护理学报 ›› 2023, Vol. 30 ›› Issue (24): 38-42.doi: 10.16460/j.issn1008-9969.2023.24.038
黄丽华1, 翟巾帼2, 田金徽3, 孔淦霞1, 王雪岩2, 陈莉瑾2, 袁心愿2, 耿薪茜2, 陈昭桐2
摘要: 目的 探讨妊娠期生活方式干预对妊娠期高血压疾病的预防效果。方法 计算机检索Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国生物医学文献数据库、中国知网、万方及维普数据库,搜集妊娠期生活方式干预对妊娠期高血压疾病及相关母婴结局的随机对照试验,检索时限均从建库至2023年6月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行分析。结果 共纳入31个随机对照试验,包括12 737名研究对象。Meta分析结果显示:与对照组相比,妊娠期生活方式干预可有效预防妊娠期高血压疾病[RR=0.69,95%CI(0.57,0.85),P=0.0004]、妊娠期高血压[RR=0.63,95%CI(0.45,0.88),P=0.007]、子痫前期[RR=0.81,95%CI(0.66,0.99),P=0.04]的发生。生活方式干预组的妊娠期糖尿病、剖宫产发生率,妊娠期总增重、巨大儿发生率、新生儿体质量均低于对照组;但2组分娩孕周、早产儿发生率差异无统计学意义(P>0.05)。结论 妊娠期生活方式干预可有效预防妊娠期高血压疾病、妊娠期糖尿病的发生,降低剖宫产和巨大儿的发生率,控制新生儿体质量和妊娠期总增重;但2组分娩孕周、早产儿发生率无统计学差异,仍需更多高质量的研究进一步验证结论。
中图分类号:
[1] Teng H, Wang Y, Han B,et al.Gestational systolic blood pressure trajectories and risk of adverse maternal and perinatal outcomes in Chinese women[J]. BMC Pregnancy Childbirth, 2021,21(1):155. DOI:10.1186/s12884-021-03599-7. [2] Ponte MP, Feliu-Soler A, Solé-Villa MJ, et al.Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension[J]. J Hum Hypertens, 2019,33(3):237-247. DOI:10.1038/s41371-018-0130-6. [3] Magro-Malosso ER, Saccone G, Di Tommaso M, et al.Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and Meta-analysis[J]. Acta Obstet Gynecol Scand, 2017,96(8):921-931. DOI:10.1111/aogs.13151. [4] Genest DS, Falcao S, Gutkowska J, et al.Impact of exercise training on preeclampsia: potential preventive mechanisms[J]. Hypertension, 2012,60(5):1104-1109. DOI:10.1161/HYPERTENSIONAHA.112.194050. [5] JPT H, Thomas J, Chandler J, et al.Cochrane handbook for systematic reviews of intervention version 6.2.0[EB/OL].[2023-08-02][2023-11-25].https://training.cochrane.org/handbook. [6] Barakat R, Pelaez M, Cordero Y, et al.Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial[J]. Am J Obstet Gynecol, 2016,214(5):641-649. DOI:10.1016/j.ajog.2015.11.039. [7] Bisson M, Alméras N, Dufresne SS, et al.A 12-week exercise program for pregnant women with obesity to improve physical activity levels: an open randomised preliminary study[J]. PLoS One, 2015,10(9):e137742. DOI:10.1371/journal.pone.0137742. [8] Bruno R, Petrella E, Bertarini V, et al.Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial[J]. Matern Child Nutr, 2017,13(3). DOI:10.1111/mcn.12333. [9] Chan RS, Tam WH, Ho IC, et al.Randomized trial examining effectiveness of lifestyle intervention in reducing gestational diabetes in high risk Chinese pregnant women in Hong Kong[J]. Sci Rep, 2018,8(1):13849. DOI:10.1038/s41598-018-32285-6. [10] Crovetto F, Crispi F, Casas R, et al.Effects of mediterranean diet or mindfulness-based stress reduction on prevention of small-for-gestational age birth weights in newborns born to at-risk pregnant individuals: The IMPACT BCN randomized clinical trial[J]. JAMA, 2021, 326(21):2150-2160. DOI:10.1001/jama.2021.20178. [11] Da SS, Hallal PC, Domingues MR, et al.A randomized controlled trial of exercise during pregnancy on maternal and neonatal outcomes: results from the PAMELA