Evidence Review: Reproductive Health

[Pages:166]Evidence Review:

Reproductive Health

Population Health and Wellness BC Ministry of Health

This paper is a review of the scientific evidence for this core program. Core program evidence reviews may draw from a number of sources, including scientific studies circulated in the academic literature, and observational or anecdotal reports recorded in community-based publications. By bringing together multiple forms of evidence, these reviews aim to provide a proven context through which public health workers can focus their local and provincial objectives. This document should be seen as a guide to understanding the scientific and community-based research, rather than as a formula for achieving success. The evidence presented for a core program will inform the health authorities in developing their priorities, but these priorities will be tailored by local context.

This Evidence Review should be read in conjunction with the accompanying Model Core Program Paper.

Evidence Review prepared by: Ann Kelly

Evidence Review accepted by: Population Health and Wellness, Ministry of Health (May 2008) Core Functions Steering Committee (November 2008)

? BC Ministry of Health, 2008

Core Public Health Functions for BC: Evidence Review Reproductive Health

TABLE OF CONTENTS

Executive Summary ......................................................................................................................... i 1.0 Overview/Setting the Context............................................................................................. 1

1.1 An Introduction to This Paper.................................................................................... 1 2.0 Methodology ....................................................................................................................... 2

2.1 Grading of the Evidence ............................................................................................ 2 2.2 Methodological Limitations....................................................................................... 3 2.3 Hierarchy and Criteria for Selection of Evidence or Reviews................................... 3 2.4 Newborn and Maternal Outcomes of Relevance to This Review.............................. 4 3.0 Fertility and Contraception ................................................................................................. 7 3.1 Fertility and Delayed Childbearing............................................................................ 7 3.2 Contraception............................................................................................................. 8 3.3 Emergency Contraception........................................................................................ 12 3.4 Abortion ................................................................................................................... 14 3.5 RU-486 Medical Early Abortion ............................................................................. 14 3.6 Preconception/Interconception Health..................................................................... 15 3.7 Summary .................................................................................................................. 16 4.0 Prevention of Transmission of Infectious Diseases to the Newborn ................................ 17 4.1 Screening for Sexually Transmitted Infections in Pregnancy.................................. 17 4.2 Chlamydia Trachomatis ........................................................................................... 18 4.3 Gonorrhea and Congenital Syphilis ......................................................................... 21 4.4 HIV/AIDS ................................................................................................................ 21 4.5 Summary Table of Screening for Infections............................................................ 23 4.6 Group B Streptococcal Infections............................................................................ 25 4.7 Summary .................................................................................................................. 25 5.0 Teen Pregnancy................................................................................................................. 27 5.1 Trends, Outcomes and Risk Factors of Teen Pregnancy ......................................... 27 5.2 System-wide Interventions....................................................................................... 28 5.3 Interventions That are Not Effective........................................................................ 29 5.4 Summary .................................................................................................................. 29 6.0 Healthy Lifestyle............................................................................................................... 30 6.1 Tobacco Use............................................................................................................. 30 6.2 Alcohol and/or Drug Use ......................................................................................... 31 6.3 Interventions Shown to be Ineffective in Improving Reproductive Health............. 32 6.4 Pre-Pregnancy Obesity............................................................................................. 38 6.5 Physical Activity...................................................................................................... 40 6.6 Summary .................................................................................................................. 40 7.0 Maternal Age and Health Status ....................................................................................... 41 7.1 Effect of Advanced Age on Fertility and Pregnancy in Women ............................. 41 7.2 Mental Health During Pregnancy and Postpartum .................................................. 42 7.3 Hypertension ............................................................................................................ 45 7.4 Diabetes During Pregnancy: Type 1, Type 2 and Gestational Diabetes.................. 48 7.5 Screening for Thyroid Disorders ............................................................................. 52 7.6 Women with Disabilities.......................................................................................... 54 7.7 Summary .................................................................................................................. 55

