum and Life Course Intervention Research (LCIR) characteristics frameworks. A two-tailed t test was used to ascertain the association between LCIR characteristics, and the outcomes achieved.
Of 2148 articles identified, 57 were in scope for detailed analysis, yielding 53 unique interventions. Overall, 42 (74%) reported some positive impact; 37 (65%) for mothers; 37 (65%) for the child, and 32 (56%) for both. Interventions with the strongest evidence based on study quality and reported outcomes were co-parenting programs designed to improve the quality and function of the co-parenting relationship, home visiting interventions, and integrative health interventions incorporating baby massage and/or yoga. Half of effective interventions were secondary prevention focused. The mean number of life course characteristics was significantly higher in the studies that reported a positive impact on the mother and/or child (p = 0.003).
Few studies specifically addressed ACEs as a defined set of adversities, yet a range of perinatal interventions showed positive impacts on individual ACE risks or exposures. Intentional incorporation of life course characteristics and bundling of evidence-based components into comprehensive perinatal interventions hold promise for future ACEs prevention.
预防不良儿童经历 (ACEs) 是公共卫生的重点，围产期是一个敏感的生命阶段，在此期间预防干预可能特别有效。保护和缓冲孕妇和婴儿免受逆境的影响，可以优化儿童的发展和健康轨迹，降低未来的发病率和死亡率，甚至打破代际逆境循环，但没有研究综合了针对围产期 ACE 的干预措施的实验证据。
(1) 确定具有母婴二元视角的高质量随机对照试验中预防围产期 ACE 的干预措施；(2) 描述其(a) 在公共卫生预防连续统中的位置和(b) 纳入旨在优化生命健康轨迹的生命历程特征；(3) 确定哪些干预措施具有有效性证据。
我们采用改良的 PRISMA-Sc 方法进行了范围综述，使用心理信息和 PubMed 中的搜索词搜索了 2000 年 1 月至 2023 年 11 月期间发表的英语文章，涵盖了广泛的逆境，还从相关参考文献中额外获取了文章。如果干预措施针对已确定的 ACE 暴露或风险；在随机对照试验 (RCT) 中进行了测试；报告了母婴的结果测量值，并且在怀孕时开始。使用公共卫生预防连续统和生命历程干预研究 (LCIR) 特征框架进一步分析干预措施。使用双尾 t 检验确定 LCIR 特征与所取得的结果之间的关联。
在确定的 2148 篇文章中，有 57 篇符合详细分析的范围，产生了 53 种独特的干预措施。总体而言，有 42 项（74%）报告了一些积极影响；37 项（65%）针对母亲；37 项（65%）针对儿童，32 项（56%）针对母亲和儿童。基于研究质量和报告结果，最有证据基础的干预措施是旨在改善共同养育关系质量和功能的共同养育计划、家访干预以及纳入婴儿按摩和/或瑜伽的综合健康干预措施。一半有效的干预措施是二级预防重点。在报告对母亲和/或儿童产生积极影响的研究中，生命历程特征的平均数量明显更高（p = 0.003）。
很少有研究专门针对 ACEs 作为一组特定的逆境，但一系列围产期干预措施显示出对个体 ACE 风险或暴露的积极影响。有针对性地纳入生命历程特征并将循证组成部分纳入综合围产期干预措施，为未来的 ACE 预防提供了希望。
