De Vito Marika, Alameddine Sara, Capannolo Giulia, Mappa Ilenia, Gualtieri Paola, Di Renzo Laura, De Lorenzo Antonino, D' Antonio Francesco, Rizzo Giuseppe
Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, 00185 Roma, Italy.
Department of Obstetrics and Gynecology, Università di Chieti, 66100 Chieti, Italy.
Healthcare (Basel). 2022 Dec 9;10(12):2490. doi: 10.3390/healthcare10122490.
Objective: To report the quality and clinical heterogeneity of the published clinical practice guidelines (CPGs) on nutrition in pregnancy. Methods: MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to nutrition in pregnancy were addressed: specific requirements during pregnancy, description of a balanced diet, weight gain, prevention of food-borne, nutrition in peculiar sub-groups of women, and maternal or perinatal outcomes. The assessment of the risk of bias and quality assessment of the included CPGs were performed using “The Appraisal of Guidelines for REsearch and Evaluation (AGREE II)” tool divided in six quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence. Mean ± standard deviation (SD) was used to summarize the scores across all the guidelines per domain. The quality of each guideline was computed using the scoring system proposed by Amer et al. A cut-off of >60% was sued to define a CGP as recommended. Results: Eighteen CPGs were included. There was a substantial heterogeneity in the recommended dose for vitamins, folic acid, and micronutrient intake during pregnancy among the different published CPGs. 27.8% (5/18) of the CPGs recommended a daily intake of folic acid of 200 mcg, 38.8% (7/18) 400 mcg, 16.7% (3/18) 600 mcg while the remaining CPGs suggested dose between 400 and 600−800 mc per day. Adequate maternal hydration was advocated in the large majority of included CPGs, but a specific amount of water intake was not reported in 83.3% (15/18) cases. There was also significant heterogeneity in various other aspects of nutrition recommendation among the different CPGs, including gestational weight gain (55.5%), prevention of food-borne diseases in pregnancy (72.2%), nutrition in particular groups of pregnant women (83.3%), maternal and perinatal outcomes (72.2%). The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 65% but only half scored more than 60%. Conclusion: The published CPGs on nutrition in pregnancy show an overall good methodology, but also a substantial heterogeneity as regard as different major aspects on nutrition in pregnancy.
报告已发表的关于孕期营养的临床实践指南（CPG）的质量和临床异质性。方法：检索MEDLINE、Embase、Scopus和ISI Web of Science数据库。涉及孕期营养的以下方面：孕期的特殊需求、均衡饮食的描述、体重增加、食源性疾病预防、特定女性亚组的营养以及孕产妇或围产期结局。使用分为六个质量领域的“研究与评价指南评估（AGREE II）”工具对纳入的CPG进行偏倚风险评估和质量评估：范围和目的、利益相关者参与、制定的严谨性、表述的清晰度、适用性、编辑独立性。每个领域所有指南的得分用均值±标准差（SD）进行汇总。每个指南的质量使用Amer等人提出的评分系统进行计算。采用>60%的临界值将CPG定义为推荐。结果：纳入了18份CPG。不同已发表的CPG在孕期维生素、叶酸和微量营养素摄入的推荐剂量方面存在很大异质性。27.8%（5/18）的CPG推荐叶酸每日摄入量为200微克，38.8%（7/18）为400微克，16.7%（3/18）为600微克，而其余CPG建议的剂量在每天400至600 - 800微克之间。绝大多数纳入的CPG都提倡孕妇充分补水，但83.3%（15/18）的案例中未报告具体的饮水量。不同CPG在营养推荐的其他各个方面也存在显著异质性，包括孕期体重增加（55.5%）、孕期食源性疾病预防（72.2%）、特定孕妇群体的营养（83.3%）、孕产妇和围产期结局（72.2%）。首次总体评估（OA1）的AGREE II标准化领域得分均值为65%，但只有一半的得分超过60%。结论：已发表的关于孕期营养的CPG总体上方法良好，但在孕期营养的不同主要方面也存在很大异质性。
