Impact of educational strategies in low-risk prenatal care: systematic review of randomized clinical trials

Silva, Esther Pereira da; Lima, Roberto Teixeira de; Osório, Mônica Maria

doi:10.1590/1413-81232015219.01602015

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Review • Ciênc. saúde colet. 21 (09) • Sept 2016 • https://doi.org/10.1590/1413-81232015219.01602015 copy

Impact of educational strategies in low-risk prenatal care: systematic review of randomized clinical trials

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to analyze the impact of educational strategies developed in low-risk prenatal care on obstetric outcomes from a systematic literature review. This review consulted databases PubMed, Medline, SciELO and Lilacs, analyzing randomized clinical trials with the following birth outcomes: birth weight, prematurity and breastfeeding, using the following combination of keywords: pre-natal, antenatal visits, education, health education, pregnancy outcomes, birth weight, prematurity, breastfeeding and randomized clinical trial. Nine studies were included following quality evaluation. Actions prove to be more effective when extended to the postpartum period. Most of them occurred during home visits and had a positive impact on breastfeeding and birth weight. The establishment of groups of pregnant women contributed to lower prevalence of prematurity. Breastfeeding was found to be the outcome most sensitive to educational strategies. Educational practices during the prenatal period contributed to favorable obstetric outcomes as they minimized pregnant women concerns and anxiety during the pregnancy process, preparing them for childbirth and postpartum, and should be incorporated into health services’ work process.

