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Published on: January 12, 2018
Interventions for the prevention of spontaneous preterm birth: a scoping review of systematic reviews
Fiona Campbell1, Shumona Salam2, Anthea Sutton3
1ScHARR, The University of Sheffield, Sheffield, UK f.campbell@sheffield.ac.uk.
Insights
Preterm birth interventions lack research from high-burden countries. More studies are needed in low-income countries to ensure safe and effective practices for reducing preterm birth (PTB).
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Evidence Synthesis
Background:
- Preterm birth (PTB) affects 11% of newborns globally, causing significant neonatal mortality and lifelong health issues.
- The burden of PTB is disproportionately high in low- and middle-income countries (LMICs).
Purpose of the Study:
- To review evidence on interventions reducing PTB risk, with a focus on LMICs.
- To assess how context is incorporated into the synthesis of PTB intervention evidence.
Main Methods:
- A scoping review of systematic reviews published between 2009 and 2020.
- Searches of five electronic databases and expert consultations identified relevant systematic reviews.
- Data from 139 systematic reviews, encompassing 1372 primary studies, were narratively described.
Main Results:
- Effective interventions included syphilis treatment, vitamin D supplementation, and cervical cerclage.
- Only 28% of primary studies were from LMICs, with just 4.5% from low-income countries (LICs).
- Few reviews (10.8%) addressed contextual applicability, and many (19.4%) omitted setting details.
Conclusions:
- There is a critical gap in research on PTB interventions from high-burden LMIC contexts.
- Inadequate consideration of context in reviews risks unsafe recommendations for practice.
- Primary research is urgently needed to develop and test interventions specifically within LIC settings.
Background:
Globally, 11% of babies are born preterm each year. Preterm birth (PTB) is a leading cause of neonatal death and under-five mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low/middle-income countries (LMICs) where the burden is highest.
Objectives:
This scoping review sought to the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis.
Design:
We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009-2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data were extracted and is described narratively.
Results:
139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low-income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies.
Conclusion:
This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions in LIC settings.
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