Vousden Nicola, Geddes-Barton Dorothea, Hanley Stephanie J, Roberts Nia, Knight Marian
Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
BMC Public Health. 2025 Mar 25;25(1):1140. doi: 10.1186/s12889-025-22283-5.
Women facing multiple disadvantage such as financial poverty, poor mental health or domestic abuse, may experience inequalities in health prior to and during pregnancy, as well as into early motherhood. This can have lifelong intergenerational impacts. The primary aim of this overview was to identify the breadth and efficacy of interventions that work across health and social care to reduce inequalities in maternal or child health. The second aim was to explore their relevance to women with lived experience.
An overview of systematic reviews and meta-analyses from high-income countries that aim to reduce inequalities for women with social disadvantage during pregnancy was performed. Searches were conducted in eight electronic databases up to August 2023 and supplemented with grey literature searches. We included any individual, hospital, or community level activities specific to women during the pre-conception, antenatal or postpartum period up to one year after. The protocol was registered. Two workshops with women with lived experience of disadvantage explored the relevance of identified interventions, and gaps in evidence, in relation to their experiences.
A total of 36 reviews, including 734 primary studies, were included in the narrative synthesis. The majority of reviews included studies undertaken in North America and were of critically low or low quality. Interventions were grouped into 11 categories. The majority of interventions were aimed at single social exposures and targeted individual behavior during pregnancy and the postnatal period. Some at risk populations were excluded from all reviews. There was potential benefit of home-based interventions, psychosocial interventions, models of maternity care and interdisciplinary programs of care for some population groups, across a range of maternal and child health outcomes. Our lived experience group felt these interventions had potential to meet their shared needs for advocacy, support and information, but they should also consider culture, past trauma and factors underpinning pregnancy such as housing and finances.
Further high-quality research is required to demonstrate efficacy and cost-effectiveness of potentially effective interventions in the European health systems. Additional research gaps include interventions prior to pregnancy, culture informed care and upstream determinants of health (PROSPERO: CRD42023455502).
面临经济贫困、心理健康不佳或遭受家庭虐待等多重不利因素的女性，在怀孕前、怀孕期间以及初为人母阶段，可能会经历健康方面的不平等。这可能会产生影响终身的代际效应。本综述的主要目的是确定跨卫生和社会护理领域开展的、旨在减少孕产妇或儿童健康不平等的干预措施的范围和效果。第二个目的是探讨这些干预措施与有实际生活经历的女性的相关性。
对来自高收入国家的旨在减少孕期处于社会不利地位的女性不平等现象的系统评价和荟萃分析进行了综述。截至2023年8月，在八个电子数据库中进行了检索，并辅以灰色文献检索。我们纳入了孕前、产前或产后直至产后一年期间针对女性的任何个人、医院或社区层面的活动。该方案已注册。举办了两场由有实际生活经历的女性参与的研讨会，探讨了已确定的干预措施的相关性以及与她们的经历相关的证据空白。
叙事性综述共纳入36项综述，包括734项原始研究。大多数综述纳入的是在北美开展的研究，且质量极低或较低。干预措施分为11类。大多数干预措施针对单一社会暴露因素，并针对孕期和产后的个体行为。一些高危人群被排除在所有综述之外。对于一些人群组而言，家庭干预、心理社会干预、孕产妇护理模式以及跨学科护理项目在一系列孕产妇和儿童健康结局方面具有潜在益处。我们的实际生活经历小组认为，这些干预措施有可能满足她们在宣传、支持和信息方面的共同需求，但也应考虑文化、过去的创伤以及诸如住房和经济状况等影响怀孕的因素。
需要进一步开展高质量研究，以证明在欧洲卫生系统中潜在有效干预措施的效果和成本效益。其他研究空白包括怀孕前的干预措施、文化适应性护理以及健康的上游决定因素（国际系统评价前瞻性注册库：CRD42023455502）。
