Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women.
Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women.
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DOI：
10.1186/s12916-018-1128-1
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发表时间：
2018-08-31
期刊：
影响因子：
9.3
通讯作者：
Teede HJ
中科院分区：
文献类型：
--
作者：
Goldstein RF;Abell SK;Ranasinha S;Misso ML;Boyle JA;Harrison CL;Black MH;Li N;Hu G;Corrado F;Hegaard H;Kim YJ;Haugen M;Song WO;Kim MH;Bogaerts A;Devlieger R;Chung JH;Teede HJ
医学研究所 (IOM) 指南与不同种族妊娠结局之间的关联尚不确定。我们评估了 2009 年 IOM 指南之外的妊娠体重增加 (GWG) 与美国、西欧和东亚地区孕产妇和婴儿结局的关联，并在亚洲进行了亚组分析。目的是探讨这些地区孕产妇孕前体重指数 (BMI)、GWG 和健康结果的种族差异。该研究采用了观察性研究的系统回顾、荟萃分析和荟萃回归。检索了 1999 年至 2017 年的 MEDLINE、MEDLINE In-Process、Embase 和所有循证医学 (EBM) 评论。研究按孕前 BMI 类别和总孕期 GWG 进行分层。比值比 (OR) 95% 置信区间 (CI) 应用每个 BMI 类别内推荐的 GWG 作为参考。主要结局为小胎龄（SGA）、早产和大胎龄（LGA）。次要结局是巨大儿、剖腹产和妊娠糖尿病。总体而言，共确定了 5874 项研究，其中纳入了 23 项 (n = 1,309,136)。美国、欧洲和亚洲的孕前超重/肥胖比例分别为 42%、30% 和 10%，体重不足的比例分别为 5%、3% 和 17%。美国、欧洲和亚洲的 GWG 低于指导值的比例分别为 21%、18% 和 31%，高于指导值的比例分别为 51%、51% 和 37%。在亚洲应用区域 BMI 类别表明，GWG 高于指导方针 (51%)，与美国和欧洲的情况相似。与指南范围内的 GWG 相比，低于指南的 GWG 与较高的 SGA（美国/欧洲 [OR 1.51；CI 1.39，1.63]；亚洲 [1.63；1.45，1.82]）和早产（美国/欧洲 [1.35；1.17，1.56]；亚洲 [1.06；0.78，1.44]）风险相关。高于指南的 GWG 与 LGA（美国/欧洲 [1.93; 1.81, 2.06]；亚洲 [1.68; 1.51, 1.87]）、巨大儿（美国/欧洲 [1.87; 1.70, 2.06]；亚洲 [2.18; 1.91, 2.49]）和剖腹产风险较高相关（美国/欧洲[1.26；1.21，1.33]；亚洲[1.37；1.30，1.45]）。当区域 BMI 类别应用于 GWG 建议时，风险仍然较高。与地区 BMI 类别 (16%) 相比，更多亚洲女性的 GWG 被归类为低于世界卫生组织 (WHO) 指南（60%），但 WHO BMI 并没有伴随着不良后果风险的增加。与东亚女性相比，美国和西欧女性的孕前 BMI 较高，并且 GWG 高于指南的比例较高。然而，当使用东亚地区的 BMI 类别时，三大洲的 GWG 高于指南的比率相似。 GWG 外部指南与所有地区的不良结果相关。如果东亚使用区域 BMI 类别，则 IOM 指南适用于美国、西欧和东亚。本文的在线版本 (10.1186/s12916-018-1128-1) 包含补充材料，可供授权用户使用。
The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions. Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes. Overall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes. Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia. The online version of this article (10.1186/s12916-018-1128-1) contains supplementary material, which is available to authorized users.
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影响因子：
7.2
作者：
Bogaerts, Annick;Ameye, Lieveke;Devlieger, Roland
通讯作者：
Devlieger, Roland
DOI：
10.1186/1477-7827-9-6
发表时间：
2011-01-18
期刊：
Reproductive biology and endocrinology : RB&E
影响因子：
--
作者：
Choi SK;Park IY;Shin JC
通讯作者：
Shin JC
影响因子：
9.8
作者：
Kominiarek, Michelle A.;Seligman, Neil S.;Dolin, Cara;Gao, Weihua;Berghella, Vincenzo;Hoffman, Matthew;Hibbard, Judith U.
通讯作者：
Hibbard, Judith U.
影响因子：
16.2
作者：
Black MH;Sacks DA;Xiang AH;Lawrence JM
通讯作者：
Lawrence JM
影响因子：
7.2
作者：
Di Benedetto, A.;D'anna, R.;Corrado, F.
通讯作者：
Corrado, F.