避孕干预对产后妇女避孕、非意愿妊娠和人工流产的影响——系统评价和Meta分析

Effect of contraceptive intervention on contraceptive use, unintended pregnancy and induced abortion among postpartum women-a systematic review and Meta-analysis

目的系统评价避孕宣教、咨询等干预对产后妇女避孕、非意愿妊娠和人工流产的影响,为提高产后妇女的生殖健康提供参考依据。方法计算机系统检索PubMed、Popline、Cochrane Library、Clinicaltrial.gov、Web of Science、世界卫生组织网站、中国知网、万方数据库、中国生物医学文献数据库等查找与产后避孕相关的随机对照临床试验(RCT),按照纳入和排除标准筛除文献并提取相关数据。对文献进行质量评价后,采用Stata12.1软件进行Meta分析。结果最终纳入13项RCT研究,纳入产妇10 606名。Meta分析显示,产后干预能提高干预组产后6个月避孕率(RR=1.50,95% CI=1.17~1.92,n=1551);但干预组产后1年避孕率与对照组接近(RR=1.02,95% CI=0.98~1.06,n=2851);干预组产后1年非意愿妊娠率显著低于对照组(RR=0.69,95% CI=0.50~0.96,n=6064),剔除低质量研究后,两者差异无统计学意义(RR=0.94,95% CI=0.72~1.22,n=3328);1项研究报道干预能显著降低产后1年人工流产率,但该研究质量评价较低。结论产后避孕宣教和咨询等干预措施可能提高产后6个月避孕率、降低产后1年非意愿妊娠率和人工流产率。但纳入的部分文献研究质量评价较低,迫切需要开展大样本、高质量的RCT研究提供可靠证据。

Objective To assess the effect of contraceptive intervention [including information, education, counseling (IEC), family planning counseling, etc.] on the contraceptive use, unintended pregnancy and induced abortion among postpartum women, so as to provide solid evidence to policy-makers, service providers and service users to improve reproductive health of women. Methods The electronic databases, including PubMed, Popline, the Cochrane Library, Web of Science, Website of World Health Organization, CNKI, China Biology Medicine disc (CBM), etc., were searched to identify the randomized control trials (RCTs) that evaluated effects of intervention on contraceptive use, unintended pregnancy and abortion in postpartum women. Eligible studies were selected according to the inclusion and exclusion criteria, followed by extracting data. Meta-analyses were performed using Stata12.0 software. Results A total of 13 articles were included and 10 606 participants were involved in this article. The Meta analysis results showed that the postpartum intervention could increase the contraceptive rate after 6 months of delivery (RR=1.50, 95% CI=1.17-1.92, n=1551). The probability of contraceptive use 1 year after delivery in intervention group was similar to that in control group (RR=1.02, 95% CI=0.98-1.06, n=2851). The likelihood of unintended pregnancy 1 year after delivery was significantly lower than that in control group (RR=0.69, 95% CI=0.50-0.96, n=6064), but the difference was not statistically significant after removing low-quality studies (RR=0.94, 95% CI=0.72-1.22, n=3328). Only one paper with low study quality provided information on induced abortion, in which, the induced abortion rate in intervention group was significantly lower than that in control group. Conclusion The contraceptive intervention (including IEC, counseling, etc.) after delivery could increase the rate of contraceptive use 6 months after delivery and reduce the risk of unintended pregnancy and induced abortion 1 year after delivery. However, more RCTs with large sample sizes are needed to confirm this conclusion because some papers with low study quality were included in this study.