Interventions to Address Disparities in Perinatal Outcomes by Ethnicity: A Systematic Review
Notice bibliographique
Résumé
BACKGROUND: Ethnic minority women face disproportionately higher risks of adverse perinatal outcomes, exacerbated by socio-economic and systemic barriers. OBJECTIVES: This systematic review evaluates the effectiveness of interventions designed to improve perinatal outcomes in these populations. SEARCH STRATEGY: We conducted a systematic review according to a pre-designed protocol (PROSPERO CRD42024516616). MEDLINE, EMBASE and Cochrane Databases were searched up to February 2024 using relevant Medical Subject Headings (MeSH) terms and keywords. SELECTION CRITERIA: We included studies involving interventions targeting pregnant women from ethnic minority groups. Outcome measures included maternal and perinatal outcomes, as well as qualitative assessments, when available. DATA COLLECTION: Two reviewers independently performed data extraction and quality assessment, resolving discrepancies by consensus. MAIN RESULTS: Studies included (n = 36) were from the United Kingdom (n = 9), United States of America (n = 9), Australia (n = 12), Canada (n = 1), Denmark (n = 2), Sweden (n = 3), involving women (n = 72 527) of varied ethnicity: Asian (n = 16 274, 22.4%), Black (n = 11 458, 15.8%), Hispanic (n = 612, 0.8%), First Nations/Aboriginal (n = 19 406, 29.1%), Mixed (n = 873, 1.2%), 'Other' (as defined in the included studies) (n = 3354, 4.6%), and women belonging to an unspecified ethnic minority group (n = 15 232, 21%), and a group of Russian, Arabic, Tigrinya, Polish and Somali women in a foreign country (82 women; 0.1%). Interventions broadly included four categories: clinical management interventions, educational programmes, treatments, and models of care. Clinical management interventions like increased foetal surveillance after 39 weeks and implemented screening for preeclampsia showed positive results, with a 64% reduction in stillbirth rates among South Asian (aOR 0.36, 95% CI 0.13-0.90, p = 0.047) with the former intervention, and a decrease in perinatal deaths with the latter intervention. Educational initiatives demonstrated diverse results, with those directed to the families showing significant improvement in satisfaction and active participation in prenatal care; however, no significant improvements were noted after the implementation of initiatives devoted to healthcare providers. Specific treatments, such as low-dose aspirin, have yielded various outcomes, with some studies reporting a reduction in preterm birth rates. Models of care, including midwifery continuity of care, nutrition implementation initiatives, home visits and language support services, showed promising results in improving maternal satisfaction and obstetric outcomes. CONCLUSIONS: This systematic review summarises the interventions to improve outcomes for these families among ethnic minority women and emphasises the lack of focused attention on improving outcomes in these groups, highlighted by the limited studies and the diverse interventions and outcomes reported. While educational and social support programmes within the model of care show promise, large-scale and high-quality studies are needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,057 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,009 | 0,008 |
| Bibliométrie | 0,009 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».