Shinde Sachin, Wang Dongqing, Yussuf Mashavu H, Mwanyika-Sando Mary, Aboud Said, Fawzi Wafaie W
T H Chan School of Public Health, Harvard University, Boston, MA, United States.
Africa Academy for Public Health, Dar es Salaam, United Republic of Tanzania.
JMIR Res Protoc. 2022 Aug 30;11(8):e40134. doi: 10.2196/40134.
Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs.
The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs.
Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I, subgroup analyses, and metaregression. The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.
We will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% CIs and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity.
This review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence.
PROSPERO CRD42022308715; https://tinyurl.com/y33cxekr.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40134.
低收入和中等收入国家（LMICs）中有20亿人缺乏关键营养素。孕期营养缺乏情况会恶化，对母亲和胎儿产生不良后果，并在产后仍有影响。孕期和哺乳期为女性补充微量营养素或许可以减轻这些影响。然而，在低收入和中等收入国家，补充微量营养素对孕妇和哺乳期妇女及其婴儿营养状况的影响仍 largely不清楚。
本系统评价和荟萃分析的目的是确定孕期或哺乳期补充单一、双重或多种微量营养素对低收入和中等收入国家母婴营养状况的影响。
将纳入评估对母亲（血清、血浆和母乳）和婴儿（血清和血浆）营养状况影响的单一、双重或微量营养素组合的随机对照试验。MEDLINE（通过PubMed）、EMBASE、CENTRAL（通过Cochrane图书馆）和世界卫生组织（WHO）图书馆数据库将用于识别相关的已发表研究，从每个数据库创建之初至2022年2月28日。将使用Cochrane偏倚风险工具评估纳入研究的偏倚风险。研究的选择、数据提取和偏倚风险评估将由2名审阅者独立进行。将对所有纳入研究进行叙述性总结。将尽可能进行荟萃分析，并使用I²、亚组分析和元回归评估效应的异质性。将使用GRADE（推荐分级、评估、制定和评价）方法评估每个结局证据的确定性。
我们将使用Stata软件（版本16，StataCorp）进行荟萃分析，并以文本和表格形式呈现本评价中所有纳入研究的叙述性和系统性总结。对于连续性结局，效应估计将表示为平均差和标准化平均差，而对于二分类结局，将表示为风险比、率比、风险比或比值比，均带有95%置信区间，并将干预组与对照组进行比较。当针对某个结局的研究在干预、对照和结局定义方面充分一致时，将进行随机效应、逆方差加权荟萃分析。对于数据不足或异质性极高的结局，我们将提供叙述性综合分析。
本评价将为低收入和中等收入国家制定针对孕期和哺乳期妇女补充微量营养素的政策和规划提供证据基础。按母亲年龄、婴儿性别、干预持续时间和剂量等变量细分的详细结果也可能有助于政策制定者、研究人员、从业者和政府机构在低收入和中等收入国家采用更有效的母婴健康政策和项目。本评价还将识别现有证据中的任何差距。
PROSPERO CRD42022308715；https://tinyurl.com/y33cxekr。
国际注册报告标识符（IRRID）：PRR1-10.2196/40134。
