Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
University College London Great Ormond Street Institute of Child Health, London, UK.
Am J Clin Nutr. 2023 Jun;117 Suppl 2:S118-S133. doi: 10.1016/j.ajcnut.2023.02.025.
Maternal infections during pregnancy have been linked to increased risk of adverse birth outcomes, including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), and stillbirth (SB).
The purpose of this article was to summarize evidence from published literature on the effect of key interventions targeting maternal infections on adverse birth outcomes.
We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and CINAHL Complete between March 2020 and May 2020 with an update to cover until August 2022. We included randomized controlled trials (RCTs) and reviews of RCTs of 15 antenatal interventions for pregnant women reporting LBW, PTB, SGA, or SB as outcomes.
Of the 15 reviewed interventions, the administration of 3 or more doses of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine [IPTp-SP; RR: 0.80 (95% CI: 0.69, 0.94)] can reduce risk of LBW compared with 2 doses. The provision of insecticide-treated bed nets, periodontal treatment, and screening and treatment of asymptomatic bacteriuria may reduce risk of LBW. Maternal viral influenza vaccination, treatment of bacterial vaginosis, intermittent preventive treatment with dihydroartemisinin-piperaquine compared with IPTp-SP, and intermittent screening and treatment of malaria during pregnancy compared with IPTp were deemed unlikely to reduce the prevalence of adverse birth outcomes.
At present, there is limited evidence from RCTs available for some potentially relevant interventions targeting maternal infections, which could be prioritized for future research.
孕妇感染与不良出生结局风险增加有关，包括低出生体重（LBW）、早产（PTB）、小于胎龄儿（SGA）和死产（SB）。
本文旨在总结已发表文献中针对母体感染的关键干预措施对不良出生结局影响的证据。
我们于 2020 年 3 月至 2020 年 5 月期间检索了 MEDLINE、Embase、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库和 CINAHL Complete，并进行了更新，以涵盖截至 2022 年 8 月的数据。我们纳入了针对孕妇的 15 项产前干预措施的随机对照试验（RCT）和 RCT 综述，这些干预措施报告的结局为 LBW、PTB、SGA 或 SB。
在所审查的 15 项干预措施中，与 2 剂相比，妊娠期间使用磺胺多辛-乙胺嘧啶（IPTp-SP）进行 3 剂或更多剂间歇性预防治疗[RR：0.80（95%CI：0.69，0.94）]可降低 LBW 风险。提供驱虫蚊帐、牙周治疗、无症状菌尿筛查和治疗可能降低 LBW 风险。孕妇病毒性流感疫苗接种、细菌性阴道病治疗、二氢青蒿素-哌喹间歇性预防治疗与 IPTp-SP 相比、妊娠期间间歇性筛查和治疗疟疾与 IPTp 相比，不太可能降低不良出生结局的发生率。
目前，针对母体感染的某些潜在相关干预措施，RCT 提供的证据有限，这些干预措施可能需要优先进行未来的研究。
