This page contains the findings of systematic reviews undertaken by the EPPI-Centre Health Promotion and Public Health Reviews Reviews Facility
Smoking in pregnancy (opens a new page)
In a review of pregnancy and social exclusion, six of the intervention studies reviewed provided sound evidence of the value of two particular approaches to targeting the social exclusion associated with unintended teenage pregnancy:
- Early childhood interventions consisting of preschool education and parenting support
- Social skills development and youth development programmes combining community service and student learning, or providing a programme of academic and social development.
A statistical meta-analysis (random effects model) revealed that these approaches reduced by 39% the number of young women reporting teenage pregnancy, and also had positive effects on employment and economic status.
The qualitative research revealed three recurrent themes in the experiences of young people: dislike of school; poor material circumstances and unhappy childhoods; and low expectations for the future.
Ten of the intervention studies provided sound evidence for the value of particular approaches. Two of these looked at welfare sanctions or bonuses, four reported on the effects of educational and career development programmes, three examined holistic, multi-agency support, and one focused on the effects of daycare. A statistical meta-analysis (random effects model) suggested that educational and career development interventions increased by 213% the number of young parents in education or training in the short-term. Daycare and welfare sanction/bonuses programmes also had positive short-term effects. None of these types of interventions showed any long-term effects. The most promising approach for reducing repeat pregnancy appears to be the provision of daycare.
The qualitative research included in the in-depth review of parenting support highlights the diversity of needs and preferences within this group; struggles against negative stereotypes of teenage parenthood; heavy reliance on family support; the continuation of problems existing before parenthood; and the wider costs and benefits of education and employment.
A Rapid Evidence Assessment looked at risk and protective factors for poor outcomes for young people. These included risk factors for teenage pregnancy and the findings of systematic reviews of preventative measures. Full details can be found in the report.
Smoking in pregnancy
Click here for details of research on smoking cessation in pregnancy.
Despite methodological barriers, there was evidence of the benefits of nursing and midwifery for a range of outcomes. An important finding of this review was that nursing and midwifery care when compared with other types of care was not shown to produce adverse outcomes.
- Targeted home visiting by nurses and midwives appears to have a beneficial effect on postnatal depression when compared with routine care.
- No evidence of a difference in effect was found between home visiting and no home visiting for the amelioration of drug and alcohol abuse in new and pregnant mothers.
- Midwife-led care for low-risk women compared to doctor-led care appears to improve a range of maternal outcomes, to reduce the number of procedures in labour, and increase satisfaction with care. There was no evidence of a differential effect for many maternal, foetal or neonatal outcomes, nor was there evidence of any additional adverse outcomes associated with midwife-led care.
Five high-quality sociological studies focused specifically on the issue of women’s identity in the transition to motherhood elicited 183 views from women participants on a range of key social and health influences. Paid employment and health care experiences were most often described; these were synthesised thematically and these themes appeared consistently over the past thirty years. Women comment that once pregnant, their relationships with employers and co-workers changed. On return to work, they were clear about their needs in relation to balancing work and home roles. They note a changing sense of connection with their local communities, including a change in their perception to time, and their relationship to it, once they stepped back from paid employment to focus on motherhood.
In terms of health care, women in more recent studies describe clear needs in their relationships with health care providers and the system in which care occurs. They highlight the importance of choice, control, and clear, respectful communication in trying to navigate the childbearing year. Many women describe being ill-prepared antenatally and postnatally for the sheer power of birth, especially when it did not happen the way they were led to believe it would.
1. Young people, pregnancy and social exclusion: A systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support (2006)
2. Targeted youth support: Rapid Evidence Assessment of effective early interventions for youth at risk of future poor outcomes (2008)
3. The socioeconomic value of nursing and midwifery: A rapid systematic review of reviews (2010)
4. Becoming a mother: a research synthesis of women’s experiences of first-time motherhood (2011)