母乳喂养对降低宫内暴露高血糖子代超重或肥胖发生风险的Meta分析

Effects of breastfeeding on reducing the risk of overweight and obesity among offspring exposed to intrauterine hyperglycemia: a meta-analysis

目的 系统评价母乳喂养时长和强度对降低宫内暴露高血糖子代超重或肥胖发生风险的作用。方法 计算机检索PubMed、EMbase、Web of Science、CBM、WanFang Data、CNKI和VIP数据库,搜集母乳喂养对降低宫内暴露高血糖子代超重或肥胖发生风险的观察性研究,检索时限均从建库至2021年9月25日。由2位研究员独立筛选文献、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13个研究,包括12 657例研究对象。Meta分析结果显示母乳喂养可降低宫内暴露高血糖子代超重或肥胖的发生风险[OR=0.67,95%CI(0.53,0.84),P=0.001]。母乳喂养1~6个月[OR=0.53,95%CI(0.37,0.75),P<0.001]和≥6个月[OR=0.56,95%CI(0.46,0.69),P<0.001]对宫内暴露高血糖子代超重或肥胖的发生均有保护作用,母乳喂养超过6个月后,延长母乳喂养时长,并不能增加其保护作用。但母乳喂养时长小于1个月为宫内暴露高血糖子代发生超重或肥胖的危险因素[OR=2.15,95%CI(1.41,3.27),P<0.001]。结论 母乳喂养1个月以上可降低宫内暴露高血糖子代超重或肥胖的发生风险,应鼓励孕期高血糖的产妇至少母乳喂养1个月以上,以预防子代超重或肥胖。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the effectiveness of breastfeeding duration and intensity in reducing the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia. Methods The PubMed, EMbase, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect observational studies on the associations of breastfeeding with the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia from inception to September 25th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Stata 16.0 software was used for the metaanalysis. Results A total of 12 657 participants from 13 observational studies were included. The results of meta-analysis showed that breastfeeding could reduce the risk of overweight or obesity among offspring exposed to intrauterine hyperglycemia(OR=0.67, 95%CI 0.53 to 0.84, P=0.001). Subgroup analysis revealed a protective effect of breastfeeding for both 1-6 months(OR=0.53, 95%CI 0.37 to 0.75, P<0.001) and ≥6 months(OR=0.56, 95%CI 0.46 to 0.69, P<0.001);however, breastfeeding shorter than one month was suggested to increase the risk of overweight or obesity(OR=2.15,95%CI 1.41 to 3.27, P<0.001). Conclusion Available evidence suggests that breastfeeding for more than one month is effective in reducing the risk of overweight or obesity in offspring exposed to intrauterine hyperglycemia, and women with hyperglycemia should be encouraged to breastfeed their offspring for at least 1 month to achieve the effect. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.