Core Public Health Functions for BC: Evidence Review Reproductive Health

8.0 Prenatal Care..................................................................................................................... 56 8.1 Prevention of Low Birth Weight.............................................................................. 56 8.2 Prevention of Preterm Birth ..................................................................................... 57 8.3 Prevention of Excess Weight Gain During Pregnancy ............................................ 58 8.4 Universal Prenatal Education Programs .................................................................. 58 8.5 Group Prenatal Care................................................................................................. 59 8.6 Enhanced Support During Pregnancy...................................................................... 59 8.7 Access to Primary Maternity Care........................................................................... 60 8.8 Physiological Birth ? Caesarean Section Consensus Statement Summary ............. 61 8.9 Interventions with Strong Evidence of Efficacy in the Prenatal Period .................. 62 8.10 Other Interventions not Proven to Improve Reproductive Health ........................... 66 8.11 Summary .................................................................................................................. 69

9.0 Situations That Increase Vulnerability for Adverse Outcomes ........................................ 71 9.1 Occupational Risks and Interventions ..................................................................... 71 9.2 Women Experiencing Violence and Abuse ............................................................. 71 9.3 Women in Corrections ............................................................................................. 75 9.4 Lesbians and Transgendered Individuals................................................................. 75 9.5 Summary .................................................................................................................. 77

10.0 Males and Health Status.................................................................................................... 78 10.1 Promoting and Protecting Male Reproductive Health ............................................. 78 10.2 Men's Involvement in Reproductive Health and Family Planning. ......................... 80 10.3 The Influence of the Male Factor on Healthy Term Pregnancy .............................. 80

Aboriginal Women........................................................................................................................ 82 10.4 Prevalence of Risk Factors....................................................................................... 82 10.5 Outcomes ................................................................................................................. 83 10.6 Promising Interventions ........................................................................................... 83

11.0 Newborn and Postnatal ..................................................................................................... 87 11.1 Newborn Screening.................................................................................................. 87 11.2 Breastfeeding ........................................................................................................... 87 11.3 Postpartum Interventions Affecting Reproductive Health....................................... 90 11.4 Summary .................................................................................................................. 91

12.0 Use of the Internet and Technology.................................................................................. 92 12.1 Self-Help and Web-based Strategies ....................................................................... 92 12.2 Self-Help With Professional Support....................................................................... 93 12.3 Other Media and Technology-based Strategies ....................................................... 94 12.4 Summary .................................................................................................................. 95

References .................................................................................................................................. 96 Glossary and Abbreviations........................................................................................................ 135 Appendix 1: Framework for Review of Core Public Health Programs ...................................... 138 Appendix 2: Selected Methods of Contraception ....................................................................... 141

List of Tables Table 1: Types of Studies Reviewed and Grading System Used............................................. 2 Table 2: Society of Obstetricians and Gynaecologists of Canada Grading System ................ 3 Table 3: Reproductive Health Outcome Measures .................................................................. 5 Table 4: Interventions Where Evidence is Lacking ? Fertility and Contraception................ 12 Table 5: Sexually Transmitted Infection Rates, Females....................................................... 17

Core Public Health Functions for BC: Evidence Review Reproductive Health

Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12: Table 13: Table 14:

Table 15:

Summary Table ? Screening for Infections ............................................................. 23 Summary Table ? Screening for Group B Streptococcal Infections........................ 25 Interventions Where Evidence Shows a Preventive Effect on Hypertension .......... 46 Interventions Where Evidence Shows No Effect on Risk of Hypertension ............ 47 Interventions Where Evidence is Lacking/Ambiguous ? Gestational Diabetes ...... 52 Summary Table ? Screening for Thyroid Disorders................................................ 52 Prenatal Interventions with Evidence of Efficacy ................................................... 64 Interventions not Proven to Improve Reproductive Health ..................................... 66 Breastfeeding Practices, Women Aged 15 to 55 Who Had a Baby in the Previous 5 Years, BC............................................................................................... 87 Evidence of Strategies to Increase Breastfeeding.................................................... 88

Core Public Health Functions for BC: Evidence Review Reproductive Health

EXECUTIVE SUMMARY

The following table summarize the strategies in this review that have the best quality of evidence.

