Stevens Briony, Buettner Petra, Watt Kerrianne, Clough Alan, Brimblecombe Julie, Judd Jenni
School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia.
Anton Breinl Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia.
Matern Child Nutr. 2015 Oct;11(4):415-32. doi: 10.1111/mcn.12183. Epub 2015 Apr 7.
The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to-date have included studies from high-, middle- and low-income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries on child growth. A systematic review of articles published in English (1970-2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer-reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full-text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer-term growth. Standardised mean differences were calculated using a random-effects meta-analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03-0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer-term physical growth due to limited evidence. Additional research is required in low- and middle-income countries to identify impacts on longer-term infant growth.
孕期补充均衡蛋白质能量对后续儿童生长的有益影响尚不清楚，可能取决于母亲怀孕时营养状况良好还是营养不良。迄今为止的系统评价纳入了来自高收入、中等收入和低收入国家的研究。然而，均衡蛋白质能量补充的效果不应一概而论。本综述评估了低收入和中等收入国家营养不良孕妇补充均衡蛋白质能量对儿童生长的影响。通过医学文献数据库（MEDLINE）、Scopus、考克兰图书馆以及手工检索，对1970年至2015年期间发表的英文文章进行了系统评价。仅纳入了经过同行评审的实验研究，这些研究分析了低收入和中等收入国家营养不良孕妇补充均衡蛋白质能量的效果，并将身体生长指标作为主要结局。两名评审员独立根据纳入标准评估全文。使用定量研究质量评估工具（EPHPP QAT）确定符合条件研究的有效性。共有七项研究符合纳入标准。所有研究均报告了出生体重，五项报告了出生身长，三项报告了出生头围，一项报告了长期生长情况。使用随机效应荟萃分析计算标准化平均差。补充均衡蛋白质能量显著提高了出生体重（七项随机对照试验，n = 2367；d = 0.20，95%置信区间，0.03 - 0.38，P = 0.02）。未观察到对出生身长或出生头围有显著益处。由于证据有限，无法确定干预措施对长期身体生长的影响。低收入和中等收入国家需要开展更多研究，以确定对婴儿长期生长的影响。
