目的:综合妊娠期服用益生菌预防先兆子痫的现有证据,以及它对相关产妇的影响,胎儿和新生儿结局。
方法:系统地搜索了六个数据库中的合格研究-OvidMedline,Embase,CINAHL,科克伦,全球索引药物和妇幼保健数据库-从成立到2023年8月2日。
方法:随机对照试验,评估益生菌对妊娠任何阶段妇女的影响。
方法:该方案已在PROSPERO(CRD42023421613)上注册。研究资格,数据提取,偏倚风险评估(ROB-2工具)和确定性评级(GRADE)由两名作者独立进行.主要结果是先兆子痫的发生率,子痫和孕产妇死亡率。进行了Meta分析,结果以95%置信区间的风险比报告。
结果:29项试验(7,735名孕妇)符合资格标准。尽管大多数使用口服给药,但在招募的女性人群和测试的益生菌类型(20种不同的菌株)的试验中存在异质性。益生菌可能对先兆子痫的风险没有影响(RR1.14,95%CI:0.84至1.53;11项试验;2,401名妇女;低确定性证据;)早产<妊娠37周(RR0.93,95%CI0.66至1.30;18项试验,4,016名妇女;低确定性证据)或分娩时的胎龄(MD=-0.03周(≈0.2天),95%CI-0.16至0.10周(≈-1.1至0.7天);13项试验,2194名妇女;低确定性证据)。很难评估益生菌对其他次要结局的影响,因为证据的确定性非常低,尽管没有观察到益处或危害。
结论:有限的证据表明补充益生菌不会影响先兆子痫的风险。需要进一步的高质量试验来明确评估怀孕期间补充益生菌的益处和可能的危害。也缺乏涉及营养不良或经历微生物菌群失调的妇女的试验数据,益生菌补充剂可能对他们有用。
This study aimed to synthesize the available evidence on probiotic administration during pregnancy for the prevention of preeclampsia and its effects on related maternal, fetal, and newborn outcomes.
Six databases were systematically searched for eligible studies, namely Ovid MEDLINE, Embase, CINAHL, Cochrane, Global Index Medicus, and the Maternity and Infant Care Database, from inception to August 2, 2023.
Randomized controlled trials that evaluated the effects of probiotic administration on women during any stage of pregnancy were eligible for inclusion.
The protocol was registered with the International Prospective Register of Systematic Reviews under identifier CRD42023421613. Evaluating study eligibility, extracting data, assessing risk of bias (ROB-2 tool), and rating certainty (Grading of Recommendations, Assessment, Development and Evaluations) were conducted independently by 2 authors. The primary outcomes were incidence of preeclampsia, eclampsia, and maternal mortality. A meta-analysis was performed, and the results were reported as risk ratios with 95% confidence intervals.
A total of 29 trials (7735 pregnant women) met the eligibility criteria. There was heterogeneity across the trials in the population of enrolled women and the type of probiotic tested (20 different strains), although most used oral administration. Probiotics may make no difference to the risk of preeclampsia (risk ratio, 1.14; 95% confidence interval, 0.84-1.53; 11 trials; 2401 women; low certainty evidence), preterm birth at <37 weeks\' gestation (risk ratio, 0.93; 95% confidence interval, 0.66-1.30; 18 trials, 4016 women; low certainty evidence), or gestational age at delivery (mean difference, -0.03 weeks [≈0.2 days]; 95% confidence interval, -0.16 to 0.10 weeks [≈ -1.1 to 0.7 days]; 13 trials, 2194 women; low certainty evidence). It is difficult to assess the effects of probiotics on other secondary outcomes because the evidence was of very low certainty, however, no benefits or harms were observed.
Limited evidence suggests that probiotic supplementation does not affect the risk for preeclampsia. Further high-quality trials are needed to definitively assess the benefits and possible harms of probiotic supplementation during pregnancy. There is also a lack of data from trials that included women who were undernourished or who experienced microbial dysbiosis and for whom probiotic supplementation might be useful.