Giảm tỷ lệ thai chết lưu: can thiệp về hành vi và dinh dưỡng trước và trong thai kỳ
Tóm tắt
Phần lớn các trường hợp thai chết lưu toàn cầu xảy ra ở các quốc gia có thu nhập thấp và trung bình, và ở nhiều bối cảnh, phần lớn các trường hợp thai chết lưu xảy ra trước sinh, trước khi bắt đầu chuyển dạ. Tình trạng dinh dưỡng kém, thiếu chăm sóc trước sinh và một số hành vi gia tăng nguy cơ thai chết lưu ở nhiều nơi thiếu nguồn lực. Các can thiệp để giảm các rủi ro này có thể làm giảm gánh nặng từ các trường hợp thai chết lưu, nhưng bằng chứng về tác động của các can thiệp này vẫn chưa được đánh giá một cách toàn diện.
Bài báo thứ hai của một tổng quan có hệ thống về các can thiệp có khả năng ảnh hưởng đến tỷ lệ thai chết lưu này đề cập đến 12 can thiệp khác nhau liên quan đến các yếu tố rủi ro do hành vi và xã hội tác động, bao gồm phơi nhiễm với các thực hành và chất độc hại, việc sử dụng và chất lượng chăm sóc trước sinh, và dinh dưỡng của mẹ trước và trong thai kỳ. Chiến lược tìm kiếm đã xem xét các tạp chí y học đã được lập chỉ mục trên PubMed và Thư viện Cochrane. Nếu có bất kỳ thử nghiệm ngẫu nhiên có đối chứng nào đủ điều kiện được nhận diện và được công bố sau tổng quan Cochrane gần đây nhất, chúng đã được thêm vào để tạo ra các phân tích tổng hợp mới. Các can thiệp được đề cập trong bài báo này tập trung vào các quốc gia có thu nhập thấp và trung bình, cả vì gánh nặng lớn của thai chết lưu và vì tỷ lệ cao các yếu tố rủi ro như suy dinh dưỡng ở mẹ và phơi nhiễm với môi trường độc hại ở những quốc gia này. Các tổng quan và nghiên cứu liên quan đến các can thiệp này đã được đánh giá và rút ra kết luận về bằng chứng cho lợi ích của những can thiệp này.
Từ góc độ chương trình, không có can thiệp nào đạt được bằng chứng rõ ràng về lợi ích. Bằng chứng cho một số yếu tố rủi ro do xã hội tác động đã được xác định, chẳng hạn như phơi nhiễm với ô nhiễm không khí trong nhà và khoảng cách giữa các lần sinh, nhưng vẫn cần phát triển các can thiệp phù hợp. Cần có thêm nghiên cứu về các can thiệp hành vi phù hợp với văn hóa và các thử nghiệm lâm sàng để tăng cường việc ngừng thuốc lá và giảm phơi nhiễm với thuốc lá không khói. Bổ sung protein- năng lượng cân bằng liên quan đến tỷ lệ thai chết lưu thấp hơn, nhưng cần có các thử nghiệm lớn được thiết kế tốt hơn để xác nhận phát hiện này. Việc bổ sung axit folic quanh thời điểm thụ thai làm giảm đáng kể các khuyết tật ống thần kinh, nhưng chưa có sự giảm đáng kể nào trong tỷ lệ thai chết lưu được ghi nhận. Bằng chứng về các can thiệp dinh dưỡng khác, bao gồm nhiều vi chất dinh dưỡng và bổ sung Vitamin A còn yếu, cho thấy sự cần thiết phải nghiên cứu thêm để đánh giá tiềm năng của các can thiệp dinh dưỡng trong việc giảm thiểu thai chết lưu.
Chăm sóc trước sinh được sử dụng rộng rãi ở các quốc gia có thu nhập thấp và trung bình, và cung cấp một cơ hội tiếp xúc tại cơ sở y tế tự nhiên để cung cấp hoặc giáo dục về nhiều can thiệp mà chúng tôi đã xem xét. Tác động của các hành vi xã hội rộng hơn, chẳng hạn như quyết định sinh sản, tiếp cận chăm sóc trước sinh, chế độ ăn uống của mẹ và các yếu tố phơi nhiễm như thuốc lá và ô nhiễm không khí trong nhà trong thai kỳ vẫn chưa được hiểu rõ, và cần có nghiên cứu thêm và các can thiệp phù hợp để kiểm tra mối liên hệ giữa các hành vi này với kết quả thai chết lưu. Đối với hầu hết các can thiệp dinh dưỡng, cần có các thử nghiệm ngẫu nhiên có đối chứng lớn hơn báo cáo các trường hợp thai chết lưu tách biệt với tử vong chu sinh tổng hợp. Nhiều trường hợp thai chết lưu trước khi sinh có thể ngăn ngừa ở các quốc gia có thu nhập thấp và trung bình, đặc biệt thông qua cải thiện chế độ ăn uống và môi trường, và thông qua việc nâng cao chất lượng chăm sóc trước sinh - đặc biệt bao gồm chẩn đoán và quản lý các thai kỳ có nguy cơ cao - mà các phụ nữ mang thai nhận được.
Từ khóa
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