Interventions to Address Disparities in Perinatal Outcomes by Ethnicity: A Systematic Review.

Abstract

<h4>Background</h4>Ethnic minority women face disproportionately higher risks of adverse perinatal outcomes, exacerbated by socio-economic and systemic barriers.<h4>Objectives</h4>This systematic review evaluates the effectiveness of interventions designed to improve perinatal outcomes in these populations.<h4>Search strategy</h4>We conducted a systematic review according to a pre-designed protocol (PROSPERO CRD42024516616). MEDLINE, EMBASE and Cochrane Databases were searched up to February 2024 using relevant Medical Subject Headings (MeSH) terms and keywords.<h4>Selection criteria</h4>We included studies involving interventions targeting pregnant women from ethnic minority groups. Outcome measures included maternal and perinatal outcomes, as well as qualitative assessments, when available.<h4>Data collection</h4>Two reviewers independently performed data extraction and quality assessment, resolving discrepancies by consensus.<h4>Main results</h4>Studies included (n = 36) were from the United Kingdom (n = 9), United States of America (n = 9), Australia (n = 12), Canada (n = 1), Denmark (n = 2), Sweden (n = 3), involving women (n = 72 527) of varied ethnicity: Asian (n = 16 274, 22.4%), Black (n = 11 458, 15.8%), Hispanic (n = 612, 0.8%), First Nations/Aboriginal (n = 19 406, 29.1%), Mixed (n = 873, 1.2%), 'Other' (as defined in the included studies) (n = 3354, 4.6%), and women belonging to an unspecified ethnic minority group (n = 15 232, 21%), and a group of Russian, Arabic, Tigrinya, Polish and Somali women in a foreign country (82 women; 0.1%). Interventions broadly included four categories: clinical management interventions, educational programmes, treatments, and models of care. Clinical management interventions like increased foetal surveillance after 39 weeks and implemented screening for preeclampsia showed positive results, with a 64% reduction in stillbirth rates among South Asian (aOR 0.36, 95% CI 0.13-0.90, p = 0.047) with the former intervention, and a decrease in perinatal deaths with the latter intervention. Educational initiatives demonstrated diverse results, with those directed to the families showing significant improvement in satisfaction and active participation in prenatal care; however, no significant improvements were noted after the implementation of initiatives devoted to healthcare providers. Specific treatments, such as low-dose aspirin, have yielded various outcomes, with some studies reporting a reduction in preterm birth rates. Models of care, including midwifery continuity of care, nutrition implementation initiatives, home visits and language support services, showed promising results in improving maternal satisfaction and obstetric outcomes.<h4>Conclusions</h4>This systematic review summarises the interventions to improve outcomes for these families among ethnic minority women and emphasises the lack of focused attention on improving outcomes in these groups, highlighted by the limited studies and the diverse interventions and outcomes reported. While educational and social support programmes within the model of care show promise, large-scale and high-quality studies are needed.