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Meta-Analysis
. 2009 Oct 7;2009(4):CD007536.
doi: 10.1002/14651858.CD007536.pub2.

Routine pre-pregnancy health promotion for improving pregnancy outcomes

Melissa Whitworth  1 , Therese Dowswell
Affiliations
Meta-Analysis

Routine pre-pregnancy health promotion for improving pregnancy outcomes

Melissa Whitworth et al. Cochrane Database Syst Rev. .

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 strategy: 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.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 1 Baby small‐for‐gestational age (< 10th percentile).
1.2
1.2. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 2 Extremely preterm birth (less than 28 weeks).
1.3
1.3. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 3 Preterm birth (less than 37 weeks).
1.4
1.4. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 4 Birthweight less than 2500 g.
1.5
1.5. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 5 Congenital anomaly.
1.6
1.6. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 6 Mean birthweight.
1.7
1.7. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 7 Maternal behaviour change: daily folic acid use (all women).
1.8
1.8. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 8 Maternal behaviour change: daily folic acid use (women planning pregnancy in next year).
1.9
1.9. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 9 Maternal behaviour change: less than 8 alcoholic drinks per week at 9 months follow up.
1.10
1.10. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 10 Maternal behaviour change: less than 8 alcoholic drinks per week (ITT analysis).
1.11
1.11. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 11 Maternal behaviour change: no more than 5 drinks on any 1 day (9 months follow up).
1.12
1.12. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 12 Maternal behaviour change: no more than 5 drinks on any 1 day (ITT analysis).
1.13
1.13. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 13 Maternal behavioural change: consuming alcohol at follow up.
1.14
1.14. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 14 Maternal behaviour change: consumed alcohol on 10 or more days in the last month.
1.15
1.15. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 15 Maternal behavioural change: smoking at follow up.
1.16
1.16. Analysis
Comparison 1 Pre‐pregnancy intervention versus routine care, Outcome 16 Interval between births (in months).
2.1
2.1. Analysis
Comparison 2 Sensitivity analysis: pre‐pregnancy intervention versus routine care: including all women randomised and not lost to follow up (Lumley study, pregnancy outcomes), Outcome 1 Became pregnant and had baby small‐for‐gestational age (< 10th percentile).
2.2
2.2. Analysis
Comparison 2 Sensitivity analysis: pre‐pregnancy intervention versus routine care: including all women randomised and not lost to follow up (Lumley study, pregnancy outcomes), Outcome 2 Became pregnant and had extremely preterm birth (less than 28 weeks).
2.3
2.3. Analysis
Comparison 2 Sensitivity analysis: pre‐pregnancy intervention versus routine care: including all women randomised and not lost to follow up (Lumley study, pregnancy outcomes), Outcome 3 Became pregnant and had preterm birth (less than 37 weeks).
2.4
2.4. Analysis
Comparison 2 Sensitivity analysis: pre‐pregnancy intervention versus routine care: including all women randomised and not lost to follow up (Lumley study, pregnancy outcomes), Outcome 4 Became pregnant and birthweight less than 2500 g.
2.5
2.5. Analysis
Comparison 2 Sensitivity analysis: pre‐pregnancy intervention versus routine care: including all women randomised and not lost to follow up (Lumley study, pregnancy outcomes), Outcome 5 Became pregnant and baby had congenital anomaly.
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