Sense of coherence in pregnancy: a systematic review of the literature.

Abstract

Background Pregnancy is acknowledged as a time of physiological, social, and psychological challenges that may compromise a pregnant woman’s quality of life. Healthcare advocates have proposed a paradigm shift in maternity services towards a framework that includes the promotion and generation of health such as Antonovsky’s framework of salutogenesis. Central to salutogenesis are general resistance resources (GRRs) (i.e., assets and resources available to an individual) and sense of coherence (SOC) (i.e., a measure of their ability to mobilize their GRRs and manage physical, mental and social stressors). To begin to explore the role of SOC in pregnancy care, we critically analyzed, synthesized and summarized studies with quantitative measures of SOC during pregnancy. Methods A systematic review of the literature was performed using PubMed & Medline, Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsychInfo between 1997 to 2022. Inclusion criteria for review were manuscripts: (1) of peer-reviewed primary investigation reports, (2) measuring SOC among pregnant women and (3) written in the English language. Manuscripts excluded were: (1) qualitative studies, (2) abstracts from conference proceedings and (3) dissertations from a Master or PhD degree. Quality assessment used the NIH National Heart, Lung, and Blood Institute Study Quality Assessment Tools. Our systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Results Our systematic review found 49 studies (i.e., prospective (n=29) and cross-sectional (n=17) cohorts) meeting inclusion criteria. Pregnant women (93% of subjects; n=27, 186) completed primarily the SOC-13 instrument along with 67 other patient reported outcomes (PROs) of mental and social health domains. Physical health measures were lacking. Overall, a low SOC score was associated with compromised health outcomes during pregnancy, labor and birth. Cause and effect inferences between measures of SOC and PROs remain largely unexplored. Conclusion The findings of this review are that low SOC is associated with poor prenatal health outcomes. Maternity care should focus on a more comprehensive approach that addresses not only morbidities and risks but also protective and stress resisting factors that promote health such as increasing a pregnant woman’s sense of coherence.