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低升糖指数饮食对妊娠母婴结局影响的Meta 分析:随机对照试验的系统评价

Effects of low-glycemic-index diets in pregnancy on maternal and newborn outcomes in pregnant women: a meta-analysis of randomized controlled trials.

机构信息

Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123, China.

Department of Nutrition, First Hospital of Hebei Medical University, Shijiazhuang, 050031, China.

出版信息

Eur J Nutr. 2018 Feb;57(1):167-177. doi: 10.1007/s00394-016-1306-x. Epub 2016 Sep 9.

Abstract

PURPOSE

Maternal diet with a high glycemic index (GI) is associated with fetal overgrowth and higher infant body adiposity. Effects of low-GI diet on maternal and newborn outcomes have been assessed in both healthy pregnancy and gestational diabetes mellitus, but the results remain inconclusive. This meta-analysis aimed to examine the effects of low-GI diets on maternal and newborn outcomes.

METHODS

PubMed, Clinical Trials, and Cochrane Library databases were searched for relevant randomized trials up to January 2016. Random- or fixed-effects models were used to calculate combined treatment effects.

RESULTS

A total of 11 trials involving 1985 women were eligible for analysis. This meta-analysis assessed 7 maternal and 11 newborn outcomes. Of these, gestational weight gain (GWG), fasting blood glucose (FBG), newborn birth weight, ponderal index (PI), proportion of macrosomia, and large for gestational age (LGA) were investigated in more than 8 trials. Compared with control diets, low-GI diets significantly reduced FBG (weight mean differences (WMD) = -0.18 mmol/L, 95 % CI: -0.33, -0.02), 2-h postprandial glucose level (WMD = -0.33 mmol/L, 95 % CI: -0.54, -0.12), and the proportion of LGA (RR = 0.52, 95 % CI: 0.31, 0.89). A lower GWG (WMD = -0.69 kg, 95 % CI: -1.74, 0.36) and birth weight (WMD = -0.10 kg, 95 % CI: -0.23, 0.03) were also observed without significant differences. Heterogeneity was observed in the GWG, FBG, and birth weight analyses. Low-GI diets did not affect other maternal and newborn outcomes. In subgroup and sensitivity analyses, the intervention effects of low GI on GWG and FBG varied.

CONCLUSIONS

Low-GI diets may have beneficial effects on maternal outcomes for those at risk of developing high glucose levels, without causing adverse effects on newborn outcomes. However, results should be interpreted with caution because of the evidence of heterogeneity and limited number of studies.

摘要

目的

高血糖指数(GI)的母体饮食与胎儿过度生长和婴儿体脂肪增加有关。低 GI 饮食对健康妊娠和妊娠期糖尿病的母婴结局的影响已经在研究中进行了评估,但结果仍不确定。本荟萃分析旨在研究低 GI 饮食对母婴结局的影响。

方法

检索了 PubMed、ClinicalTrials 和 Cochrane Library 数据库,以获取截至 2016 年 1 月的相关随机试验。使用随机或固定效应模型计算联合治疗效果。

结果

共有 11 项涉及 1985 名妇女的试验符合纳入标准。本荟萃分析评估了 7 项母体结局和 11 项新生儿结局。其中,妊娠体重增加(GWG)、空腹血糖(FBG)、新生儿出生体重、体脂指数(PI)、巨大儿比例和大于胎龄儿(LGA)的研究超过 8 项。与对照饮食相比,低 GI 饮食显著降低了 FBG(体重平均差异(WMD)=-0.18mmol/L,95%置信区间:-0.33,-0.02)、餐后 2 小时血糖水平(WMD=-0.33mmol/L,95%置信区间:-0.54,-0.12)和 LGA 的比例(RR=0.52,95%置信区间:0.31,0.89)。GWG 也较低(WMD=-0.69kg,95%置信区间:-1.74,0.36)和出生体重(WMD=-0.10kg,95%置信区间:-0.23,0.03),但无显著差异。GWG、FBG 和出生体重分析存在异质性。低 GI 饮食对其他母婴结局没有影响。在亚组和敏感性分析中,低 GI 对 GWG 和 FBG 的干预效果存在差异。

结论

低 GI 饮食可能对有发生高血糖风险的产妇结局有有益影响,而不会对新生儿结局产生不良影响。然而,由于证据存在异质性和研究数量有限,结果应谨慎解释。

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