Park Jay J H, Harari Ofir, Siden Ellie, Zoratti Michael, Dron Louis, Zannat Noor-E, Lester Richard T, Thorlund Kristian, Mills Edward J
MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada.
Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.
Gates Open Res. 2020 Sep 24;3:1657. doi: 10.12688/gatesopenres.13081.2. eCollection 2019.
Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants' characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. PROSPERO CRD42018110446; registered on 17 October 2018.
改善孕妇健康对于预防不良分娩结局至关重要，如早产和低出生体重。我们评估了微量营养素、能量蛋白质平衡、驱虫、孕产妇教育以及水、环境卫生与个人卫生（WASH）等领域的干预措施对这些不良分娩结局的比较效果。对于这项网状Meta分析，我们检索了在低收入和中等收入国家（LMICs）为孕妇提供干预措施的随机临床试验（RCTs）。我们检索了截至2019年9月17日发表的报告，并人工检索了现有综述的参考文献。我们从符合条件的研究中提取了关于研究特征、干预措施、基线时参与者特征以及分娩结局的数据。我们使用在LMICs进行的研究比较了对早产（妊娠周数<37周）、低出生体重（LBW；<2500克）和出生体重（连续变量）的影响。我们的网状Meta分析基于101项RCTs（132篇论文），涉及206,531名参与者。几种微量营养素和能量食物补充剂干预措施显示出优于标准治疗的效果。例如，与标准治疗相比，孕妇的微量营养素补充剂，如铁和钙，降低了早产风险（铁：RR = 0.70，95%可信区间[Crl] 0.47，1.01；钙：RR = 0.76，95%Crl 0.56，0.99）。与标准治疗相比，每日摄入1500千卡当地食物分别降低了早产风险（RR = 0.36，95%Crl 0.16，0.77）和低出生体重风险（RR = 0.17，95%Crl 0.09，0.29）。教育和驱虫干预措施并未显示出分娩结局的改善，且没有WASH干预试验报告这些不良分娩结局。我们发现了几种可改善分娩结局的孕期干预措施。然而，尽管不良分娩结局的原因是多方面的，但大多数临床试验仅评估了单一领域（如微量营养素）的干预措施。有必要将不同领域的干预措施组合成套餐并测试其有效性。PROSPERO CRD42018110446；于2018年10月17日注册。
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