Dewan Michael C, Mummareddy Nishit, Bonfield Christopher
Department of Neurological Surgery, Vanderbilt University Medical Center, T-4224 Medical Center North, Nashville, TN, 37232-2380, USA.
Eur Spine J. 2018 Feb;27(2):253-263. doi: 10.1007/s00586-017-5203-7. Epub 2017 Jun 29.
The study's aim was to address three fundamental questions related to pregnancy and adolescent idiopathic scoliosis (AIS), and provide clinically applicable answers to spine specialists and general practitioners alike.
The authors performed a systematic literature review using MEDLINE, EMBASE, Google Scholar, and Cochrane Database of Systematic Reviews to identify articles published between 1980 and 2015 that described pregnancy-related characteristics and outcomes in AIS patients. The search was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and evidence was classified according to the Oxford CEBM (Centre for Evidence-Based Medicine) appraisal tool.
Twenty-two articles incorporating more than 3125 AIS patients were included. All studies concluded level 2b evidence or lower. Nulliparity rates were slightly higher among AIS patients, and more frequent infertility treatment was required. Pregnancy-related back pain was common, and while non-disabling, may have been more severe than in healthy women. Minor curve progression often occurred during pregnancy, though its permanence was questioned and significance unknown. Back pain and curve progression occurred independent of AIS treatment modality. With modern technology, anesthetic and obstetric complications in the perinatal period were not elevated in AIS mothers.
Women with AIS experience slightly elevated rates of nulliparity, infertility treatment, prepartum back pain, and peripartum curve progression. However, most women are able to have children and are not at increased risk of pregnancy-related complications. Higher quality evidence is needed to better define these relationships and allow more guided counseling and treatment.
本研究旨在解决与妊娠及青少年特发性脊柱侧凸（AIS）相关的三个基本问题，并为脊柱专科医生和全科医生提供临床适用的答案。
作者使用MEDLINE、EMBASE、谷歌学术和Cochrane系统评价数据库进行系统文献综述，以识别1980年至2015年间发表的描述AIS患者妊娠相关特征和结局的文章。检索按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行，证据根据牛津循证医学中心（CEBM）评估工具进行分类。
纳入了22篇文章，涉及3125例以上AIS患者。所有研究得出的证据等级为2b级或更低。AIS患者的未生育率略高，需要更频繁地进行不孕治疗。妊娠相关背痛很常见，虽然不致残，但可能比健康女性更严重。妊娠期间常出现轻微的侧弯进展，但其持续性受到质疑且意义不明。背痛和侧弯进展与AIS治疗方式无关。借助现代技术，AIS母亲围产期的麻醉和产科并发症并未增加。
AIS女性的未生育率、不孕治疗率、产前背痛和围产期侧弯进展率略有升高。然而，大多数女性能够生育，且妊娠相关并发症风险并未增加。需要更高质量的证据来更好地界定这些关系，以便进行更有指导的咨询和治疗。
