背景:母亲的营养对于怀孕和后代的健康至关重要。怀孕期间经历粮食不安全是产妇饮食不平等的驱动因素,潜在的母婴健康后果。这项系统评价探讨了妊娠期食物不安全与母婴健康结果之间的关系。
结果:搜索包括8个数据库(MEDLINE,Embase,Scopus,WebofScience,PsychInfo,ASSIA,ProQuest中的SSPC,和CINAHL),灰色文学,前后引文链接,联系作者。在高收入国家(HIC)进行的研究报告了有关怀孕和孕产妇或婴儿健康方面的粮食不安全数据,包括2008年1月1日至2023年11月21日。筛选,数据提取,质量评估独立进行,一式两份。当数据适合汇集时,进行随机效应荟萃分析,否则进行叙事综合。该协议已在PROSPERO(CRD42022311669)上注册,报告与PRISMA清单(S1文件)。搜索确定了24,223项结果和25项研究(n=93,871名女性),其中23项来自北美,2项来自欧洲。Meta分析显示,粮食不安全与高应激水平相关(OR4.07,95%CI[1.22,13.55],I296.40%),心境障碍(OR2.53,95%CI[1.46,4.39],I255.62%),妊娠期糖尿病(OR1.64,95%CI[1.37,1.95],I20.00%),但不是剖宫产(OR1.42,95%CI[0.78,2.60],I256.35%),出生体重(MD-58.26g,95%CI[-128.02,11.50],I238.41%),小于胎龄(OR1.20,95%,CI[0.88,1.63],I244.66%),胎龄大(OR0.88,95%CI[0.70,1.12]I211.93%),早产(OR1.18,95%CI[0.98,1.42],I20.00%),或新生儿重症监护(OR2.01,95%CI[0.85,4.78],I270.48%)。叙事综合显示,粮食不安全与牙齿问题显着相关,抑郁症,焦虑,和母体血清全氟辛烷磺酸浓度。与其他有机卤素化学品没有显著关联,辅助分娩,产后出血,入院,逗留时间,先天性异常,或新生儿发病率。报告了子痫前期的混合关联,高血压,和社区/复原力措施。
结论:产妇食物不安全与一些不良妊娠结局有关,特别是心理健康和妊娠期糖尿病。大多数纳入研究是在北美进行的,主要是美利坚合众国,突出了其他背景下的研究差距。需要对其他HIC进行进一步研究,以了解不同背景下的这些关联,比如那些没有嵌入干预的地方,以帮助告知政策和护理要求。
BACKGROUND: Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic
review explored associations between food insecurity in pregnancy and maternal and infant health outcomes.
RESULTS: Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I2 56.35%), birth weight (MD -58.26 g, 95% CI [-128.02, 11.50], I2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures.
CONCLUSIONS: Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.