目的:评估和量化孕前孕妇超重与肥胖之间的关系,和后代先天性心脏病(CHD)的风险。
方法:本系统综述和荟萃分析包括对PubMed,Medline,WebofScience,和Scopus直到4月20日,2023年。针对不断上升的体重指数类别(超重,肥胖,中度和重度肥胖)与正常体重(参考)相比。固定效应或随机效应模型用于根据异质性程度组合个体研究风险估计。进行了敏感性分析,以加权相关主持人的汇总估计,特别是怀孕前和怀孕期间的糖尿病。如果至少有两项研究具有可获得的数据,则进行特定先天性心脏缺陷的亚组分析。研究结果以两种方式呈现:作为缺陷组,使用严重性和地形功能标准进行分类,作为个人缺陷。每个效应估计的证据的确定性根据建议评估的等级进行评估,发展,和评估(等级)指南。
结果:共纳入了20项研究,共4,861,693例患者和86,136例冠心病病例。从中度肥胖到重度肥胖,冠心病的风险逐渐增加(合并比值比(OR),分别为:1.15,95%置信区间(CI),1.11-1.20,和1.39,95%CI,1.27-1.53)。敏感性分析表明,这种影响独立于怀孕前或怀孕期间的母亲糖尿病状况而持续存在。在亚组分析中,肥胖与严重CHD风险增加1.5倍相关(合并OR,1.48;95%CI,1.03-2.13)。具体来说,严重肥胖被发现与更高的风险有关,对于包括法洛四联症在内的特定CHD,增加高达1.8倍(合并OR,1.72;95%CI,1.38-2.16),肺动脉瓣狭窄(合并OR,1.79;95%CI,1.39-2.30),和房间隔缺损(合并OR,1.71;95%CI,1.48-1.97)。
结论:孕妇体重是预防冠心病的一个重要的可改变的危险因素,特别是严重的形式。需要进一步的研究来调查怀孕前的体重管理是否可以作为CHD的预防措施。此外,对于肥胖的孕妇,胎儿超声心动图应该是常规诊断程序。本文受版权保护。保留所有权利。
OBJECTIVE: To assess and quantify the association between pre-pregnancy maternal overweight and obesity, and the risk of congenital heart defects (CHDs) in offspring.
METHODS: This systematic
review and meta-analysis included searches of PubMed, Medline, Web of science, and Scopus up to April 20th, 2023. Risk estimates were abstracted or calculated for rising body mass index categories (overweight, obesity, moderate and severe obesity) compared to normal weight (reference). Fixed-effects or random-effects models were used to combine individual study risk estimates based on the degree of heterogeneity. Sensitivity analyses were conducted to weight pooled estimates for relevant moderators, particularly diabetes prior and during pregnancy. Subgroup analyses for specific congenital heart defects were conducted if there were at least two studies with accessible data. The findings were presented in two ways: as groups of defects, categorized using severity and topographic-functional criteria, and as individual defects. The certainty of the evidence for each effect estimate was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.
RESULTS: Twenty studies for a total of 4,861,693 patients and 86,136 CHDs cases were included. The risk for CHDs progressively increases from moderate to severe obesity (pooled odds ratio (OR), respectively: 1.15, 95% confidence interval (CI), 1.11-1.20, and 1.39, 95% CI, 1.27-1.53). Sensitivity analysis indicated that this effect persists independently of maternal diabetes status before or during pregnancy. In subgroup analysis, obesity was associated with up to a 1.5-fold increase in the risk of severe CHDs (pooled OR, 1.48; 95% CI, 1.03-2.13). Specifically, severe obesity was found to be associated with an even higher risk, increasing up to 1.8 times for specific CHDs including tetralogy of Fallot (pooled OR, 1.72; 95% CI, 1.38-2.16), pulmonary valve stenosis (pooled OR, 1.79; 95% CI, 1.39-2.30), and atrial septal defects (pooled OR, 1.71; 95% CI, 1.48-1.97).
CONCLUSIONS: Maternal weight emerged as a crucial modifiable risk factor for preventing CHDs, particularly the severe forms. Future research is needed to investigate whether weight management prior to pregnancy might serve as a preventive measure against CHDs. Additionally, for pregnant women with obesity, fetal echocardiography ought to be a routine diagnostic procedure. This article is protected by copyright. All rights reserved.