Preconception care: promoting reproductive planning.
Preconception care: promoting reproductive planning.
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DOI：
10.1186/1742-4755-11-s3-s2
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发表时间：
2014-09-26
影响因子：
3.4
通讯作者：
Bhutta ZA
中科院分区：
文献类型：
--
作者：
Dean SV;Lassi ZS;Imam AM;Bhutta ZA
孕前护理认识到，许多少女和年轻女性将在缺乏所需知识、技能或支持的情况下被迫成为母亲。全球每年有 6000 万青少年生育，尽管青春期怀孕的死亡率至少是 20-29 岁女性怀孕死亡率的两倍。生殖计划和避孕药具的使用可以预防少女和妇女的意外怀孕、不安全堕胎和性传播感染。较小的家庭也意味着更好的营养和发展机会，但 2.22 亿对夫妇仍然无法获得现代避孕措施。对证据进行系统回顾和荟萃分析，以确定青少年、妇女和育龄夫妇的孕前护理对 MNCH 结果的可能影响。采用综合策略搜索电子参考图书馆，包括观察性试验和临床对照试验。针对每种孕前风险和干预措施的交叉引用和单独的搜索策略确保了更广泛的研究捕获。综合干预措施可以防止青春期首次怀孕的几率降低 15%，青春期重复怀孕的几率降低 37%。此类干预措施应解决根本的社会和社区因素，包括性健康和生殖健康服务、避孕药具的提供；个人发展计划并强调完成教育。适当的生育间隔（从出生到下一次妊娠的间隔时间为 18-24 个月，而间隔时间小于 6 个月）可以显着降低孕产妇死亡率、早产、死产、低出生体重和早期新生儿死亡。改善青少年健康并预防青少年怀孕；通过增加正确和持续使用有效避孕措施来促进生育间隔是孕前护理的基础。在更广泛的范围内促进生殖计划与可靠地提供有效避孕措施密切相关，但是，需要制定创新战略，或者可以扩大社区卫生工作者和同伴教育人员等现有战略，以鼓励女孩和妇女计划其家庭。
Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception. A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths. Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families.