Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women
Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women
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DOI：
10.1093/humrep/dex241
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发表时间：
2017-09-01
影响因子：
6.1
通讯作者：
Moran, L. J.
中科院分区：
文献类型：
--
作者：
Lan, L.;Harrison, C. L.;Moran, L. J.
研究问题：孕前生活方式干预对活产、出生体重和怀孕率的影响是什么？结论：生活方式干预对体重减轻和自然妊娠率增加有好处，但对活产和出生体重没有好处。已知情况：关于孕前咨询和干预的实践和内容的证据是可变的和有限的。研究设计、规模、持续时间：系统评价和meta分析（MA）。主要搜索词是那些与孕前生活方式有关的词。检索数据库为Ovid MEDLINE(R)、EBM Reviews、PsycINFO、EMBASE和CINAHL Plus。发表的文章没有语言限制。最终搜索于2017年1月10日进行。参与者/材料、环境、方法：参与者为有意怀孕的非怀孕育龄妇女或其男性伴侣。排除标准包括BMI < 18 kg/m(2)、动物试验、一方或双方伴侣有遗传性疾病以及仅关注戒酒或戒烟/减少、微量营养素补充或糖尿病控制的试验。评估了人体测量学、生育能力、产科和胎儿结局。进行偏倚和质量评估。主要结果和偶然性的作用：检索返回1802篇文章和8项研究纳入分析。目标人群主要是寻求生殖援助的超重或肥胖的低生育能力妇女，很少有以社区为基础的研究，也没有包括男性。MA显示干预后体重（n = 3, P < 0.00001，平均差值：-3.48 kg, 95% CI: -4.29, -2.67, I-2 = 0%）和BMI （n = 2, P < 0.00001，平均差值：-1.40 kg/m(2), 95% CI: -1.95, -0.84, I-2 = 24%）有更大的降低。唯一显著的生育结局是自然妊娠率增加（n = 2, P = 0.003，优势比：1.87,CI: 1.24, 2.81, I-2 = 0%）。在抗逆转录病毒治疗不良事件、临床妊娠、妊娠并发症、分娩并发症、活产、早产、出生体重、新生儿死亡率或焦虑方面没有观察到差异。3项研究的偏倚风险为高，3项研究为中等，2项研究为低，大多数研究的损耗偏倚为中等或高。局限性和谨慎的原因：研究结果仅限于接受抗逆转录病毒治疗的超重或肥胖的低生育能力或不孕妇女，未对男性进行研究。干预措施在持续时间和方案方面的异质性意味着无法得出关于最佳生活方式干预的方法或组成部分的结论。损耗偏差本身是影响干预效果的重要因素。研究结果的更广泛意义：现有的孕前生活方式干预主要针对接受抗逆转录病毒治疗的超重和肥胖低生育能力妇女，重点是减肥。值得注意的是，自然受孕随着生活方式的干预而增加。这强调需要进一步研究在更广泛的人群中探索孕前生活方式干预的最佳组成部分，以及干预的最佳性质，强度和时间。研究经费/竞争利益：没有申报利益冲突。C.L.H.是美国国家心脏基金会博士后研究员。B.H.由阿尔弗雷德·迪肯博士后研究奖学金资助。H.J.T.和B.W.M.持有NHMRC从业者奖学金。L.J.M.由SACVRDP奖学金资助；该方案由国家卫生基金、南澳大利亚卫生部和南澳大利亚卫生和医学研究所共同资助。普洛斯彼罗注册号：crd42015023952。
STUDY QUESTION: What is the impact of preconception lifestyle interventions on live birth, birth weight and pregnancy rate?SUMMARY ANSWER: Lifestyle interventions showed benefits for weight loss and increased natural pregnancy rate, but not for live birth or birth weight.WHAT IS KNOWN ALREADY: Evidence on the practice and content of preconception counseling and interventions is variable and limited.STUDY DESIGN, SIZE, DURATION: Systematic review and meta-analysis (MA). Main search terms were those related to preconception lifestyle. Database searched were Ovid MEDLINE(R), EBM Reviews, PsycINFO, EMBASE and CINAHL Plus. No language restriction was placed on the published articles. The final search was performed on 10 January 2017.PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were non-pregnant women of childbearing age intent on conceiving or their male partners. Exclusion criteria include participants with BMI < 18 kg/m(2), animal trials, hereditary disorder in one or both partners and trials focusing solely on alcohol or smoking cessation/reduction, micronutrient supplementation, or diabetes control. Anthropometric, fertility, obstetric and fetal outcomes were assessed. Bias and quality assessments were performed.MAIN RESULTS AND THE ROLE OF CHANCE: The search returned 1802 articles and eight studies were included for analysis. Populations targeted were primarily overweight or obese subfertile women seeking reproductive assistance, with few community-based studies and none including men. MA showed greater reduction in weight (n = 3, P < 0.00001, mean difference: -3.48 kg, 95% CI: -4.29, -2.67, I-2 = 0%) and BMI (n = 2, P < 0.00001, mean difference: -1.40 kg/m(2), 95% CI: -1.95, -0.84, I-2 = 24%) with intervention. The only significant fertility outcome was an increased natural pregnancy rate (n = 2, P = 0.003, odds ratio: 1.87, CI: 1.24, 2.81, I-2 = 0%). No differences were observed for ART adverse events, clinical pregnancy, pregnancy complications, delivery complications, live birth, premature birth, birth weight, neonatal mortality or anxiety. Risk of bias were high for three studies, moderate for three studies and low for two studies, Attrition bias was moderate or high in majority of studies.LIMITATIONS, REASONS FOR CAUTION: Results were limited to subfertile or infertile women who were overweight or obese undergoing ART with no studies in men. The heterogeneous nature of the interventions in terms of duration and regimen means no conclusions could be made regarding the method or components of optimal lifestyle intervention. Attrition bias itself is an important factor that could affect efficacy of interventions.WIDER IMPLICATIONS OF THE FINDINGS: Existing preconception lifestyle interventions primarily targeted overweight and obese subfertile women undergoing ART with a focus on weight loss. It is important to note that natural conception increased with lifestyle intervention. This emphasizes the need for further research exploring optimal components of preconception lifestyle interventions in the broader population and on the optimal nature, intensity and timing of interventions.STUDY FUNDING/COMPETING INTEREST(S): No conflict of interest declared. C.L.H. is a National Heart Foundation Postdoctoral Research Fellow. B.H. is funded by an Alfred Deakin Postdoctoral Research Fellowship. H.J.T. and B.W.M. hold NHMRC Practitioner fellowships. L.J.M. is supported by a SACVRDP Fellowship; a program collaboratively funded by the NHF, the South Australian Department of Health and the South Australian Health and Medical Research Institute.PROSPERO REGISTRATION NUMBER: CRD42015023952.