目的:本研究旨在综合现有证据,证明产前皮质类固醇(ACS)治疗对有孕前/妊娠期糖尿病的早产风险的妇女的有效性。绒毛膜羊膜炎或胎儿生长受限(FGR),或早产晚期的计划剖宫产(CS)。
方法:对MEDLINE的系统搜索,EMBASE,CINAHL,科克伦图书馆,WebofScience和GlobalIndexMedicus于2021年6月6日在四个亚群中进行了所有比较随机或非随机干预研究。非随机研究的偏差风险评估工具和Cochrane偏差风险工具用于评估偏差风险。建议评估的分级,开发和评估工具评估了证据的确定性。
结果:纳入了32项研究,涉及5018名孕妇和10819名新生儿。关于女性糖尿病患者的数据有限,女性计划接受CS的证据尚无定论。使用ACS与新生儿死亡几率可能降低相关(合并OR:0.51;95%CI:0.31至0.85,低确定性),绒毛膜羊膜炎女性的脑室内出血(合并OR:0.41;95%CI:0.23~0.72,低确定性)和呼吸窘迫综合征(合并OR:0.59;95%CI:0.45~0.77,低确定性).在有FGR的女性中,表面活性剂使用率(合并OR:0.38;95%CI:0.23至0.62,中等确定性),机械通气(合并OR:0.42;95%CI:0.26~0.66,中度确定性)和氧疗(合并OR:0.48;95%CI:0.30~0.77,中度确定性)可能降低;低血糖发生率可能升高(合并OR:2.06;95%CI:1.27~3.32,中度确定性).
结论:对于患有糖尿病的女性,缺乏关于ACS的证据。ACS治疗可能对患有绒毛膜羊膜炎的女性有益,并且可能对FGR有益。有有限的直接试验证据表明,在晚期早产期间接受计划CS的女性中,ACS的疗效。尽管全部证据表明这可能是有益的。
■CRD42021267816。
This study aimed to synthesise available evidence on the efficacy of antenatal corticosteroid (ACS) therapy among women at risk of imminent preterm birth with pregestational/gestational diabetes, chorioamnionitis or fetal growth restriction (FGR), or planned caesarean section (CS) in the late preterm period.
A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science and Global Index Medicus was conducted for all comparative randomised or non-randomised interventional studies in the four subpopulations on 6 June 2021. Risk of Bias Assessment tool for Non-randomised Studies and the Cochrane Risk of Bias tool were used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluations tool assessed the certainty of evidence.
Thirty-two studies involving 5018 pregnant women and 10 819 neonates were included. Data on women with diabetes were limited, and evidence on women undergoing planned CS was inconclusive. ACS use was associated with possibly reduced odds of neonatal death (pooled OR: 0.51; 95% CI: 0.31 to 0.85, low certainty), intraventricular haemorrhage (pooled OR: 0.41; 95% CI: 0.23 to 0.72, low certainty) and respiratory distress syndrome (pooled OR: 0.59; 95% CI: 0.45 to 0.77, low certainty) in women with chorioamnionitis. Among women with FGR, the rates of surfactant use (pooled OR: 0.38; 95% CI: 0.23 to 0.62, moderate certainty), mechanical ventilation (pooled OR: 0.42; 95% CI: 0.26 to 0.66, moderate certainty) and oxygen therapy (pooled OR: 0.48; 95% CI: 0.30 to 0.77, moderate certainty) were probably reduced; however, the rate of hypoglycaemia probably increased (pooled OR: 2.06; 95% CI: 1.27 to 3.32, moderate certainty).
There is a paucity of evidence on ACS for women who have diabetes. ACS therapy may have benefits in women with chorioamnionitis and is probably beneficial in FGR. There is limited direct trial evidence on ACS efficacy in women undergoing planned CS in the late preterm period, though the totality of evidence suggests it is probably beneficial.
CRD42021267816.