非药物干预减少分娩恐惧的网状Meta分析

Non-pharmacological interventions to reduce fear of childbirth:a network metaanalysis

目的系统评价非药物干预减少孕产妇分娩恐惧的效果。方法计算机检索The Cochrane Library、PubMed、EMbase、Web of Science、CNKI、WanFang Data、VIP和CBM数据库,搜集非药物干预减少孕产妇分娩恐惧的随机对照试验(RCT),检索时限均为建库至2021年12月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 15.0软件进行网状Meta分析。结果共纳入19个RCT,包括3409例患者,涉及10种非药物干预方法(产前教育、情景模拟健康教育、心理指导、瑜伽训练、催眠、移动学习教育、认知行为疗法、身体放松指导、呼吸指导和常规护理)。网状Meta分析最佳概率排序结果显示,在Wijma分娩期待问卷(W-DEQ-A)评分方面:产前教育>瑜伽训练>认知行为疗法>情景模拟健康教育>心理指导>身体放松指导>常规护理;在Wijma分娩体验问卷(W-DEQ-B)评分方面:移动学习教育>产前教育>情景模拟健康教育>认知行为疗法>呼吸指导>催眠>心理指导>身体放松指导>常规护理。结论当前证据显示,产前教育、移动学习教育、情景模拟健康教育、瑜伽训练可能是改善孕产妇分娩恐惧较为有效的干预方式。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of non-pharmacological interventions to reduce fear of childbirth.Methods The Cochrane Library,PubMed,EMbase,Web of Science,CNKI,WanFang Data,VIP,and CBM databases were electronically searched to collect randomized controlled trials(RCTs)of the efficacy of nonpharmacological interventions to reduce fear of childbirth from inception to December 2021.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies;then,a network meta-analysis was performed using Stata 15.0 software.Results A total of 19 RCTs involving 3409 patients were included.Ten non-pharmacological interventions(prenatal education,scenario-based health education,psychological guidance,yoga training,hypnosis,mobile learning education,cognitive behavioral therapy,physical relaxation guidance,breathing guidance,and usual care)were included.The results of the reticulated meta-analysis of the Wijma Delivery Expectancy Questionnaire(W-DEQ-A)showed that the rankings of the interventions were as follows:prenatal education>yoga training>cognitive behavioral therapy>situational simulation health education>psychological guidance>physical relaxation guidance>conventional care.The results of the Wijma Experience of Childbirth Questionnaire(WDEQ-B)mesh meta-analysis showed that the rankings of the interventions were as follows:mobile learning education>prenatal education>scenario-based health education>cognitive behavioral therapy>breathing instruction>hypnosis>psychological instruction>physical relaxation instruction>usual care.Conclusion The current evidence suggests that prenatal education,mobile learning education,situational simulation health education,and yoga training may be effective interventions in improving maternal fear of childbirth.Due to the limited quality and quantity of the included studies,more high-quality studies are needed to verify the above conclusion.