Subject

Outcome

Intervention

Chapter 3: Fertility and Contraception

Preconception/ Interconception Health

Reduction in infertility

Prevention of unwanted pregnancies Reduction in neural tube defects and other congenital anomalies

Smoking cessation Reduction in percentage of trans fats in diet. Access to contraception and abortion Preconception screening of women seeking family planning for risk conditions Preconception folate supplements Fortification of food with folic acid Enhanced diabetic control and education.

Chapter 4: Infectious Diseases

Chlamydia trachomatis HIV/AIDS

Reduction in pelvic inflammatory disease and infertility.

Prevention of transmission of HIV to fetus. Strep B

Screening for chlamydia for women under 25 in high risk situations Partner screening Expedited partner therapy HIV screening offered on an opt out basis at the first prenatal visit The Canadian Guidelines on Sexually Transmitted Infections recommends screening and treatment at 12-16 weeks in high risk pregnancies (i.e., previous preterm labour/delivery or premature rupture of the membranes).

Chapter 5: Teen Pregnancy

Reduction in teen pregnancy

Access to contraception Multi-strategy country-wide strategies that include access to contraception, education, public awareness and education regarding sexual behaviour.

Chapter 6: Healthy Lifestyle

Reduction in smoking in pregnancy and alcohol consumption during pregnancy leads to reduction in fetal mortality, preterm birth and reduction in low birth weight.

Fewer complications during pregnancy and labour such as gestational diabetes and hypertension and therefore lower risk of preterm birth, caesarean delivery.

High-quality family or school based programs targeted at adolescents Screening and brief interventions for smoking and alcohol consumption in primary care. Smoking cessation Quitlines Weight gain during pregnancy within the guidelines of the Institute of Medicine

Chapter 7: Maternal Age and Health Status

Reduction in congenital anomalies Perinatal complications

Postpartum mental health

Lower blood pressure Lower risk of preeclampsia Reduction in Edinburgh Postnatal Depression Scale scores

Preconception care for diabetic women Lifestyle interventions and/or metformin to prevent diabetes in pre-diabetic people Diabetic management in pregnancy including dietary advice, blood glucose monitoring and insulin monitoring Calcium supplement

Screening, support, interventions and home visitation by nurses for high risk women.

Chapter 8: Prenatal Care

Lower risk of congenital anomalies

Improved fetal growth and birth outcomes. Reduction of the risk of preterm birth, infants small for gestational age and stillbirths

Folic acid containing multivitamin in the preconception period and first trimester period A balanced supplement of energy and protein

Avoiding shift work, lifting loads and job psychological demands

Population Health and Wellness, Ministry of Health

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Core Public Health Functions for BC: Evidence Review Reproductive Health

Subject

Outcome

Chapter 9: Other Conditions that Increase Vulnerability for Adverse Outcomes

Improved quality of care

Improved reproductive health outcomes Possible reduction in preterm births

Chapter 10: Aboriginal Women

Chapter 11: Newborn and Postnatal Services

Breastfeeding

Improved childhood immunity and development Reduction in infant mortality Reduction in childhood obesity Postpartum weight loss

Chapter 12: Use of the Internet and Technology

Improved mental health Reduced alcohol consumption A wide variety of health outcomes. Weight loss

Intervention

Adoption of best practices for women experiencing violence or abuse. Provision of prenatal care to imprisoned women Provision of adequate prenatal leave for working women Limits to physical burdens in the workplace for pregnant women.

Adoption of best practices for providing care to Aboriginal women and women experiencing violence or abuse bases on the Guidelines by the SOGC.

Support for breastfeeding in the postnatal hospital stay Breastfeeding counselling in primary care Media programs Unrestricted feeding, baby to mother contact and skin to skin contact from birth onwards. Avoiding supplementary formula Preventing discharge packs in the hospital

Computerized cognitive behaviour therapy Bibliotherapy Phone contact Behaviour therapy + Internet support

Population Health and Wellness, Ministry of Health

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Core Public Health Functions for BC: Evidence Review Reproductive Health

Figure A: Evidence-based Logic Model of Public Health Strategies to Improved Reproductive Health

Population Health and Wellness, Ministry of Health

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