study[J]. Int J Behav Nutr Phys Act, 2017,14(1):175. DOI:10.1186/s12966-017-0632-6. [12] Ding B, Gou B, Guan H, et al.WeChat-assisted dietary and exercise intervention for prevention of gestational diabetes mellitus in overweight/obese pregnant women: a two-arm randomized clinical trial[J].Arch Gynecol Obstet, 2021,304(3):609-618. DOI:10.1007/s00404-021-05984-1. [13] Dodd JM, Turnbull D, McPhee AJ, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial[J]. BMJ, 2014,348:g1285. DOI:10.1136/bmj.g1285. [14] Dodd JM, Deussen AR, Louise J.A randomised trial to optimise gestational weight gain and improve maternal and infant health outcomes through antenatal dietary, lifestyle and exercise advice: the OPTIMISE randomised trial[J]. Nutrients, 2019,11(12). DOI:10.3390/nu11122911. [15] Guelinckx I, Devlieger R, Mullie P, et al.Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial[J]. Am J Clin Nutr, 2010,91(2):373-380. DOI:10.3945/ajcn.2009.28166. [16] Koivusalo SB, Rönö K, Klemetti MM, et al.Gestational diabetes mellitus can be prevented by lifestyle intervention: the finnish gestational diabetes prevention study (RADIEL): a randomized controlled trial[J]. Diabetes Care, 2016,39(1):24-30. DOI:10.2337/dc15-0511. [17] Kong KL, Campbell CG, Foster RC, et al.A pilot walking program promotes moderate-intensity physical activity during pregnancy[J]. Med Sci Sports Exerc, 2014,46(3):462-471. DOI:10.1249/MSS.0000000000000141. [18] Kunath J, Günther J, Rauh K, et al.Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care-the cluster-randomised GeliS trial[J].BMC Med, 2019,17(1):5.DOI:10.1186/s12916-018-1235-z. [19] Lin X, Yang T, Zhang X, et al.Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk for gestational diabetes mellitus[J]. J Int Med Res, 2020, 48(12):1220778682. DOI:10.1177/0300060520979130. [20] Liu J, Wilcox S, Wingard E,et al.A behavioral lifestyle intervention to limit gestational weight gain in pregnant women with overweight and obesity[J]. Obesity (Silver Spring), 2021,29(4):672-680. DOI:10.1002/oby.23119. [21] McCarthy EA, Walker SP, Ugoni A, et al. Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial[J]. BJOG, 2016,123(6):965-973. DOI:10.1111/1471-0528.13919. [22] Menichini D, Petrella E, Dipace V, et al.The impact of an early lifestyle intervention on pregnancy outcomes in a cohort of insulin-resistant overweight and obese women[J]. Nutrients, 2020,12(5):1496. DOI:10.3390/nu12051496. [23] Petrella E, Malavolti M, Bertarini V, et al.Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program[J]. J Matern Fetal Neonatal Med, 2014,27(13):1348-1352.DOI:10.3109/14767058.2013.858318. [24] Price BB, Amini SB, Kappeler K.Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial[J]. Med Sci Sports Exerc, 2012,44(12):2263-2269. DOI: 10.1249/MSS.0b013e318267ad67. [25] Rakhshani A, Nagarathna R, Mhaskar R,et al.The effects of yoga in prevention of pregnancy complications in high-risk pregnancies:a randomized controlled trial[J].Prev Med,2012,55(4):333-340.DOI:10.1016/j.ypmed.2012.07.020. [26] Ruiz JR, Perales M, Pelaez M, et al.Supervised exercise-based intervention to prevent excessive gestational weight gain:a randomized controlled trial[J].Mayo Clin Proc, 2013,88(12):1388-1397. DOI:10.1016/j.mayocp.2013.07.020. [27] Seneviratne SN, Jiang Y, Derraik J, et al.Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: a randomised controlled trial[J]. BJOG, 2016,123(4):588-597. DOI:10.1111/1471-0528.13738. [28] Thornton YS, Smarkola C, Kopacz SM, et al.Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial[J]. J Natl Med Assoc, 2009,101(6):569-577. DOI:10.1016/s0027-9684(15)30942-1. [29] Vesco KK, Karanja N, King JC, et al.Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial[J]. Obesity (Silver Spring), 2014,22(9):1989-1996. DOI:10.1002/oby.20831. [30] Vinter CA, Jensen DM, Ovesen P, et al.The LiP (lifestyle in pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women[J].Diabetes Care, 2011,34(12):2502-2507. DOI:10.2337/dc11-1150. [31] Wang C, Wei Y, Zhang X, et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women[J]. Am J Obstet Gynecol, 2017,216(4):340-351. DOI:10.1016/j.ajog.2017.01.037. [32] 孙雪. 联合生活方式干预对超重和肥胖孕妇妊娠结局的影响分析[J]. 中国实用乡村医生杂志,2022,29(3):37-39,44. DOI:10.3969/j.issn.1672-7185.2022.03.012. [33] 杨群, 郝加虎, 连俊红, 等. 个体化运动方案对孕期增重及妊娠结局的影响[J]. 华南国防医学杂志, 2020,34(1):64-66. DOI:10.13730/j.issn.1009-2595.2020.01.017. [34] 王红菊, 魏兆莲, 王素芳, 等. 饮食和生活方式的咨询指导对孕妇体重指数及妊娠结局的影响[J]. 中华疾病控制杂志, 2014,18(4):301-303. [35] 穆娟,苗治晶,张悦,等. 孕期个体化膳食营养干预对孕妇膳食营养摄入状况和母婴结局的影响[J]. 中国计划生育学杂志,2019,27(11):1502-1505. DOI:10.3969/j.issn.1004-8189.2019.11.021. [36] 邵艳玲,何暖红.瑜伽训练在孕妇中的临床应用价值[J].中国当代医药,2018,25(1):85-87. |
[1] | 孙菲, 刘敏, 胡珊珊, 吴蕾, 刘君, 李萍. 基于Meta分析构建早产儿母亲泌乳建立风险预测评分模型[J]. 护理学报, 2023, 30(23): 1-5. |
[2] | 钱怡, 周清平, 梁振宁, 王晨曦, 刘涵月, 于瑶, 玉素扑江·图尔荪, 王冬. 慢性病患者参与医患共同决策影响因素的Meta分析[J]. 护理学报, 2023, 30(20): 19-23. |
[3] | 余小燕, 刘于, 黄毅. 小丑照护对患儿焦虑疼痛干预效果的Meta分析[J]. 护理学报, 2022, 29(4): 21-26. |
[4] | 李婧雯, 梅紧紧, 王艺莹, 郭健, 任彬彬, 冯晓东, 李瑞青. 不同针刺方法治疗脑卒中后患者肢体痉挛总有效率的贝叶斯网状Meta分析[J]. 护理学报, 2022, 29(3): 1-6. |
[5] | 赵琼兰, 李辉, 文晓慧, 何平平, 廖红伍, 刘芬, 龚小戎. “三主”视角下《妇产科护理学》的课程思政教学实践[J]. 护理学报, 2022, 29(16): 22-25. |
[6] | 胡正中, 廖园园, 周毅峰, 彭瑨, 秦月兰. 结直肠癌患者手术切口感染危险因素的Meta分析[J]. 护理学报, 2021, 28(8): 23-27. |
[7] | 陆涵, 赵媛, 朱晓丽, 林惠仙, 史婷婷. 基于改良早期预警评分护送方案在急危重症患者院内转运中应用效果的Meta分析[J]. 护理学报, 2021, 28(4): 19-25. |
[8] | 从维莲, 周春兰, 胡明钰, 刘丽萍. 延迟自体乳房重建术对上肢淋巴水肿治疗效果的系统评价[J]. 护理学报, 2021, 28(4): 26-30. |
[9] | 徐思英, 黄莹, 刘丽华, 胡雅. 基于互联网认知行为疗法对产妇负性情绪干预效果的Meta分析[J]. 护理学报, 2021, 28(4): 36-42. |
[10] | 梁冬燕, 公丕欣, 邱玲动, 王慧, 邵梅莹, 孙铮. 胸腔镜下肺癌根治术患者加速康复效果的Meta分析[J]. 护理学报, 2021, 28(23): 41-46. |
[11] | 张萌, 陈维萍, 刘翠萍, 王大伟, 刘磊, 王雪春, 岳崇玉. 剖宫产术后阴道分娩护理质量敏感性分级指标的构建[J]. 护理学报, 2021, 28(18): 61-65. |
[12] | 迟俊婷, 陈飞, 李思彦, 张静, 陶红霞, 阮海慧, 牛晓丹, 王艳红. 近5年中国科学引文数据库护理干预性系统评价/Meta分析报告质量分析[J]. 护理学报, 2021, 28(17): 1-5. |
[13] | 成荫, 张燕红, 朱姝芹, 王兆芹. 计算机认知行为疗法降低青少年抑郁发生的Meta分析[J]. 护理学报, 2021, 28(17): 46-52. |
[14] | 刘瑾, 路娜, 张凤娃, 牛晓丹, 袁蓉敬, 李雯艳, 王叶同, 王艳红. 乳腺癌患者癌症复发恐惧影响因素的Meta分析[J]. 护理学报, 2021, 28(14): 1-7. |
[15] | 牛晓丹, 张静, 郭静波, 阮海慧, 迟俊婷, 陶红霞, 王艳红. 糖尿病患者衰弱危险因素的Meta分析[J]. 护理学报, 2021, 28(11): 1-6. |
|