School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran.
Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Adv Nutr. 2021 Jul 30;12(4):1332-1352. doi: 10.1093/advances/nmaa156.
The aim was to systematically review and meta-analyze prospective cohort studies investigating the relation between maternal dietary patterns during pregnancy with pregnancy and birth outcomes. PubMed, Scopus, and ISI Web of Science were searched from inception until October 2019 for eligible studies. Studies reporting relative risk, ORs, or incidences (for binary data) or means ± SDs or B-coefficients (for continuous outcomes) comparing the highest and lowest adherence with maternal dietary patterns were included. Dietary patterns were categorized as "healthy," "unhealthy," or "mixed." No language restrictions were applied. Study-specific effect sizes with SEs for outcomes of interest were pooled using a random-effects model. Quality of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Sixty-six relevant publications were included. A higher maternal adherence to a healthy diet was associated with a reduced risk of gestational hypertension (14%, P < 0.001), maternal depression (40%, P = 0.004), low birth weight (28%, P = 0.001), preterm birth (56%, P < 0.001), higher gestational weight gain (Hedges' g: 0.15; P = 0.01), and birth weight (Hedges' g: 0.19; P = 0.007). Higher maternal adherence to an unhealthy or a mixed diet was associated with higher odds of gestational hypertension (23%, P < 0.001 for unhealthy, and 8%, P = 0.01 for mixed diet). In stratified analyses, a higher healthy eating index was associated with reduced odds of being large based on gestational age (31%, P = 0.02) and a higher head circumference at birth (0.23 cm, P = 0.02). The Mediterranean and "prudent" dietary patterns were related to lower odds of being small based on gestational age (46%, P = 0.04) and preterm birth (52%, P = 0.03), respectively. The overall GRADE quality of the evidence for most associations was low or very low, indicating that future high-quality research is warranted. This study was registered at http://www.crd.york.ac.uk/PROSPERO as CRD42018089756.
系统综述和荟萃分析前瞻性队列研究，调查妊娠期间母体饮食模式与妊娠和分娩结局的关系。从建立到 2019 年 10 月，在 PubMed、Scopus 和 ISI Web of Science 上搜索符合条件的研究。纳入报告相对风险、ORs 或发病率（用于二项数据）或平均值 ± SDs 或 B-系数（用于连续结果）的研究，比较最高和最低的母体饮食模式依从性。饮食模式分为“健康”、“不健康”或“混合”。不应用语言限制。使用随机效应模型汇总感兴趣结局的研究特异性效应大小和 SE。使用推荐评估、制定和评估（GRADE）的分级来评估证据质量。纳入 66 项相关出版物。较高的母体健康饮食依从性与妊娠期高血压的风险降低（14%，P < 0.001）、产妇抑郁（40%，P = 0.004）、低出生体重（28%，P = 0.001）、早产（56%，P < 0.001）、较高的妊娠体重增加（Hedges' g：0.15；P = 0.01）和出生体重（Hedges' g：0.19；P = 0.007）相关。较高的母体不健康或混合饮食依从性与妊娠期高血压的几率增加相关（不健康饮食为 23%，P < 0.001，混合饮食为 8%，P = 0.01）。在分层分析中，较高的健康饮食指数与基于胎龄的较大（31%，P = 0.02）和出生时头围较大（0.23cm，P = 0.02）的几率降低相关。地中海和“谨慎”饮食模式与基于胎龄的较小（46%，P = 0.04）和早产（52%，P = 0.03）的几率降低相关。大多数关联的总体 GRADE 证据质量为低或极低，表明未来需要高质量的研究。本研究在 http://www.crd.york.ac.uk/PROSPERO 上注册，注册号为 CRD42018089756。
