Kim Sun-Hee, Jung Sun-Young, Park Jin-Hwa, 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.
J Med Internet Res. 2025 Jun 3;27:e60690. doi: 10.2196/60690.
Preconception health is essential for preventing premature birth, yet engagement in preconception care remains low. Internet-based interventions offer scalable solutions, but their effectiveness in this context is underexplored.
This systematic review aimed to describe the characteristics and designs of studies on internet-based interventions and evaluate their effectiveness in preventing premature birth among preconceptional women of childbearing age.
We searched MEDLINE, Embase, CINAHL, and the Cochrane Library for randomized controlled trials and quasi-experimental studies on internet-based interventions targeting premature birth prevention, covering publications up to December 2023 with no language or geographic restrictions. The search, conducted initially in February 2023 and updated in March 2024, followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and was registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021277024). Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the revised Cochrane Risk of Bias tool. Due to heterogeneity in populations, interventions, and outcomes, a narrative synthesis was performed instead of a meta-analysis.
From 3437 articles identified across 2 searches, 9 studies were included after excluding duplicates and ineligible papers. Studies, primarily from high-income countries (eg, 4/9, 44% from the United States), varied in design (4/9, 44% randomized controlled trials; 5/9, 56% quasi-experimental) and timing (5/9, 56% post 2020). The overall risk of bias was high in 6/9 (67%) studies, with only 1/9 (11%) rated low risk. Interventions, delivered via websites (4/9, 44%), conversational agents (3/9, 33%), or other platforms, significantly improved reproductive health knowledge in 3/9 (33%) studies but showed no consistent impact on self-efficacy (no effect in 2/3 [67%] studies assessing it). Behavioral outcomes, such as folic acid use and contraception initiation, were inconsistent across 5/9 (56%) studies, with significant effects in short-term (eg, 2/9, 22%) but not long-term interventions (eg, 2/4, 50% at 12 months). No studies directly measured premature birth as an outcome.
Internet-based interventions showed mixed effectiveness across reproductive health outcomes pertinent to premature birth prevention, with notable gains in knowledge but limited success in altering behaviors. Given the small number of studies and the prevalent high risk of bias, these findings warrant cautious interpretation. Future research, including robust clinical trials, is essential to develop, evaluate, and disseminate effective and safe internet-based interventions for preconception care.
PROSPERO CRD42021277024; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021277024.
孕前健康对于预防早产至关重要，但孕前保健的参与率仍然很低。基于互联网的干预措施提供了可扩展的解决方案，但其在这方面的有效性尚未得到充分探索。
本系统评价旨在描述基于互联网的干预措施的研究特征和设计，并评估其在预防育龄孕前妇女早产方面的有效性。
我们在MEDLINE、Embase、CINAHL和Cochrane图书馆中检索了针对预防早产的基于互联网的干预措施的随机对照试验和准实验研究，涵盖截至2023年12月的出版物，无语言或地理限制。该检索最初于2023年2月进行，并于2024年3月更新，遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，并在PROSPERO（国际前瞻性系统评价注册库；CRD42021277024）注册。两名评审员独立筛选研究、提取数据，并使用修订后的Cochrane偏倚风险工具评估偏倚风险。由于人群、干预措施和结果存在异质性，因此进行了叙述性综合分析而非Meta分析。
在两次检索中识别出的3437篇文章中，排除重复和不合格论文后纳入了9项研究。这些研究主要来自高收入国家（例如，4/9，44%来自美国），设计（4/9，44%为随机对照试验；5/9，56%为准实验）和时间（5/9，56%在2020年之后）各不相同。6/9（67%）的研究总体偏倚风险较高，只有1/9（11%）的研究偏倚风险较低。通过网站（4/9，44%）、对话代理（3/9，33%）或其他平台提供的干预措施，在3/9（33%）的研究中显著提高了生殖健康知识，但对自我效能没有一致影响（在2/3 [67%]评估自我效能的研究中没有效果）。叶酸使用和避孕开始等行为结果在5/9（56%）的研究中不一致，短期干预有显著效果（例如，2/9，22%），但长期干预没有（例如，12个月时2/4，50%）。没有研究直接将早产作为结果进行测量。
基于互联网的干预措施在与早产预防相关的生殖健康结果方面显示出混合效果，在知识方面有显著提高，但在改变行为方面取得的成功有限。鉴于研究数量较少且普遍存在较高的偏倚风险，这些发现需要谨慎解释。未来的研究，包括强有力的临床试验，对于开发、评估和传播有效的基于互联网的孕前保健干预措施至关重要。
PROSPERO CRD42021277024；https://www.crd.york.ac.uk/PROSPERO/view/CRD
42021277024。
