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Obesity in Pregnancy – Patient-Reported Outcomes in Qualitative Research: A Systematic Review

Published:January 24, 2020DOI:https://doi.org/10.1016/j.jogc.2019.09.011

      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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