Tareke Amare Abera, Melak Edom Getnet, Mengistu Bezawit Ketsela, Hussen Jafar, Molla Asressie
Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
BMC Nutr. 2024 Nov 14;10(1):151. doi: 10.1186/s40795-024-00960-9.
Maternal nutrition is a key factor influencing birth and offspring health outcomes in later life. Dietary diversity (DD) is a proxy for the macro/micronutrient adequacy of an individual's diet. There is inadequate comprehensive evidence regarding maternal nutrition during pregnancy, measured through DD and birth outcomes. This study aimed to provide extensive evidence on maternal DD during pregnancy and birth outcomes.
A comprehensive search was performed using PubMed, HINARI, and Google Scholar databases up to January 17, 2024. Studies conducted among pregnant mothers and measuring maternal DD with an evaluation of birth outcomes (low birth weight, small for gestational age, preterm birth), in the global context without design restriction were included. The Newcastle Ottawa Scale and the Cochrane Risk of Bias tool were used to assess the risk of bias. The results are summarized in a table, and odds ratios were pooled where possible. Between-study heterogeneity was evaluated using I statistics. Potential publication bias was assessed using a funnel plot and Egger's regression test. To explore the robustness, a leave-one-out sensitivity analysis was conducted.
Thirty-three studies were used to synthesize narrative evidence (low birth weight: 31, preterm birth: 9, and small for gestational age: 4). In contrast, 24 records for low birth weight, eight for preterm birth, and four for small for gestational age were used to pool the results quantitatively. Of the 31 studies, 17 reported a positive association between maternal DD and infant birth weight, 13 studies reported a neutral association (not statistically significant), and one study reported a negative association. Overall, inadequate DD increased the risk of low birth weight OR = 1.71, 95% CI; (1.24-2.18), with I of 68.7%. No significant association was observed between maternal DD and preterm birth. Inadequate DD was significantly associated with small for gestational age (OR = 1.32, 95% CI; 1.15-1.49, and I = 0.0%).
Inadequate maternal DD is associated with an increased risk of low birth weight and small for gestational age but not preterm birth, underscoring the importance of promoting adequate DD during pregnancy. To address these issues, it is essential to implement and expand nutritional programs targeted at pregnant women, especially in low-resource settings, to ensure they receive diverse and adequate diets. Further research is needed to address the current limitations and to explore the long-term implications of maternal nutrition on child health. The study was prospectively registered on PROSPERO (registration number CRD42024513197). No funding was received for this study.
孕产妇营养是影响分娩及子代成年后健康结局的关键因素。饮食多样性（DD）是个体饮食中宏量/微量营养素充足程度的一项指标。关于孕期通过饮食多样性衡量的孕产妇营养与分娩结局，目前尚无充分的综合证据。本研究旨在提供关于孕期孕产妇饮食多样性及分娩结局的广泛证据。
截至2024年1月17日，使用PubMed、HINARI和谷歌学术数据库进行了全面检索。纳入在全球范围内针对怀孕母亲开展的、测量孕产妇饮食多样性并评估分娩结局（低出生体重、小于胎龄儿、早产）且无设计限制的研究。采用纽卡斯尔渥太华量表和Cochrane偏倚风险工具评估偏倚风险。结果汇总于表格中，并在可能的情况下合并比值比。使用I统计量评估研究间异质性。采用漏斗图和Egger回归检验评估潜在的发表偏倚。为探究稳健性，进行了逐一剔除敏感性分析。
33项研究用于综合叙述性证据（低出生体重：31项，早产：9项，小于胎龄儿：4项）。相比之下，24项低出生体重记录、8项早产记录和4项小于胎龄儿记录用于定量汇总结果。在31项研究中，17项报告孕产妇饮食多样性与婴儿出生体重呈正相关，13项研究报告为中性关联（无统计学意义），1项研究报告为负相关。总体而言，饮食多样性不足增加了低出生体重风险，OR = 1.71，95% CI：（1.24 - 2.18），I为68.7%。未观察到孕产妇饮食多样性与早产之间存在显著关联。饮食多样性不足与小于胎龄儿显著相关（OR = 1.32，95% CI：1.15 - 1.49，I = 0.0%）。
孕产妇饮食多样性不足与低出生体重及小于胎龄儿风险增加相关，但与早产无关，这凸显了孕期促进充足饮食多样性的重要性。为解决这些问题，必须实施并扩大针对孕妇的营养项目，尤其是在资源匮乏地区，以确保她们获得多样化且充足的饮食。需要进一步研究以解决当前的局限性，并探究孕产妇营养对儿童健康的长期影响。本研究已在PROSPERO上进行前瞻性注册（注册号CRD42024513197）。本研究未获得资金支持。
