Saccone Gabriele, Berghella Vincenzo
Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
Am J Obstet Gynecol. 2015 Aug;213(2):135-40. doi: 10.1016/j.ajog.2015.03.013. Epub 2015 Mar 7.
The purpose of this study was to evaluate the efficacy of omega-3 supplementation for the prevention of recurrent preterm birth (PTB) in asymptomatic singleton gestations with previous PTB. We searched fish oil, long chain polyunsaturated fatty acids, pregnancy, and omega-3 in MEDLINE, OVID, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE, and the Cochrane Central Register of Controlled Trials from inception of each database to December 2014 with no limit for language. In addition the reference lists of all identified articles were examined to identify studies that were not captured by electronic searches. We performed a metaanalysis of randomized controlled trials of asymptomatic singleton gestations with previous PTB who were assigned randomly to prophylactic omega-3 supplementation vs control (either placebo or no treatment). The primary outcome was predefined as PTB at <37 weeks of gestation. The pooled results were reported as relative risk (RR) with 95% confidence interval (95% CI). The protocol of this review was registered with PROSPERO (registration number: CRD42015016371). Two randomized controlled trials that included 1080 women were analyzed. The mean gestational age at randomization was approximately 134 days in both groups (mean difference, 0.01 days; 95% CI, -0.13 to 0.14). Women who received omega-3 had similar rates of PTB at <37 weeks of gestation (34.5% vs 39.8%; RR, 0.81; 95% CI, 0.59-1.12) and PTB at <34 weeks of gestation (12.0% vs 15.4%; RR, 0.62; 95% CI, 0.26-1.46) compared with control subjects. The omega-3 groups had a statistically significantly longer latency (mean difference, 2.10 days; 95% CI, 1.98-2.22) and higher birthweight (mean difference, 102.52 g; 95% CI, 20.09-184.95) compared with control subjects; the other secondary outcomes (which included gestational age at delivery, spontaneous PTB at <37 and 34 weeks of gestation, admission to the intensive care unit, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, and perinatal death) were similar. Omega-3 supplementation during pregnancy does not prevent recurrent PTB in asymptomatic singleton gestations with previous PTB. The benefits in longer latency and higher birth weight may deserve further study.
本研究的目的是评估补充ω-3对预防有既往早产史的无症状单胎妊娠复发早产（PTB）的疗效。我们在MEDLINE、OVID、Scopus、ClinicalTrials.gov、PROSPERO国际系统评价前瞻性注册库、EMBASE和Cochrane对照试验中央注册库中检索了鱼油、长链多不饱和脂肪酸、妊娠和ω-3，检索时间从每个数据库创建之初至2014年12月，无语言限制。此外，还查阅了所有已识别文章的参考文献列表，以确定电子检索未涵盖的研究。我们对有既往PTB史的无症状单胎妊娠随机对照试验进行了荟萃分析，这些试验将受试者随机分配至预防性补充ω-3组与对照组（安慰剂或不治疗）。主要结局预先定义为妊娠<37周时的PTB。汇总结果以相对风险（RR）及95%置信区间（95%CI）报告。本综述方案已在PROSPERO注册（注册号：CRD42015016371）。分析了两项纳入1080名女性的随机对照试验。两组随机分组时的平均孕周约为134天（平均差值为0.01天；95%CI为-0.13至0.14）。与对照组相比，接受ω-3补充剂的女性在妊娠<37周时的PTB发生率（34.5%对39.8%；RR为0.81；95%CI为0.59-1.12）和妊娠<34周时的PTB发生率（12.0%对15.4%；RR为0.62；95%CI为0.26-1.46）相似。与对照组相比，ω-3组的潜伏期在统计学上显著更长（平均差值为2.10天；95%CI为1.98-2.22）且出生体重更高（平均差值为102.52g；95%CI为20.09-184.95）；其他次要结局（包括分娩时的孕周、妊娠<37周和<34周时的自发性PTB、入住重症监护病房、脑室内出血、坏死性小肠结肠炎、败血症和围产期死亡）相似。孕期补充ω-3不能预防有既往PTB史的无症状单胎妊娠复发PTB。在延长潜伏期和增加出生体重方面的益处可能值得进一步研究。
