美国南卡罗来纳大学Nandita Perumal团队研究了中低收入国家妊娠期妊娠体重增加（GWG）与新生儿结局之间的相关性。相关论文发表在2023年9月21日出版的《英国医学杂志》上。

为了评估中低收入国家妊娠期妊娠体重增加（GWG）与新生儿结局之间的相关性，研究组进行了一项个体参与者的数据荟萃分析，在24个中低收入国家进行了一项前瞻性妊娠研究。主要结局为九种新生儿结局与出生时的时间（早产）和人体测量（体重、身长和头围）、死产和新生儿死亡有关。

研究组在PubMed、Embase和Web of Science上进行了系统搜索，确定了2000年后发表的53项前瞻性妊娠研究，其中包括GWG、出生时的时间和人体测量以及新生儿死亡率的数据。GWG充足性定义为观察到的母亲体重增加与基于医学研究所体重指数特定指南的推荐体重增加的比率，该指南来源于高收入环境中的数据，以及INTERGROWTH-21 GWG标准。进而生成针对研究的估计值，并根据混杂因素进行校正，然后使用随机效应荟萃分析模型进行汇总。孕妇年龄和孕前体重指数被视为GWG充足性和新生儿结局之间关系的潜在调节因素。

总体而言，55%的参与者的GWG严重不足（<70%）或中度不足（70%-<90%），22%的参与者GWG充足（90-125%），23%的参与者GWG过量（≥125%）。GWG严重不足与低出生体重（校正后的相对风险为1.62；48项研究，93337名参与者；τ²=0.006）、小于胎龄儿（1.44；51项研究，93191名参与者；τ²=0.016）、短于胎龄（1.47；40项研究，83827名参与者；τ²=0.074）和小头畸形（1.57；31项研究，80046名参与者；τ²=0.145）风险较高相关。

GWG过高与早产（1.22；48项研究，103762名参与者；τ²=0.008）、胎龄较大（1.44；47项研究，90044名参与者；τ²=0.009）和巨大儿（1.52；29项研究，68138名参与者；τ²=0）风险较高相关。孕妇年龄和孕前体重指数改变了GWG充足性与几个新生儿结局之间的关联方向和程度。

研究结果表明，GWG不足和过量与不同环境下新生儿不良结局的风险较高有关。促进妊娠期最佳GWG的干预措施可能会减轻新生儿不良结局的负担，但需要进一步研究，以根据中低收入国家的数据评估GWG的最佳范围。

附：英文原文

Title: Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

Author: Nandita Perumal, Dongqing Wang, Anne Marie Darling, Enju Liu, Molin Wang, Tahmeed Ahmed, Parul Christian, Kathryn G Dewey, Gilberto Kac, Stephen H Kennedy, Vishak Subramoney, Brittany Briggs, Wafaie W Fawzi

Issue&Volume: 2023/09/21

Abstract:

Objective To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries.

Design Individual participant data meta-analysis.

Setting Prospective pregnancy studies from 24 low and middle income countries.

Main outcome measures Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death.

Analysis methods A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes.

Results Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy.

Conclusions Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.

DOI: 10.1136/bmj-2022-072249

Source: https://www.bmj.com/content/382/bmj-2022-072249