Sahar A Choudhry, G Saradjha Brédy, Cyerra Cruise, Qai Hinds, Margaret A McConnell, Sumit Agarwal, David B Flynn, Mara E Murray Horwitz
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引用次数: 0
Abstract
Background: Unconditional cash transfers (UCTs) through social programs or direct cash transfers (DCTs) may address drivers of pregnancy-related morbidity and mortality.
Purpose: To summarize evidence on UCTs and postpartum outcomes in the United States.
Data sources: PubMed, Embase, Web of Science, Social Science Research Network, and structured internet searches through 28 January 2025.
Study selection: Primary research reporting associations between UCTs and postpartum outcomes (0 to 2 years after delivery) in the United States.
Data extraction: Dual data extraction with predefined outcomes: infant or child care, reproductive health, substance use, other mental health outcomes, and other outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 and ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tools. Strength of evidence (SOE) was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
Data synthesis: Eleven reports from 6 studies were identified. Four quasi-experimental (QE) studies examined 3 different social programs, 2 of which targeted populations with low incomes. Seven reports from 2 randomized controlled trials (RCTs) examined DCTs to postpartum persons with low incomes. The evidence on UCTs showed an increase in breastfeeding (high SOE [2 RCTs, 2 QE studies]), little or no difference in postpartum mood (high SOE [1 RCT, 2 QE studies]), and low SOE or insufficient evidence for all other associations.
Limitations: Unpublished studies and those not published in English may have been missed. Nonrandomized studies were subject to reporting or recall bias, reducing SOE. Study heterogeneity prevented meta-analysis.
Conclusion: Unconditional cash transfers increase breastfeeding in diverse settings and populations and result in little or no difference in postpartum mood specifically in persons with low incomes. No studies examined DCTs given during pregnancy. More evidence is needed on associations between UCTs and key clinical outcomes, such as postpartum maternal morbidity and mortality.
Primary funding source: None. (Registered on Open Science Framework [https://osf.io/4c3nx]).
背景：通过社会项目或直接现金转移（dct）的无条件现金转移（uct）可以解决妊娠相关发病率和死亡率的驱动因素。目的：总结美国uct与产后结局的相关证据。数据来源：PubMed， Embase, Web of Science, Social Science Research Network，以及截至2025年1月28日的结构化互联网搜索。研究选择：在美国，主要研究报告了uct与产后结局（分娩后0 - 2年）之间的关系。数据提取：具有预定义结果的双重数据提取：婴儿或儿童保育、生殖健康、物质使用、其他精神健康结果和其他结果。使用Cochrane Risk of Bias 2和ROBINS-I （Risk of Bias In Non-randomised Studies - of Interventions）工具评估研究质量。证据强度（SOE）采用GRADE（分级建议评估，发展和评价）方法进行评估。数据综合：从6项研究中确定了11份报告。四项准实验（QE）研究考察了三种不同的社会项目，其中两项针对低收入人群。来自两项随机对照试验（RCTs）的七篇报告对低收入产后妇女的dct进行了研究。uct的证据显示母乳喂养增加（高SOE[2个RCT， 2个QE研究]），产后情绪差异很小或没有差异（高SOE[1个RCT， 2个QE研究]），低SOE或所有其他关联证据不足。局限性：未发表的研究和未用英文发表的研究可能被遗漏。非随机研究容易出现报告偏倚或回忆偏倚，降低SOE。研究异质性阻碍了meta分析。结论：在不同的环境和人群中，无条件现金转移增加了母乳喂养，对产后情绪的影响很小或没有影响，特别是对低收入人群。没有研究检查怀孕期间的dct。需要更多的证据来证明uct与关键临床结果（如产后产妇发病率和死亡率）之间的关联。主要资金来源：无。（注册于Open Science Framework [https://osf.io/4c3nx]]）。
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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