妊娠期补铁对妊娠糖尿病发病率影响的meta分析

A meta analysis of effect of iron supplement during pregnancy on gestational diabetes mellitus

目的：用meta分析方法探讨妊娠期补铁对妊娠糖尿病发病率的影响。方法：计算机检索CochraneLibrary（1980—2015）、PubMed（1980—2015）、WebofKnowledge（1980-2015）、CBMdisc（1980—2015）、中国知网（1980—2015）、万方（1980—2015）、维普（1980—2015）并结合手工检索相关杂志，收集国内外有关妊娠期补铁对妊娠糖尿病发病率影响的随机对照试验（RcT）。对于检索到的文献由两位研究者独立地按照纳入排除标准进行资料提取及方法学质量评价，并采用RevMan5．2软件对妊娠糖尿病发病率进行meta分析，GRADE系统进行证据质量评价和等级推荐。结果：共检索到315篇文献，排除非随机对照试验、干预措施不符合纳入标准、失访情况不明确、重复发表的研究，共纳入2项RCT，累计调查人数1824例，其中补铁干预组921例，常规对照组903例。meta分析显示与常规对照组相比，补铁干预组妊娠糖尿病的发生率无差异（RR=0．95，95％CI：O．68～1．33，P=0．77）。基于GRADE系统的证据推荐等级评价结果显示妊娠糖尿病发生率证据质量为高级。结论：非贫血孕妇妊娠期间补铁不会引起妊娠糖尿病发病率的增加，但仍需更多大规模高质量的随机对照研究进一步确认。

Objective： To explore the effect of iron supplement during pregnancy on gestational diabetes mellitus （GDM）. Method： Medical databases including Cochrane Library, Pub Med, Web of Science, Chinese Biological Medi- cine disk （CBM）, China National Knowledge Internet （CNKI）, Wanfang and VIP were searched from 1980 to 2015 by computer. And some related journals were hand searched. According to the inclusion and exclusion criteria, randomized controlled trials （RCTs） about iron supplement effected on GDM were included, and data of the included RCT were extracted, and the methodological quality was evaluated by two researchers independently. Meta analysis was conducted by RevManS. 2 software and the evidence qualities and recommendation levels were determined according to the GRADE System. Result= 315 articles were retrieved and evaluated. Among them, articles were excluded, which was about non randomized controlled trials, trials without correct interventions, no followed--up situation distinctly , and published repeated. Only two articles with total of 1824 cases （921 cases treated with iron supplement and 920 cases treated with placebo） were included for Meta analysis. There was no significant difference of incidence of GDM in the iron supplement group and placebo group（RR=0.95,95%CI：0.68-1.33,P=0.77）. And based on the GRADE system, the evidence level was high. Conclusion： The result suggests that iron supplement during the pregnancy will not increase the risk of GDM. Further researches should be conducted to prove more evidences.