背景:2013年的系统评价和荟萃分析报告了先天性畸形的风险增加,与没有哮喘的母亲所生的婴儿相比,患有哮喘的妇女所生的婴儿中的新生儿死亡和新生儿住院。
目的:我们的目的是更新母体哮喘与新生儿不良结局之间关联的证据。
方法:我们执行了英语MEDLINE,Embase,CINAHL,和COCHRANE搜索术语(哮喘或喘息)和(pregnan*或perinat*或obstet*)。
方法:2012年3月至2023年9月发表的研究报告了至少一种感兴趣的结果(先天性畸形,死产,新生儿死亡,围产期死亡率,新生儿住院,新生儿短暂的呼吸急促,呼吸窘迫综合征和新生儿败血症)在有和没有哮喘的女性人群中。
方法:该研究是根据2020年首选报告项目的系统评价和荟萃分析(PRISMA)和流行病学观察性研究荟萃分析(MOOSE)指南进行报告的。个别研究的质量由两名评审员使用纽卡斯尔-渥太华量表独立评估。使用随机效应模型(≥3项研究)或固定效应模型(≤2项研究),根据患病率数据和逆通用方差方法计算相对风险(RR),其中结合了单个研究的调整比值比(aOR)。
结果:共纳入18项新研究,以及2013年回顾的22项研究。先前观察到的围产期死亡率风险增加(相对风险[RR]1.14,95%置信区间[CI]:1.05,1.23n=16项研究;aOR1.07,95%CI:0.98-1.17n=6),先天性畸形(RR1.36,95%CI:1.32-1.40n=17;aOR1.42,95%CI:1.38-1.47n=6),和新生儿住院(RR1.27,95%CI:1.25-1.30n=12;aOR1.1,95%CI:1.07-1.16n=3),而新生儿死亡的风险不再显著(RR1.33,95%CI:0.95-1.84n=8).先前报道的重大先天性畸形(RR1.18,95%CI:1.15-1.21;aOR1.20,95%CI:1.15-1.26n=3)和呼吸窘迫综合征(RR1.25,95%CI:1.17-1.34n=4;aOR1.09,95%CI:1.01-1.18n=2)的非重大风险达到统计学意义。
结论:医疗保健专业人员应继续意识到母亲患有哮喘的新生儿的风险增加。
BACKGROUND: A systematic review and meta-analysis from 2013 reported increased risks of congenital malformations, neonatal death and neonatal hospitalization amongst infants born to women with asthma compared to infants born to mothers without asthma.
OBJECTIVE: Our objective was to update the evidence on the associations between maternal asthma and adverse neonatal outcomes.
METHODS: We performed an English-language MEDLINE, Embase, CINAHL, and COCHRANE search with the terms (asthma or wheeze) and (pregnan* or perinat* or obstet*).
METHODS: Studies published from March 2012 until September 2023 reporting at least one outcome of interest (congenital malformations, stillbirth, neonatal death, perinatal mortality, neonatal hospitalization, transient tachypnea of the newborn, respiratory distress syndrome and neonatal sepsis) in a population of women with and without asthma.
METHODS: The study was reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Quality of individual studies was assessed by two reviewers independently using the Newcastle-Ottawa Scale. Random effects models (≥3 studies) or fixed effect models (≤2 studies) were used with restricted maximum likelihood to calculate relative risk (RR) from prevalence data and the inverse generic variance method where adjusted odds ratios (aORs) from individual studies were combined.
RESULTS: A total of 18 new studies were included, along with the 22 studies from the 2013 review. Previously observed increased risks remained for perinatal mortality (relative risk [RR] 1.14, 95% confidence interval [CI]: 1.05, 1.23 n = 16 studies; aOR 1.07, 95% CI: 0.98-1.17 n = 6), congenital malformations (RR 1.36, 95% CI: 1.32-1.40 n = 17; aOR 1.42, 95% CI: 1.38-1.47 n = 6), and neonatal hospitalization (RR 1.27, 95% CI: 1.25-1.30 n = 12; aOR 1.1, 95% CI: 1.07-1.16 n = 3) amongst infants born to mothers with asthma, while the risk for neonatal death was no longer significant (RR 1.33, 95% CI: 0.95-1.84 n = 8). Previously reported non-significant risks for major congenital malformations (RR1.18, 95% CI: 1.15-1.21; aOR 1.20, 95% CI: 1.15-1.26 n = 3) and respiratory distress syndrome (RR 1.25, 95% CI: 1.17-1.34 n = 4; aOR 1.09, 95% CI: 1.01-1.18 n = 2) reached statistical significance.
CONCLUSIONS: Healthcare professionals should remain aware of the increased risks to neonates being born to mothers with asthma.