Routine pre-pregnancy health promotion for improving pregnancy outcomes

 

Abstract

Background

A number of potentially modifiable risk factors are known to be associated with poor pregnancy outcomes. These include smoking, drinking excess alcohol, and poor nutrition. Routine health promotion (encompassing education, advice and general health assessment) in the pre-pregnancy period has been proposed for improving pregnancy outcomes by encouraging behavioural change, or allowing early identification of risk factors. While results from observational studies have been encouraging, this review examines evidence from randomised controlled trials of preconception health promotion.

Objectives

To assess the effectiveness of routine pre-pregnancy health promotion for improving pregnancy outcomes when compared with no pre-pregnancy care or usual care.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2009).

Selection criteria

Randomised and quasi-randomised trials examining health promotion interventions which aim to identify and modify risk factors before pregnancy. The review focuses on all women of childbearing age rather than those in high-risk groups. We have excluded trials where interventions are aimed specifically at women with established medical, obstetric or genetic risks or already receiving treatment as part of programmes for high-risk groups.

Data collection and analysis

Two review authors independently assessed eligibility and carried out data extraction.

Main results

Four trials (2300 women) are included. The interventions ranged from brief advice through to education on health and lifestyle over several sessions. For most outcomes, data were only available from individual studies. Only one study followed up through pregnancy and there was no strong evidence of a difference between groups for preterm birth, congenital anomalies or weight for gestational age; only one finding (mean birthweight) reached statistical significance (mean difference -97.00, 95% confidence interval (CI) -168.05 to -25.95). This finding needs to be interpreted with caution as pregnancy outcome data were available for only half of the women randomised. There was some evidence that health promotion interventions were associated with positive maternal behavioural change including lower rates of binge drinking (risk ratio 1.24, 95% CI 1.06 to 1.44). Overall, there has been little research in this area and there is a lack of evidence on the effects of pre-pregnancy health promotion on pregnancy outcomes.

Authors' conclusions

There is little evidence on the effects of pre-pregnancy health promotion and much more research is needed in this area. There is currently insufficient evidence to recommend the widespread implementation of routine pre-pregnancy health promotion for women of childbearing age, either in the general population or between pregnancies.

 

Plain language summary

Health promotion before pregnancy to improve outcomes for mothers and babies

Smoking, drinking excess alcohol, poor nutrition and other lifestyle factors can lead to poor outcomes for mothers and babies. The provision of routine health promotion (including advice and education and sometimes screening tests) before conception may encourage changes to improve health, and may be an opportunity to identify risk factors such as infection that can be treated before pregnancy begins. The review looks at randomised controlled trials examining routine health promotion before pregnancy to see whether it changes behaviour and leads to improved health for mothers and babies. Four trials with 2300 women provided information for the review. The health promotion offered to women in these studies ranged from very brief advice on a specific topic through to more general advice and education on health and lifestyle over several sessions. In only one study were women followed up through pregnancy and there was little evidence of any differences between groups, although the babies of women who had received the health promotion intervention had slightly lower birthweights. There was some evidence that health promotion interventions encourage women to have more healthy lifestyles, such as lower rates of binge drinking. Overall, there was little evidence on the effects of pre-pregnancy health promotion on the health of mothers and babies, and more evidence is needed before its widespread implementation can be recommended.

 

摘要

背景

常規孕前健康促進對懷孕結果的改善

已知有許多潛在的危險因素對懷孕造成不良影響，這些因素包括抽煙、飲酒過量及營養不良。許多觀察性研究證實，常規孕前健康促進(給予完整教育、建議和整體健康評估)可由行為改變或早期發現危險因素進而改善懷孕結果，本回顧性研究將檢視孕前健康促進的隨機對照試驗證據。

目標

相較沒有孕前照護及一般照護,評估常規孕前健康促進對改善懷孕結果的效益。

搜尋策略

我們搜尋Cochrane Pregnancy and Childbirth Group's Trials Register (February2009) 。

選擇標準

檢視以健康促進方式在孕前發現和改變危險因素的隨機和半隨機試驗。此次的回顧性研究的參與者為生育年齡的婦女，而不是特定的高危險妊娠族群。我們排除了那些針對已有內科疾病、生產或基因風險以及已經在接受相關治療的高危險族群的試驗。

資料收集與分析

2位回顧作者獨立進行試驗評估及資料摘錄。

主要結論

選取4篇共有2300名婦女參與的試驗。孕前健康促進方式包含了簡要的建議到系列性健康及生活型態教育課程。對於大多數研究需要的結果，只有個別試驗的資料。也只有一篇試驗有追蹤婦女懷孕期的情況，其結果顯示，各組之間在早產率、 先天異常機率和胎兒體重上無顯著差異， 只有平均出生體重一項有統計上的差異(平均差為−97.00,95% 的信賴區間為−168.05至−25.95)。 因為現有的結果僅為半數隨機分組婦女資料的分析，其意義需謹慎解讀。一些證據顯示，孕前健康促進與婦女降低過量飲酒比率(相對危險性1.24,95% 信賴區間為1.06 – 1.44)等行為改善有關，整體而言，此領域的研究很少，缺乏孕前健康促進對改善懷孕結果效益的證據。

作者結論

孕前健康促進對改善懷孕結果的證據有限，這個領域需要更多的研究，目前還沒有足夠證據建議對育齡婦女廣泛推行孕前健康促進。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抽菸、飲酒過量、營養不良和不健康生活型態等因素會導致對母嬰的不良影響，常規孕前健康促進(包括相關的健康建議、教育課程和篩檢檢查)有助於改善婦女健康，有機會發現諸如感染等危險因素，並且可以使婦女在懷孕前接受治療。此篇回顧性研究納入對常規孕前健康促進的隨機對照試驗，探討孕前健康促進是否可以因行為的改變進而改善母嬰的健康。四篇有2300名婦女參與的試驗提供了相關的資訊。在這四篇試驗中，孕前健康促進包括了對特定議題提供簡短的建議到提供系列性健康與生活型態的教育課程。其中只有一篇試驗有婦女懷孕期間的資料分析，有孕前健康促進的婦女,其新生兒平均出生體重相較其他組別略低，各組間的結果沒有顯著差異。有證據顯示，健康促進有助於婦女有更健康的生活型態，例如降低過量飲酒機率等。就整體而言，孕前健康促進對改善母嬰健康的證據不多，在規劃推廣孕前健康促進前需更多的研究證據。