孕期补锌对新生儿健康影响随机对照试验meta分析

Effects of zinc supplementation during pregnancy on neonatal health: a meta-analysis of randomized controlled trials

目的 采用meta分析方法系统定量评价健康孕妇孕期补锌对新生儿出生体重、出生身长、出生头围、早产、低出生体重和围生期死亡的影响,为孕妇合理补锌提供充分的科学依据。方法 检索Pubmed、OVID、EMBASE、WOK、SCOPUS和万方、中国生物医学文献数据库等多个中英文数据库的相关文献,收集所有关于孕妇孕期补充锌与新生儿出生体重、出生身长、出生头围、早产、低出生体重和围生期死亡关系的随机对照试验原始研究数据,应用Rev Man 5.2软件进行meta分析。结果 共纳入符合要求的原始文献15篇,包括14篇英文文献和1篇中文文献;meta分析结果显示,孕期补锌对出生体重影响的MD=18.13（95%CI=-26.72~62.99）,对出生身长影响的MD=-0.10（95%CI=-0.24~0.03）,对出生头围影响的MD=-0.04（95%CI=-0.13~0.05）,对早产影响的相对危险度RR=0.84（95%CI=0.74~0.96）,对低出生体重影响的RR=0.85（95%CI=0.66~1.11）,对围生期死亡影响的RR=1.27（95%CI=0.68~2.38）;孕期干预组单独补充锌对出生体重影响的MD=-30.73（95%CI=-86.82~25.35）,对早产影响的RR=0.89（95%CI=0.71~1.11）,对低出生体重影响的RR=0.77（95%CI=0.44~1.37）;而含锌的多种微量营养素联合补充对出生体重影响的MD=38.13（95%CI=-20.60~96.85）,对出生身长影响的MD=-0.08（95%CI=-0.24~0.08）,对出生头围影响的MD=-0.02（95%CI=-0.18~0.13）,对早产影响的RR=0.78（95%CI=0.64~0.95）,对低出生体重影响的RR=0.80（95%CI=0.51~1.26）。结论 孕期单独补充锌可降低早产的发生,但对新生儿出生体重、出生身长、出生头围、低出生体重和围生期死亡无影响。

Objective To comprehensively summarize the associations between zinc supplementation and birth weight, birth length, birth head circumference, preterm birth, low birth weight, and death in the perinatal period of neo- nates and to provide evidences for zinc supplementation in pregnant women. Methods We searched PubMed, EMBASE, OVID, SCOPUS, Web of Science, Sino Med （CBM）and Wanfang database and collected data about birth weight, birth length ,birth head circumference ,preterm birth, low birth weight and death in the perinatal period from the included studies. The data were analyzed with Review Manager 5.2. Results Fifteen randomized controlled trial studies with sufficient information were included. The combined mean difference （MD） （95 % confidence interval E 95 % CI] ）of zinc supplementation was 18.13 （ - 26. 72 - 62. 99） for birth weight, - 0. 10 （ - 0. 24 - 0. 03 ） for birth length, - 0. 04 （ - 0. 13 - 0. 05 ） for birth head circumference. The combined risk ratio（RR） （ 95% CI） was 0. 84 （ 0. 74 - 0. 96 ） for pre- term birth,0. 85 （0. 66 - 1.11 ）for low birth weight, 1.27 （0. 68 -2. 38 ）for death in the perinatal period of neonates. The combined MD（95% CI） of only zinc supplementation was - 30. 73 （ - 86. 82 - 25.35 ） for birth weight. The combined RR （ 95 % C1） of only zinc supplementation was 0. 89 （ 0. 71 - 1.11 ） for preterm birth, 0. 77 （ 0.44 - 1.37 ） for low birth weight. Similarly, the combined MD（95% C1）of multiple micronutrients supplementation with zinc was 38. 13 （ -20. 60 - 96. 85 ） for birth weight, - 0. 08 （ - 0. 24 - 0. 08 ） for birth length, - 0. 02 （ - 0. 18 - 0. l 3 ） for birth head circumfer- ence. The combined RR （95 % CI） was 0. 78 （ 0. 64 - 0. 95 ） for preterm birth, 0. 80 （ 0. 51 - 1.26 ） for low birth weight. Conclusion The results of this analysis indicate that zinc supplementation could reduce preterm birth and has significant effects on birth weight, birth length, head circumference,low birth weight and death of neonates in the perinatal period.