母乳喂养预防妊娠糖尿病女性产后发展为前驱期糖尿病和糖尿病的Meta分析

The preventive effects of breastfeeding on progression to pre-diabetes mellitus(DM)and DM among females with prior gestational diabetes mellitus: a meta-analysis

目的系统评价母乳喂养强度和喂养时长对有妊娠糖尿病(GDM)病史的女性发展为前驱期糖尿病和糖尿病的影响。方法计算机检索PubMed、Web of Science、CNKI和WanFang Data数据库,搜集GDM和母乳喂养相关性的队列研究,检索时限均为建库至2021年1月8日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行Meta分析。结果共纳入29个队列研究。Meta分析结果显示:母乳喂养可降低有GDM病史女性发生前驱期糖尿病[RR=0.64,95%CI(0.57,0.71),P<0.001]及糖尿病[RR=0.75,95%CI(0.66,0.86),P<0.001]的风险。亚组分析结果显示:母乳喂养0~6月、6~12月均对前驱期糖尿病的发生有保护作用;母乳喂养0~6月及超过12个月均对糖尿病的发生有保护作用,且此保护作用随着母乳喂养时间的延长而变得显著。但未观察到母乳喂养能降低GDM复发[RR=0.72,95%CI(0.47,1.09),P=0.14]。结论母乳喂养对GDM女性产后患前驱期糖尿病、糖尿病均有保护作用。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the preventive effect of breastfeeding intensity and duration on progression to pre-diabetes mellitus(DM) and DM among females with prior gestational diabetes mellitus(GDM).Methods PubMed, Web of Science, CNKI, and WanFang Data databases were electronically searched to collect cohort studies on the correlation of GDM and breastfeeding from inception to January 8 th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software. Results A total of 29 cohort studies were included. The results of the meta-analysis showed that breastfeeding could lower the risk of pre-DM(RR=0.64, 95%CI 0.57 to 0.71, P<0.001) and DM(RR=0.75, 95%CI 0.66 to 0.86, P<0.001) among females with prior GDM. Subgroup analysis showed that breastfeeding exhibited protective effects against pre-DM after 0 to 6 months as well as 6 to 12 months. Both breastfeeding for 0 to 6 months and over 12 months could decrease the risk of DM. These effects became prominent with the extension of the follow-up period.However, no significant association was observed between breastfeeding and recurrence of GDM(RR=0.72, 95%CI 0.47 to1.09, P=0.14). Conclusions Breastfeeding may be a major contributor in protecting against pre-DM and DM among females with prior GDM history. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.