Goddard Lucy, Patel Rajan, Astbury Nerys M, Tucker Katherine, McManus Richard J
Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, United Kingdom.
Pregnancy Hypertens. 2023 Mar;31:60-72. doi: 10.1016/j.preghy.2022.12.004. Epub 2022 Dec 24.
Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important role in disease management in non-pregnant populations.
To review the existing evidence of randomised controlled trials (RCTs) that examine lifestyle interventions in pregnant people with chronic hypertension and/or pre-existing diabetes.
A systematic review and narrative synthesis was conducted. Five electronic databases were searched from inception to April 2021 for RCTs evaluating antenatal lifestyle interventions in people with chronic hypertension and/or pre-existing diabetes with outcomes to include weight or blood pressure change.
Nine randomised controlled trials including 7438 pregnant women were eligible. Eight studies were mixed pregnant populations that included women with chronic hypertension and/or pre-existing diabetes. One study included only pregnant women with pre-existing diabetes. Intervention characteristics and procedures varied and targeted diet, physical activity and/or gestational weight. All studies reported weight and one study reported blood pressure change. Outcome data were frequently unavailable for the subset of women of interest, including subgroup data on important pregnancy and birth complications. Eligibility criteria were often ambiguous and baseline data on chronic hypertension was often omitted.
A lack of primary interventional trials examining the effect of lifestyle interventions on weight and blood pressure outcomes in pregnant populations with chronic hypertension and/or pre-existing diabetes was evident. Lifestyle modification has the potential to alter disease progression. Future trials should address the ambiguity and frequent exclusion of these important populations.
患有慢性高血压、孕前糖尿病或两者兼有的孕妇患心血管疾病的风险很高。生活方式干预在非孕妇人群的疾病管理中起着重要作用。
回顾现有随机对照试验（RCT）的证据，这些试验研究了慢性高血压和/或孕前糖尿病孕妇的生活方式干预。
进行了系统评价和叙述性综合分析。从数据库建立至2021年4月，检索了五个电子数据库，以查找评估慢性高血压和/或孕前糖尿病患者产前生活方式干预的随机对照试验，结局包括体重或血压变化。
九项随机对照试验符合条件，共纳入7438名孕妇。八项研究的孕妇群体混合，包括患有慢性高血压和/或孕前糖尿病的妇女。一项研究仅纳入孕前糖尿病孕妇。干预特征和程序各不相同，目标是饮食、身体活动和/或孕期体重。所有研究均报告了体重，一项研究报告了血压变化。对于感兴趣的女性亚组，包括重要妊娠和分娩并发症的亚组数据，结局数据通常不可用。纳入标准往往不明确，慢性高血压的基线数据常常被省略。
明显缺乏对慢性高血压和/或孕前糖尿病孕妇进行生活方式干预对体重和血压结局影响的原发性干预试验。生活方式改变有可能改变疾病进展。未来的试验应解决这些重要人群定义不明确和经常被排除在外的问题。
