产前营养补充剂对中低收入国家孕妇体重增长的影响：一项个体参与者数据的荟萃分析。
Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data.
机构信息
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Am J Clin Nutr. 2022 Dec 19;116(6):1864-1876. doi: 10.1093/ajcn/nqac259.
BACKGROUND
Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs).
OBJECTIVES
We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs.
METHODS
A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression.
RESULTS
MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG.
CONCLUSIONS
Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.
背景
低于或高于医学研究所（IOM）建议的妊娠期体重增加（GWG）与围产期不良结局有关。很少有研究调查产前营养补充剂对中低收入国家（LMICs）GWG 的影响。
目的
我们旨在研究多种微量营养素补充剂（MMSs）和小剂量脂质基营养素补充剂（LNSs）对 LMICs 中 GWG 的影响。
方法
采用两阶段个体参与者数据荟萃分析，比较 MMSs（来自 14 项试验的 45507 名女性）和小剂量 LNSs（来自 4 项试验的 6237 名女性）与仅铁和叶酸补充剂对 GWG 的影响。根据 IOM 2009 指南，计算 GWG 的充足百分比和分娩时的总增重。二项结局包括严重不足（充足百分比<70%）、不足（<90%）和过多（>125%）GWG。使用固定效应逆方差模型汇总各试验结果。使用 I2、分层分析和荟萃回归检查异质性。
结果
MMSs 使 GWG 的充足百分比更高[加权均数差（WMD）：0.86%；95%CI：0.28%，1.44%；P<0.01]，分娩时 GWG 更高（WMD：209g；95%CI：139，280g；P<0.01），而对照组的 GWG 较低。接受 MMSs 的女性发生严重不足 GWG 的风险降低了 2.9%（RR：0.971；95%CI：0.956，0.987；P<0.01）。小剂量 LNSs 与 GWG 充足百分比之间无关联（WMD：1.51%；95%CI：-0.38%，3.40%；P=0.21）。MMSs 和小剂量 LNSs 均与过多 GWG 无关。
结论
与仅铁和叶酸相比，母体 MMSs 与更大的 GWG 充足百分比和分娩时的总 GWG 相关。这一发现与之前关于出生结局的结果一致，并将为制定政策和将常规产前铁和叶酸补充剂转换为 MMSs 提供信息。
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