University College London Great Ormond Street Institute of Child Health, London, UK.
Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Am J Clin Nutr. 2023 Jun;117 Suppl 2:S134-S147. doi: 10.1016/j.ajcnut.2023.01.024.
Poor nutrition during pregnancy can lead to adverse birth outcomes including low birth weight (LBW).
This modular systematic review aimed to provide evidence for the effects of seven antenatal nutritional interventions on the risks of LBW, preterm birth (PTB), small-for-gestational-age (SGA) and stillbirth (SB).
We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and CINAHL Complete between April and June 2020, with a further update in September 2022 (Embase only). We included randomized controlled trials (RCTs) and reviews of RCTs to estimate the effect sizes of the selected interventions on the four birth outcomes.
Evidence suggests that balanced protein and energy (BPE) supplementation for pregnant women with undernutrition can reduce the risk of LBW, SGA and SB. Evidence from low and lower middle-income countries (MIC) suggests that multiple micronutrient (MMN) supplementation can reduce the risk of LBW and SGA in comparison with iron or iron and folic acid supplementation and lipid-based nutrient supplements (LNS) with any quantity of energy can reduce the risk of LBW in comparison with MMN supplementation. Evidence from high and upper MIC suggests that supplementation with omega-3 fatty acids (O3FA) can reduce the risk and supplementation with high-dose calcium might possibly reduce the risk of LBW and PTB. Antenatal dietary education programs might possibly reduce the risk of LBW in comparison with standard-of-care. No RCTs were identified for monitoring weight gain followed by interventions to support weight gain in women who are underweight.
Provision of BPE, MMN and LNS to pregnant women in populations with undernutrition can reduce the risk of LBW and related outcomes. The benefits of O3FA and calcium supplementation to this population require further investigation. Targeting interventions to pregnant women who are not gaining weight has not been tested with RCTs.
孕期营养状况不佳可导致不良分娩结局，包括低出生体重（LBW）。
本系统评价旨在提供证据，评估七种产前营养干预措施对 LBW、早产（PTB）、小于胎龄儿（SGA）和死产（SB）风险的影响。
我们检索了 MEDLINE、Embase、Cochrane 系统评价数据库、Cochrane 对照试验中心注册库和 CINAHL Complete，检索时间为 2020 年 4 月至 6 月，2022 年 9 月（仅 Embase）进行了更新。我们纳入了随机对照试验（RCT）和 RCT 系统评价，以评估所选干预措施对四种分娩结局的影响效应大小。
有证据表明，对于营养不良的孕妇，给予平衡蛋白和能量（BPE）补充可降低 LBW、SGA 和 SB 的风险。来自中低收入国家（MIC）的证据表明，与铁或铁加叶酸补充剂相比，多种微量营养素（MMN）补充剂可降低 LBW 和 SGA 的风险，与 MMN 补充剂相比，任何数量能量的脂类营养素补充剂（LNS）可降低 LBW 的风险。来自高收入和中高收入国家的证据表明，补充欧米伽 3 脂肪酸（O3FA）可降低 LBW 和 PTB 的风险，补充高剂量钙可能降低 LBW 和 PTB 的风险。产前饮食教育计划与标准护理相比，可能降低 LBW 的风险。未发现针对体重不足妇女监测体重增加并随后进行支持体重增加的干预措施的 RCT。
为营养不良人群中的孕妇提供 BPE、MMN 和 LNS 可降低 LBW 及相关结局的风险。O3FA 和钙补充对该人群的益处需要进一步研究。针对未增重孕妇的干预措施尚未通过 RCT 进行测试。
