Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis.
Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis.
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DOI：
10.3390/nu9101141
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发表时间：
2017-10-18
期刊：
影响因子：
5.9
通讯作者：
Thakkinstian A
中科院分区：
文献类型：
--
作者：
Khaing W;Vallibhakara SA;Tantrakul V;Vallibhakara O;Rattanasiri S;McEvoy M;Attia J;Thakkinstian A
在妊娠期补充维生素D（含或不含钙）对降低先兆子痫和妊娠或妊娠高血压风险的作用存在争议。在Medline、Scopus和科克伦数据库中系统检索了从开始到2017年7月的文献。只有英文的随机对照试验（RCT）被选中，如果他们有任何一对干预措施（钙，维生素D，两者兼而有之，或安慰剂）。采用系统评价和两步网络荟萃分析间接估计补充效应。27项随机对照试验，28，000名女性符合条件。一项直接荟萃分析表明，与安慰剂相比，钙、维生素D和钙+维生素D可降低先兆子痫的风险，合并风险比（RR）分别为0.54（0.41，0.70）、0.47（0.24，0.89）和0.50（0.32，0.78）。网络荟萃分析的结果相似，相应的RR分别为0.49（0.35，0.69）、0.43（0.17，1.11）和0.57（0.30，1.10）。所有对照组均无显著性。根据累积排序概率按表面排序的补充功效分别为：维生素D（47.4%）、钙（31.6%）和钙加维生素D（19.6%）。钙补充剂可用于预防先兆子痫。维生素D可能也有很好的效果，但需要进一步的大规模随机对照试验来证实我们的发现。
Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings.