Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses.
Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses.
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DOI：
10.1136/bmj.c3428
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发表时间：
2010-07-20
期刊：
影响因子：
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通讯作者：
Knowledge Synthesis Group
中科院分区：
文献类型：
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作者：
McDonald SD;Han Z;Mulla S;Beyene J;Knowledge Synthesis Group
目的探讨发达国家和发展中国家母亲超重和肥胖与单胎妊娠早产和低出生体重的关系。设计系统回顾和荟萃分析。数据来源：Medline和Embase，以及已识别文章的参考列表。研究选择包括正常体重指数妇女参照组的研究，评估超重和肥胖对两个主要结局的影响：早产（37周前）和低出生体重（<2500 g）。两名评估员独立审查标题、摘要和全文，使用试点数据收集表格提取数据，并评估质量。纳入84项研究（64项队列研究和20项病例对照研究），共1 095 834名妇女。虽然超重和肥胖妇女的早产总体风险与正常体重妇女相似，但超重和肥胖妇女诱发早产的风险增加（相对风险1.30,95%可信区间1.23至1.37）。尽管总体而言，超重和肥胖妇女生下低出生体重婴儿的风险降低了（0.84,0.75至0.95），但发展中国家的降低幅度大于发达国家（0.58,0.47至0.71 v 0.90, 0.79至1.01）。在考虑发表偏倚后，超重和肥胖对低出生体重的明显保护作用随着“缺失”研究的加入而消失（0.95,0.85至1.07），而超重和肥胖妇女的早产风险明显更高（1.24,1.13至1.37）。结论：超重和肥胖妇女早产和诱发早产的风险增加，并且在考虑发表偏倚后，总体上早产的风险似乎增加。在发展中国家，母亲超重和肥胖对低出生体重的有益影响更大，但考虑到发表偏倚后就消失了。
Objective To determine the relation between overweight and obesity in mothers and preterm birth and low birth weight in singleton pregnancies in developed and developing countries. Design Systematic review and meta-analyses. Data sources Medline and Embase from their inceptions, and reference lists of identified articles. Study selection Studies including a reference group of women with normal body mass index that assessed the effect of overweight and obesity on two primary outcomes: preterm birth (before 37 weeks) and low birth weight (<2500 g). Data extraction Two assessors independently reviewed titles, abstracts, and full articles, extracted data using a piloted data collection form, and assessed quality. Data synthesis 84 studies (64 cohort and 20 case-control) were included, totalling 1 095 834 women. Although the overall risk of preterm birth was similar in overweight and obese women and women of normal weight, the risk of induced preterm birth was increased in overweight and obese women (relative risk 1.30, 95% confidence interval 1.23 to 1.37). Although overall the risk of having an infant of low birth weight was decreased in overweight and obese women (0.84, 0.75 to 0.95), the decrease was greater in developing countries than in developed countries (0.58, 0.47 to 0.71 v 0.90, 0.79 to 1.01). After accounting for publication bias, the apparent protective effect of overweight and obesity on low birth weight disappeared with the addition of imputed “missing” studies (0.95, 0.85 to 1.07), whereas the risk of preterm birth appeared significantly higher in overweight and obese women (1.24, 1.13 to 1.37). Conclusions Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall. The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias.