Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Institute for Health and Welfare, FI-00271, Helsinki, Finland.
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:S160-S169. doi: 10.1016/j.ajcnut.2022.11.029.
Low birth weight (LBW) increases the risk of short- and long-term morbidity and mortality from early life to adulthood. Despite research effort to improve birth outcomes the progress has been slow.
This systematic search and review of English language scientific literature on clinical trials aimed to compare the efficacy antenatal interventions to reduce environmental exposures including a reduction of toxins exposure, and improving sanitation, hygiene, and health-seeking behaviors, which target pregnant women to improve birth outcomes.
We performed eight systematic searches in MEDLINE (OvidSP), Embase (OvidSP), Cochrane Database of Systematic Reviews (Wiley Cochrane Library), Cochrane Central Register of Controlled Trials (Wiley Cochrane Library), CINAHL Complete (EbscoHOST) between 17 March 2020 and 26 May 2020.
Four documents identified describe interventions to reduce indoor air pollution: two randomised controlled trials (RCTs), one systematic review and meta-analysis (SRMA) on preventative antihelminth treatment and one RCT on antenatal counselling against unnecessary caesarean section. Based on the published literature, interventions to reduce indoor air pollution (LBW: RR: 0.90 [0.56, 1.44], PTB: OR: 2.37 [1.11, 5.07]) or preventative antihelminth treatment (LBW: RR: 1.00 [0.79, 1.27], PTB: RR: 0.88 [0.43, 1.78]) are not likely to reduce the risk of LBW or Preterm birth (PTB). Data is insufficient on antenatal counselling against caesarian-sections. For other interventions, there is lack of published research data from RCTs.
We conclude that there is a paucity of evidence from RCT on interventions that modify environmental risk factors during pregnancy to potentially improve birth outcomes. Magic bullets approach might not work and that it would be important to study the effect of the broader interventions, particularly in LMIC settings. Global interdisciplinary action to reduce harmful environmental exposures, is likely to help to reach global targets for LBW reduction and sustainably improve long-term population health.
低出生体重（LBW）增加了从婴儿期到成年期短期和长期发病和死亡的风险。尽管为改善生育结果付出了研究努力，但进展缓慢。
本系统搜索和综述了英语科学文献中的临床试验，旨在比较减少环境暴露的产前干预措施的疗效，包括减少毒素暴露、改善卫生、卫生习惯和寻求卫生保健行为，以改善生育结果。
我们在 2020 年 3 月 17 日至 5 月 26 日期间在 MEDLINE（OvidSP）、Embase（OvidSP）、Cochrane 系统评价数据库（Wiley Cochrane Library）、Cochrane 对照试验中心注册（Wiley Cochrane Library）和 CINAHL Complete（EbscoHOST）进行了八项系统搜索。
有四份文件描述了减少室内空气污染的干预措施：两项随机对照试验（RCT）、一项预防性驱虫治疗的系统评价和荟萃分析（SRMA）以及一项关于产前咨询以避免不必要剖宫产的 RCT。根据已发表的文献，减少室内空气污染的干预措施（LBW：RR：0.90[0.56，1.44]，PTB：OR：2.37[1.11，5.07]）或预防性驱虫治疗（LBW：RR：1.00[0.79，1.27]，PTB：RR：0.88[0.43，1.78]）不太可能降低 LBW 或早产（PTB）的风险。关于产前咨询剖宫产的数据不足。对于其他干预措施，缺乏 RCT 发表的研究数据。
我们的结论是，RCT 关于改变怀孕期间环境风险因素以潜在改善生育结果的干预措施的证据很少。灵丹妙药的方法可能不起作用，研究更广泛的干预措施的效果很重要，特别是在 LMIC 环境中。全球减少有害环境暴露的跨学科行动，可能有助于实现减少 LBW 的全球目标，并可持续改善长期人口健康。
