背景:在怀孕和分娩期间,除了积极的感觉,女性经历诸如对分娩的恐惧(FoC)并担心其后果,这可能会在怀孕期间对母亲和她的孩子产生负面影响,delivery,和产后。进行这项研究是为了确定产前非药物干预措施对减少FoC的有效性。
方法:本研究方案注册于PROSPERO(ID:CRD42023468547)。PubMed,WebofScience,科克伦,Scopus,SID(科学信息数据库)和GoogleScholar搜索引擎数据库进行了系统搜索,直到2023年7月27日,没有时间限制,仅限于波斯语和英语研究,以执行此概述。使用等级评估证据的确定性,使用AMSTAR2的方法学质量和使用PRISMA评分的报告质量。对从原始试验中提取的数据进行Meta分析,以评估不同干预措施对降低FoC的效果。使用亚组分析和荟萃回归模型来检查高度异质性,敏感性分析用于消除高偏倚风险研究对研究结果的影响.
结果:总体而言,概述中包括15项系统综述(SRs),其中9项研究进行了荟萃分析.考虑到方法学质量,这些SR处于低到极低的状态,并且有关于报告质量的相对完整的报告.Meta分析结果表明,心理干预(SMD-2.02,95%CI-2.69至-1.36,16项试验,1057名与会者,I2=95%)和产前教育(SMD-0.88,95%CI-1.16至-0.61,4项试验,432名参与者,I2=72.8%)相对于产前常规护理而言,FoC显着降低,证据的确定性较低。相对于产前常规护理,分心技术导致FoC显着降低,证据具有很高的确定性(SMD-0.75,95%CI-1.18至-0.33,4项试验,329名与会者,I2=69%),但是,相对于证据的确定性非常低的产前常规护理,加强护理不会导致FoC显着下降(SMD-1.14,95%CI-2.85至0.58,3项试验,232名参与者,I2=97%)。
结论:分心技术可有效降低FoC。关于心理干预和产前教育对减少FoC的影响,研究结果表明,干预措施可能导致FoC的减少。非常不确定的证据表明,加强护理不能有效降低FoC。
BACKGROUND: During pregnancy and childbirth, alongside positive feelings, women undergo feelings such as fear of childbirth (FoC) and worry about its consequences, which could leave negative effects on the mother and her child during pregnancy, delivery, and postpartum. The study was carried out to determine the effectiveness of prenatal non-pharmacological interventions on reducing the FoC.
METHODS: The protocol of the study was registered in PROSPERO (ID: CRD42023468547). PubMed, Web of Science, Cochrane, Scopus, SID (Scientific Information Database) and Google Scholar search engine databases were systematically searched until July 27, 2023 with no limitation of time and limited to Persian and English studies in order to perform this overview. Certainty of evidence was assessed using GRADE, methodological quality using AMSTAR 2 and reporting quality using PRISMA score. Meta-analysis was performed on the data extracted from the original trials to evaluate the effect of different interventions on reducing the FoC. Sub-group analysis and meta-regression models were used to examine high heterogeneity, and sensitivity analysis was used to eliminate the effect of high risk of bias studies on the study findings.
RESULTS: Overall, 15 systematic reviews (SRs) were included in the overview, among which meta-analysis was performed in 9 studies. Considering methodological quality, these SRs were in low to critically low status and had relatively complete reports regarding reporting quality. Meta-analysis findings indicated that psychological interventions (SMD -2.02, 95% CI -2.69 to -1.36, 16 trials, 1057 participants, I2 = 95%) and prenatal educations (SMD -0.88, 95% CI -1.16 to -0.61, 4 trials, 432 participants, I2 = 72.8%) cause a significant reduction in FoC relative to prenatal usual cares with low certainty of evidence. Distraction techniques lead to a significant reduction in FoC relative to prenatal usual care with high certainty of evidence (SMD -0.75, 95% CI -1.18 to -0.33, 4 trials, 329 participants, I2 = 69%), but enhanced cares do not result in a significant decrease FoC relative to prenatal usual care with very low certainty of evidence (SMD -1.14, 95% CI -2.85 to 0.58, 3 trials, 232 participants, I2 = 97%).
CONCLUSIONS: Distraction techniques are effective in reducing FoC. Regarding the effect of psychological interventions and prenatal educations on the reduction of FoC, the findings indicated that the interventions may result in the reduction of FoC. Very uncertain evidence showed that enhanced cares are not effective in reducing the FoC.