Abstract
The purpose of this study was to determine the clinical and non-clinical outcomes
that pregnant women with obesity value as pertaining to their health and that of their
babies. In this systematic review of the qualitative literature, a search of four
databases was conducted for studies using qualitative methods in pregnant women with
obesity. From the included studies, the review synthesized relevant themes representing
the voiced concerns and perceived benefits of and barriers to the uptake of interventions,
to yield patient-reported outcomes (PROs). PROs were categorized into domains according
to the published taxonomy of outcomes in medical research. Of the 89 identified studies,
27 were included, none of which were primarily intended to elicit PROs. A total of
256 PROs and 7 distinct themes were identified. Only 13% of PROs represented physiological
or clinical outcomes, whereas 21% represented the core area of emotional functioning
or well-being, and 15% represented the area of delivery of care. The most frequently
voiced concern was inadequate health care provider support (60%), and women considered
intervention-specific challenges to be the greatest barriers to the uptake of interventions
(34%). This study synthesized the qualitative evidence of concerns that pregnant women
with obesity have regarding their pregnancy and postpartum care, as well as specific
barriers they perceive to the uptake of interventions. In addition, this study revealed
that clinical outcomes, which are most often reported in clinical trials, comprise
only a minority of outcomes considered important by these women. A core outcome set
that adequately incorporates PROs is required to inform the conduct of future trials
in pregnant women with obesity.
Résumé
L'objectif de cette étude était de déterminer les résultats cliniques et non cliniques
que les femmes enceintes atteintes d'obésité estiment liés à leur santé ou à celle
de leur bébé. Dans cette revue systématique de la littérature qualitative, une recherche
a été effectuée dans 4 bases de données pour répertorier les études utilisant des
méthodes qualitatives auprès de femmes enceintes atteintes d'obésité. À partir des
études retenues, la revue a synthétisé les thèmes pertinents représentant les inquiétudes
exprimées ainsi que les obstacles et bienfaits perçus de l'adhésion aux interventions,
pour en extraire les résultats rapportés par les patientes. Ces résultats ont été
classés par domaine selon la taxonomie publiée des résultats en recherche médicale.
Dans les 89 études recensées, 27 ont été retenues et aucune d'entre elles ne poursuivait
l'objectif premier de recueillir les résultats rapportés par les patientes. Un total
de 256 résultats rapportés par les patientes et 7 thèmes distincts ont été établis.
Seulement 13 % des résultats rapportés par les patientes se rapportaient à des résultats
physiologiques ou cliniques, tandis que 21 % portaient sur l'aspect de l'adaptation
affective ou du bien-être et 15 %, sur la prestation des soins. Les inquiétudes les
plus fréquemment exprimées traitaient du soutien inadéquat fourni par les fournisseurs
de soins de santé (60 %). Les femmes estimaient que les difficultés spécifiques à
l'intervention étaient les plus grands obstacles à l'adhésion aux interventions (34
%). Cette étude a synthétisé les données qualitatives qui se rapportent aux inquiétudes
des femmes enceintes atteintes d'obésité par rapport à la grossesse et aux soins post-partum,
ainsi qu'aux obstacles particuliers qu'elles perçoivent en regard de l'adhésion aux
interventions. De plus, cette étude révèle que les résultats cliniques (les plus souvent
rapportés dans les essais cliniques) ne comprennent qu'une minorité de résultats jugés
importants par ces femmes. Il est nécessaire de créer un ensemble de résultats fondamentaux
qui englobe adéquatement les résultats rapportés par les patientes afin d'étayer la
réalisation des futurs essais menés auprès de femmes enceintes atteintes d'obésité.
Keywords
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Article info
Publication history
Published online: January 24, 2020
Footnotes
Disclosures: Funding for this work was provided by the Bernard Ludwig Fellowship in Obstetrics and Gynaecology (Ontario Student Opportunity Trust Fund).
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
