Cognitive impairment during pregnancy: a meta-analysis
Cognitive impairment during pregnancy: a meta-analysis
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DOI：
10.5694/mja17.00131
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发表时间：
2018-01-15
影响因子：
11.4
通讯作者：
Hayden, Melissa J.
中科院分区：
文献类型：
--
作者：
Davies, Sasha J.;Lum, Jarrad A. G.;Hayden, Melissa J.
目的：许多妇女报告在怀孕期间认知功能下降，但试图经验性地评估这种变化产生了不一致的结果。我们的目的是确定怀孕是否与认知功能的客观下降有关，并评估怀孕期间任何下降的进展。研究设计：我们对20项研究进行了荟萃分析，应用随机效应模型，这些研究报告了怀孕与认知变化之间的定量关系。数据来源：全文文献由CINAHL、MEDLINE和PsychINFO.Data synthesis检索：评估的20项研究包括709名孕妇和521名非孕妇。妊娠女性的总体认知功能比非妊娠女性差（标准化平均差异[SMD]，0.52 [95%CI，0.07-0.97]; P = 0.025）。对横断面研究的分析发现，一般认知功能（SMD，1.28 [95% CI 0.26-2.30]; P = 0.014），记忆（SMD，1.47 [95% CI，0.27-2.68]; P = 0.017），和执行功能（SMD，0.46 [95% CI，0.03-0.89]; P = 0.036）在妊娠晚期（与对照组妇女相比）显著降低，但在前两个三个月没有。纵向研究发现，一般认知功能在第一和第二个三个月之间下降（SMD，0.29 [95% CI，0.08-0.50]; P = 0.006）和记忆（SMD，0.33 [95%CI，0.12-0.54]; P = 0.002），但在第二和第三孕期之间没有。一般认知功能，记忆力和执行功能显着较差的孕妇比对照组妇女，特别是在第三个三个月。这些差异主要发生在妊娠的头三个月，这与最近发现的妊娠期间脑灰质体积长期减少是一致的。这些影响对孕妇生活质量和日常功能的影响需要进一步调查。
Objectives: Many women report declines in cognitive function during pregnancy, but attempts to empirically evaluate such changes have yielded inconsistent results. We aimed to determine whether pregnancy is associated with objective declines in cognitive functioning, and to assess the progression of any declines during pregnancy.Study design: We undertook a meta-analysis, applying a random effects model, of 20 studies that have reported quantitative relationships between pregnancy and changes in cognition.Data sources: Full text articles indexed by Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, MEDLINE Complete, and PsychINFO.Data synthesis: The 20 studies assessed included 709 pregnant women and 521 non-pregnant women. Overall cognitive functioning was poorer in pregnant women than in non-pregnant women (standardised mean difference [SMD], 0.52 [95% CI, 0.07-0.97]; P = 0.025). Analysis of cross-sectional studies found that general cognitive functioning (SMD, 1.28 [95% CI 0.26-2.30]; P = 0.014), memory (SMD, 1.47 [95% CI, 0.27-2.68]; P = 0.017), and executive functioning (SMD, 0.46 [95% CI, 0.03-0.89]; P = 0.036) were significantly reduced during the third trimester of pregnancy (compared with control women), but not during the first two trimesters. Longitudinal studies found declines between the first and second trimesters in general cognitive functioning (SMD, 0.29 [95% CI, 0.08-0.50]; P = 0.006) and memory (SMD, 0.33 [95% CI, 0.12-0.54]; P = 0.002), but not between the second and third trimesters.Conclusions: General cognitive functioning, memory, and executive functioning were significantly poorer in pregnant than in control women, particularly during the third trimester. The differences primarily develop during the first trimester, and are consistent with recent findings of long term reductions in brain grey matter volume during pregnancy. The impact of these effects on the quality of life and everyday functioning of pregnant women requires further investigation.