Interventions that enhance health services for parents and infants to improve child development and social and emotional wellbeing in high-income countries:A systematic review

摘要

Background: Experiences in the first 1000 days of life have a critical influence on child development and health. Health services that provide support for families need evidence 35 about how best to improve their provision. Methods: We systematically reviewed the evidence for interventions in high-income countries to improve child development by enhancing health service contact with parents from the antenatal period to 24 months postpartum. We searched 15 databases and trial registers for studies published in any language between 01/01/1996 and 01/04/2016. We also searched programme or organisation websites and the electronic table of contents of eight journals. Results: Primary outcomes were motor, cognitive, and language development, and social- emotional wellbeing, measured to 39 months of age (to allow the interventions time to produce demonstrable effects). Results were reported using narrative synthesis, due to the variation in study populations, intervention design and outcome measurement. 22 of the 46 12,986 studies identified met eligibility criteria. Using GRADE criteria, the quality of evidence overall was moderate to low. There was limited evidence for intervention effectiveness: positive effects were seen in 1/6 studies for motor development, 4/11 for language development, 4/8 for cognitive development, and 3/19 for social-emotional wellbeing. However, most studies showing positive effects were at high/unclear risk of bias, within- study effects were inconsistent, and negative effects were also seen. Intervention content and intensity varied greatly, but this was not associated with effectiveness. Conclusions: There is insufficient evidence that interventions currently available to enhance health service contacts up to 24 months postpartum are effective for improving child development. There is an urgent need for robust evaluation of existing interventions, and to develop and evaluate novel interventions to to enhance the offer to all families.enhance the offer to all families.