Kalliala Ilkka, Markozannes Georgios, Gunter Marc J, Paraskevaidis Evangelos, Gabra Hani, Mitra Anita, Terzidou Vasso, Bennett Phillip, Martin-Hirsch Pierre, Tsilidis Konstantinos K, Kyrgiou Maria
Department of Surgery and Cancer, IRDB, Faculty of Medicine, Imperial College, London W12 0NN, UK.
Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00029 HUS, Finland.
BMJ. 2017 Oct 26;359:j4511. doi: 10.1136/bmj.j4511.
To study the strength and validity of associations between adiposity and risk of any type of obstetric or gynaecological conditions. An umbrella review of meta-analyses. PubMed, Cochrane database of systematic reviews, manual screening of references for systematic reviews or meta-analyses of observational and interventional studies evaluating the association between adiposity and risk of any obstetrical or gynaecological outcome. Meta-analyses of cohort studies on associations between indices of adiposity and obstetric and gynaecological outcomes. Evidence from observational studies was graded into strong, highly suggestive, suggestive, or weak based on the significance of the random effects summary estimate and the largest study in the included meta-analysis, the number of cases, heterogeneity between studies, 95% prediction intervals, small study effects, excess significance bias, and sensitivity analysis with credibility ceilings. Interventional meta-analyses were assessed separately. 156 meta-analyses of observational studies were included, investigating associations between adiposity and risk of 84 obstetric or gynaecological outcomes. Of the 144 meta-analyses that included cohort studies, only 11 (8%) had strong evidence for eight outcomes: adiposity was associated with a higher risk of endometrial cancer, ovarian cancer, antenatal depression, total and emergency caesarean section, pre-eclampsia, fetal macrosomia, and low Apgar score. The summary effect estimates ranged from 1.21 (95% confidence interval 1.13 to 1.29) for an association between a 0.1 unit increase in waist to hip ratio and risk endometrial cancer up to 4.14 (3.61 to 4.75) for risk of pre-eclampsia for BMI >35 compared with <25. Only three out of these eight outcomes were also assessed in meta-analyses of trials evaluating weight loss interventions. These interventions significantly reduced the risk of caesarean section and pre-eclampsia, whereas there was no evidence of association with fetal macrosomia. Although the associations between adiposity and obstetric and gynaecological outcomes have been extensively studied, only a minority were considered strong and without hints of bias.
研究肥胖与任何类型的妇产科疾病风险之间关联的强度和有效性。对荟萃分析进行的综合评价。检索了PubMed、Cochrane系统评价数据库，并手动筛选了关于评估肥胖与任何妇产科结局风险之间关联的观察性和干预性研究的系统评价或荟萃分析的参考文献。对关于肥胖指标与妇产科结局之间关联的队列研究进行荟萃分析。根据随机效应汇总估计值的显著性、纳入的荟萃分析中最大的研究、病例数、研究间的异质性、95%预测区间、小研究效应、过度显著性偏差以及可信度上限的敏感性分析，将观察性研究的证据分为强、高度提示、提示或弱四类。对干预性荟萃分析进行单独评估。纳入了156项观察性研究的荟萃分析，调查了肥胖与84种妇产科结局风险之间的关联。在纳入队列研究的144项荟萃分析中，只有11项（8%）有强有力的证据支持8种结局：肥胖与子宫内膜癌、卵巢癌、产前抑郁、剖宫产和急诊剖宫产、先兆子痫、巨大儿和低阿氏评分的风险较高有关。汇总效应估计值范围从腰围臀围比增加0.1单位与子宫内膜癌风险之间的关联的1.21（95%置信区间1.13至1.29）到BMI>35与<25相比先兆子痫风险的4.14（3.61至4.75）。在评估减肥干预措施的试验的荟萃分析中，这8种结局中只有3种也得到了评估。这些干预措施显著降低了剖宫产和先兆子痫的风险，而没有证据表明与巨大儿有关。尽管肥胖与妇产科结局之间的关联已得到广泛研究，但只有少数被认为是强有力的且没有偏差迹象。
