目的:关于多发性硬化症(MS)对母婴结局的影响知之甚少。因此,本系统评价和荟萃分析旨在研究MS对有MS病史的孕妇母婴结局的影响。
方法:本综述的设计符合PRISMA指南。两名研究人员使用国际数据库对文献进行了独立审查,没有时间限制,直到2023年1月。包括PubMed,WebofScience,CINAHLPlus,Embase,Scopus,科学直接,谷歌学者。随机效应荟萃分析,使用Stata17.2中的dbmetan命令,用于计算关联的合并度量。
结果:荟萃分析确定了15项研究,涉及33,174,541名孕妇(32,191名MS和33,142,350名作为对照)。研究结果表明,有MS病史的妇女剖宫产的风险增加(OR=1.28,95%置信区间[CI]:1.14-1.45,p值:0.042)。此外,这些妇女的新生儿结局风险较高,如早产(OR=1.39,95%CI:1.08-1.78,p值:0.02),先天性畸形(OR=1.32,95CI:1.16-1.50,p值:0.031),Apgar评分<7(OR=2.13,95%CI:1.19-3.79,p值:0.03),小于胎龄(OR=1.27,95%CI:1.08-1.51,p值:0.040)。
结论:患有MS的孕妇比没有MS的孕妇更有可能出现不良妊娠结果。因此,MS孕妇应制定详细的怀孕前后计划,在与他们的医生协商后,配偶,家庭,和朋友,关于必要的护理和补充。未来的研究需要应用前瞻性队列设计来控制潜在的混杂因素,以进一步验证研究结果。
OBJECTIVE: Little is known regarding the impact of multiple sclerosis (MS) on maternal and neonatal outcomes. Consequently, this systematic review and meta-analysis aimed to study the impacts of MS on maternal and neonatal outcomes in pregnant women with a history of MS.
METHODS: This review was designed in line with the PRISMA guidelines. Two researchers conducted independent reviews of the literature without time restrictions until January 2023 using international databases, including PubMed, Web of Science, CINAHL Plus, Embase, Scopus, Science Direct, and Google Scholar. A random-effect meta-analysis, using the db metan command in Stata 17.2, was used to calculate the pooled measure of association.
RESULTS: The meta-analysis identified 15 studies involving 33,174,541 pregnant women (32,191 with MS and 33,142,350 as controls). The findings indicate that women with a history of MS are at an increased risk of cesarean delivery (OR=1.28, 95% Confidence Intervals [CI]: 1.14-1.45, p-value: 0.042). Also, these women are at higher risk of neonatal outcomes, such as preterm birth (OR= 1.39, 95% CI: 1.08-1.78, p-value: 0.02), congenital malformations (OR=1.32, 95%CI: 1.16-1.50, p-value: 0.031), Apgar score <7 (OR=2.13, 95% CI: 1.19-3.79, p-value: 0.03), and small for gestational age (OR=1.27, 95% CI: 1.08-1.51, p-value: 0.040).
CONCLUSIONS: Pregnant women with MS have a greater chance of adverse pregnancy results than pregnant women without MS. Consequently, pregnant women with MS should create detailed before and after pregnancy plans, in consultation with their doctors, spouses, families, and friends, regarding the necessary care and supplements. Future studies applying a prospective cohort design that control for potential confounders are needed to further validate the findings.