背景:怀孕期间营养不良会增加分娩小的脆弱新生儿的风险。少量基于脂质的营养补充剂(SQ-LNS)包含大量和微量营养素,可以帮助预防多种营养缺乏。
目的:我们检查了妊娠期SQ-LNS的作用,与a)铁和叶酸或护理标准(IFA/SOC)或b)多种微量营养素补充剂(MMS)相比,并确定了修改SQ-LNS对出生结局影响估计的特征。
方法:我们对怀孕期间提供的4项SQ-LNS随机对照试验的个体参与者数据进行了2阶段荟萃分析(n=5,273)。我们生成了与IFA/SOC或MMS相比的SQ-LNS的特定研究和亚组估计值,并汇总了估计值。在敏感性分析中,我们检查了结果是否根据胎龄约会的方法而有所不同,出生人体测量学,或研究设计。
结果:SQ-LNS(与IFA/SOC相比)增加了出生体重(平均差:49g;95%CI:26,71g)和所有出生人体测量z评分(0.10-0.13SD);它将低出生体重的风险降低了11%,新生儿发育迟缓17%,新生儿消瘦11%,和15%的小头部尺寸。只有2项试验比较了SQ-LNS和MMS;出生结局的p值>0.10,头围除外(例如,胎龄z评分+0.11;95%CI:-0.01,0.23)。SQ-LNS与IFA/SOC的效果估计值在女婴中更高,对于某些结果,在体重指数<20kg/m2的母亲中,炎症,疟疾,或家庭粮食不安全。对于女性婴儿的某些结局,SQ-LNS与MMS的效果估计值更大,第一胎婴儿,和母亲<25岁。
结论:与IFA/SOC相比,SQ-LNS对多个结局有积极影响,但需要进一步研究直接比较SQ-LNS和MMS。将SQ-LNS定位到脆弱的亚群可能值得考虑。在www注册的分析。crd.约克。AC.英国/PROSPERO(CRD42021283391)。系统审查或荟萃分析的注册和注册号码:在www注册。crd.约克。AC.英国/PROSPERO于2021年4月11日作为CRD42021283391。
BACKGROUND: Undernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies.
OBJECTIVE: We examined the effects of SQ-LNSs provided during pregnancy compared with 1) iron and folic acid or standard of care (IFA/SOC) or 2) multiple micronutrient supplements (MMSs) and identified characteristics that modified the estimates of effects of SQ-LNSs on birth outcomes.
METHODS: We conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNSs provided during pregnancy (n = 5273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether the results differed depending on methods for gestational age dating, birth anthropometry, or study design.
RESULTS: SQ-LNSs (compared with IFA/SOC) increased birth weight [mean difference: +49 g; 95% confidence interval (CI): 26, 71 g] and all birth anthropometric z-scores (+0.10-0.13 standard deviation); it reduced risk of low birth weight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNSs and MMSs; P values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age: +0.11; 95% CI: -0.01, 0.23). Effect estimates for SQ-LNSs compared with IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index <20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNSs compared with MMSs were greater for certain outcomes among female infants, first-born infants, and mothers <25 y.
CONCLUSIONS: SQ-LNSs had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNSs and MMSs is needed. Targeting SQ-LNSs to vulnerable subgroups may be worth considering.
BACKGROUND: This study was registered at PROSPERO as CRD42021283391.