Bayih Wubet Alebachew, Belay Demeke Mesfin, Ayalew Metadel Yibeltal, Tassew Misganaw Abie, Chanie Ermiyas Sisay, Feleke Dejen Getaneh, Asnakew Sintayehu, Legas Getasew, Belete Amsalu, Mekie Maru, Yitbarek Getachew Yideg, Aytenew Tigabu Munye, Dessie Tigabu, Selomon Nigus, Kebede Solomon Demis, Liyeh Tewachew Muche, Birhanie Binyam Minuye
Debre Tabor University, Ethiopia.
Bahir Dar University, Ethiopia.
Heliyon. 2021 Apr 22;7(4):e06740. doi: 10.1016/j.heliyon.2021.e06740. eCollection 2021 Apr.
Substance use during pregnancy mainly khat chewing (20%) and alcohol drinking (18.1%) are commonly practiced in Ethiopia. However, the effect of using these substances has not been studied nationally yet. Thus, this study was aimed to examine national evidence about the effect of substance use during pregnancy on birth outcome in the country, 2020.
Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size and reported effect of antenatal substance use on birth outcome on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the fixed-effects model due to homogenous primary studies (I = 0.0%). Presence of publication bias was detected from asymmetry of funnel plot and statistically significant Egger's test (p = 0.000).
In this systematic review and meta-analysis, a total of 5,343 mother-neonate pairs were included from 15 studies. Alcohol, khat, cigarette and narghile were used during pregnancy, and significant adverse birth outcomes attributable to these substances were reported. From the pooled effect of alcohol use, drinking mothers were twice (95%CI: AOR = 2.16; 1.16, 3.17) likely to have newborns with birth defect; 9 times (95% CI: AOR = 9.39; 2.84, 15.94) more prone to own low birth weight neonates; and 1.9 times more prone to deliver preterm neonates (95% CI: AOR = 1.93; 0.52, 3.33) than the nondrinkers. Khat users were 2.4 times (95%CI: AOR = 2.4; 1.11, 5.19) more likely to have congenitally defected neonates; and 3.1 times (95%CI: AOR = 3.19; 1.01, 5.37) more risked to possess low birth weight neonates. Furthermore, antenatal cigarette smokers (95% CI: AOR = 4.36 (1.75, 6.98)) and narghile users (95% CI: AOR = 20.1; 3.94, 103) were at 4 and 20 times more likelihood of having low birth weight neonates as compared to their counterparts.
Prematurity, low birth weight and congenital malformation were the investigated adverse effects of antenatal substance use in Ethiopia. Therefore, the existing public health efforts should be encouraged to help women stop using these substances completely before pregnancy. Moreover, increasing public awareness about the potential negative impacts of substance use during pregnancy on birth outcome would be of greatest importance for comprehensive prevention of the problem.
在埃塞俄比亚，孕期物质使用主要是恰特草咀嚼（20%）和饮酒（18.1%）较为常见。然而，使用这些物质的影响尚未在全国范围内进行研究。因此，本研究旨在调查2020年该国关于孕期物质使用对出生结局影响的全国性证据。
通过谷歌学术、HINARI、SCOPUS和PubMed数据库检索原始研究。纳入研究的方法学和证据质量通过适用于观察性研究的改良纽卡斯尔-渥太华质量评估工具量表进行严格评估。两位作者从符合条件的研究中提取作者/年份、研究地区、研究设计、样本量以及产前物质使用对出生结局的报告影响，并录入到一个Excel电子表格中。在严格评估和数据提取过程中，两位作者之间的分歧由第三位作者参与解决。然后将提取的数据导出到Stata 14版本。由于纳入的原始研究具有同质性（I² = 0.0%），使用固定效应模型合并效应量。通过漏斗图的不对称性和具有统计学意义的埃格检验（p = 0.000）检测发表偏倚的存在。
在这项系统评价和荟萃分析中，共纳入了15项研究中的5343对母婴。孕期有饮酒、咀嚼恰特草、吸烟和吸食水烟的情况，并且报告了这些物质导致的显著不良出生结局。从饮酒的合并效应来看，饮酒母亲所生新生儿出现出生缺陷的可能性是不饮酒母亲的两倍（95%置信区间：比值比 = 2.16；1.16，3.17）；生出低体重新生儿的可能性高9倍（95%置信区间：比值比 = 9.39；2.84，15.94）；早产的可能性高1.9倍（95%置信区间：比值比 = 1.93；0.52，3.33）。咀嚼恰特草的使用者生出先天性缺陷新生儿的可能性高2.4倍（95%置信区间：比值比 = 2.4；1.11，5.19）；生出低体重新生儿的风险高3.1倍（95%置信区间：比值比 = 3.19；1.01，5.37）。此外，产前吸烟者（95%置信区间：比值比 = 4.36（1.75，6.98））和吸食水烟者（95%置信区间：比值比 = 20.1；3.94，103）生出低体重新生儿的可能性分别是其对应人群的4倍和20倍。
早产、低体重和先天性畸形是埃塞俄比亚产前物质使用所导致的不良影响。因此，应鼓励现有的公共卫生措施，帮助女性在怀孕前完全停止使用这些物质。此外，提高公众对孕期物质使用对出生结局潜在负面影响的认识对于全面预防该问题至关重要。