Key words
Prenatal; Randomized controlled trial; Health education

Author, year, location	Quality Level	Sample	Reviewed outcomes of interest to the study	Inclusion criteria	Intervention Strategy	Intervention Duration	Review outcomes
Brent N et al. (1995), EUA	A	– 108 pregnant women (I = 51; C = 58)	– Breastfeeding	– Low income pregnant women; – Reside near study location; – Low-risk pregnant women	– Strategic home visits by health professionals trained in lactation; – Discussion on the importance of breastfeeding, questions, breast physiology.	Monthly during prenatal care up to 1st year postpartum	Prevalence of early exclusive breastfeeding initiation: I = 61% C = 32% p = 0,02^* * Significant outcomes.
Chapman D et al. (2004), EUA	A	– 165 pregnant women (I = 90; C = 75)	– Breastfeeding	– Pregnancy < 26 weeks; – >18 years of age; – Study location dwellers; – Low income; – Low-risk pregnant women	– Strategic home visits of community women trained in breastfeeding; – Topics covered include anatomy and physiology of the breast, breastfeeding management, counseling techniques and related social and cultural factors; – Educational materials	Monthly in prenatal up to the 6th month postpartum	Prevalence of no early exclusive breastfeeding initiation: I = 8,9 % C = 22,7% OR = 0,39 (CI 95% 0,18-0,36)^* * Significant outcomes.
Olds D et al. (2004), EUA	A	1.178 pregnant women (I = 735; C = 443)	– Birth weight	– Pregnant women residing at the study location with no prior childbirth – Pregnant women without health plans – Low-risk pregnant women	– Strategic home visits by health professionals; – Discussing issues on maternal and fetal health, encouraging self-care and family planning with the use of illustrative materials and teaching	Monthly during prenatal care	Prevalence of low birth weight: I = 2,8% C = 7,7% p = 0,03^* * Significant outcomes.
Bonuck K et al (2005), EUA	A	304 pregnant women (I = 145; C = 159)	– Breastfeeding	– < 24 weeks pregnancy Contact with mother and child available up to 12 months postpartum – pregnant women/ mothers not taking medicines incompatible with breastfeeding – Low-risk pregnant women	– Strategic home visits by local workers trained in breastfeeding; – Workers discussed the physiological characteristics and benefits of breastfeeding using illustrative materials, dolls and artificial nipples and also preparation for childbirth and early initiation of breastfeeding	Monthly during prenatal care up to 12 months postpartum	Prevalence of exclusive breastfeeding in 6 months postpartum: I = 53% C = 39,3% p<0,028^* * Significant outcomes.
Aidam B et al. (2005), Gana	B	231 pregnant women (I = 136; C = 95)	– Breastfeeding	– Pregnant women in the last quarter; – Gave birth to term babies with adequate birth weight in the selected hospitals of the study; – Residing in the community for at least 06 months postpartum – Low-risk pregnant women	– Strategic and participatory home visits by breastfeeding-trained counsellors (nurses and nutritionists); – Issues discussed during visits: Mother and child breastfeeding benefits, early initiation of this practice, the importance of colostrum, breastfeeding techniques, artificial milks risks and prevention and treatment of lactation issues.	Monthly during prenatal care up to 1st year postpartum	Prevalence of exclusive breastfeeding initiation in the first three months postpartum: I = 92,1% C = 65,9% p = 0,04^* * Significant outcomes. Prevalence of exclusive breastfeeding in the first six months postpartum: I = 39,5% C = 19,6% p = 0,02^* * Significant outcomes.
Ickovics J et al. (2007), EUA	A	993 pregnant women (I = 623; C = 370)	– Prematurity – Birth weight – Breastfeeding	– < 24 weeks pregnancy – < 25 years of age – Non high-risk pregnant women – Speaking English or Spanish	– Prenatal care was performed in groups (maxim 8 pregnant women) with professionals discussing issues raised by the very pregnant women regarding concerns related to pregnancy, childbirth, breastfeeding, newborns care; pregnant women were handed copies of their tests and weight records (self-care incentive).	Monthly during prenatal care	Prevalence of prematurity: I = 9,8% C = 13,8% OR = 0,67 (CI 95% 0,44-0,99) p = 0,045^* * Significant outcomes. Prevalence of low birth weight: I = 10,7% C = 11,3% OR = 0,98 (CI 95% 0,64- 1,50) p = 0,90 Early initiation of exclusive breastfeeding I = 66,5% C = 54,6% OR = 1,73 (CI 95% 1,28- 2,35) p = 0,01^* * Significant outcomes.
Edwards R et al. (2013), EUA	A	248 pregnant women (I = 124; C = 124)	– Breastfeeding	– < 34 weeks pregnancy – < 21 years of age – Non high-risk pregnant women	– Strategic home visits by “doulas”; – Visits topics: breastfeeding benefits, using illustrative materials and videos; personal breastfeeding experiences were shared, addressing child nutrition and dispelling breastfeeding myths.	Monthly during prenatal care up to 12 months postpartum	Early initiation of exclusive breastfeeding : I = 63,9% C = 49,6% p = 0,02^* * Significant outcomes. Duration of exclusive breastfeeding > 4 months: I = 8,3% C = 4,4% p = 0,10
Karp S et al. (2013), EUA	A	-130 pregnant women (I = 73; C = 57)	– Breastfeeding	– < 24 weeks pregnancy; – Speaking and reading English; – Living close to study location – Low income; – Low-risk pregnant women	– Strategic home visits by health professionals; – Visits topics: breastfeeding benefits, breastfeeding avoidance risks and discussing prior breastfeeding difficulties; – Educational resources, teaching materials	Monthly during prenatal care and 01 visit postpartum	Prevalence of exclusive breastfeeding early initiation I = 68,5% C = 59,6% p = 0,295
Lutenbacher M et al. (2013), EUA	B	211 pregnant women (I = 109; C = 102)	– Prematurity	– < 24 weeks pregnancy – 1 prior preterm childbirth – Speaking English – Living close to study location – Low-risk pregnant women	– Strategic home visits by health professionals according to specific protocols addressed: – Guidance to pregnant women regarding childbirth, breastfeeding, pregnancy concerns, using teaching materials and ensuring access to psychiatric and social services, when necessary.	Monthly during prenatal care and 01 immediate visit postpartum	Prevalence of prematurity: I = 8% C = 13% p = 0,361

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[1] Collaborations

EP Silva contributed to the concept of the study, design, review, data interpretation and drafting of the study. RT Lima worked on data review and interpretation and critical review of the study. MM Osório contributed to the concept and design of the study, data review and interpretation, drafting of the study and critical review and approval of the version to be published.