J Acad Nutr Diet. 2020 Oct;120(10):1730-1744. doi: 10.1016/j.jand.2019.10.024. Epub 2020 Feb 7.
Malnutrition during the critical period of pregnancy has significant health outcomes for both the mother and her offspring. Medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) may help mitigate negative health effects, although studies that support the role of the RDN have not been comprehensively evaluated. The objective was to explore the health effects of MNT by an RDN on maternal and infant outcomes in pregnant women with malnutrition. A systematic review of studies published between 2000 and 2014 that incorporated MNT by an RDN during pregnancy were retrieved from a PubMed search, using criteria established by the Academy of Nutrition and Dietetics Evidence Analysis Process. Among 94 identified studies, five controlled trials met the inclusion criteria. The initial search was extended to include one study published between 2014 and 2019. Outcomes included maternal gestational weight gain, maternal markers of glycemic control, maternal complications such as hypertension, incidence of caesarean section, infant birth weight both in grams and in clinical categories, infant gestational age, and infant complications. There was good/strong evidence that MNT by an RDN decreased gestational weight gain, although there was no effect on maternal complications, caesarean section deliveries, and gestational age among women with mixed body mass index status or those who were overweight/obese. The evidence was deemed fair in support of an effect on glycemic control, infant birth weight, and infant complications. The heterogeneity in the results are due to the variation among populations studied, types of interventions, and inconsistency among outcomes. In addition, the training and educational requirements of the RDN or the international equivalent may vary widely across the four countries in which studies were conducted. There was good evidence for MNT by an RDN during pregnancy on improving gestational weight gain among overweight/obese women. To better support the role of MNT by an RDN in the health care of pregnant women, research that clearly identifies the role of the RDN in the intervention, includes a control group, and studies more heterogeneous populations is needed.
孕妇营养不良对母婴健康均有严重影响。注册营养师实施的医学营养治疗（MNT）可能有助于减轻不良健康影响，但支持营养师作用的研究尚未得到全面评估。本研究旨在探讨在营养不良孕妇中，营养师实施的 MNT 对母婴结局的影响。通过对 2000 年至 2014 年间发表的研究进行系统回顾，检索 PubMed 数据库，采用营养与饮食学会证据分析流程制定的标准进行评估。在 94 项已识别的研究中，有 5 项对照试验符合纳入标准。最初的检索结果扩展到包括 2014 年至 2019 年发表的一项研究。结局指标包括孕妇妊娠期体重增加、孕妇血糖控制标志物、产妇高血压等并发症、剖宫产率、婴儿出生体重（克数和临床分类）、婴儿胎龄和婴儿并发症。有充分证据表明，营养师实施的 MNT 可减少妊娠期体重增加，尽管对于 BMI 混合状态或超重/肥胖孕妇，MNT 对产妇并发症、剖宫产率和胎龄无影响。有中等质量证据表明 MNT 对血糖控制、婴儿出生体重和婴儿并发症有影响。结果的异质性归因于研究人群、干预措施类型以及结局指标的不一致性。此外，营养师的培训和教育要求或其国际等效要求可能因研究开展的四个国家而有很大差异。有充分证据表明，营养师实施的 MNT 可改善超重/肥胖孕妇的妊娠期体重增加。为了更好地支持营养师在孕妇保健中的作用，需要开展明确确定营养师在干预中的作用、包含对照组和研究更多异质人群的研究。
