不同地区妊娠期妇女补充叶酸与妊娠期糖尿病发病风险关系的Meta分析

Meta-Analysis of the Association Between Folic Acid Supplementation and Risk of Gestational Diabetes Mellitus in Pregnant Women from Different Regions

目的 系统评价不同地区妊娠期妇女补充叶酸与妊娠期糖尿病(GDM)发病风险的关系。方法 计算机检索PubMed,Web of Science,The Cochrane Library,Embase,ClinicalTrials. gov,Chinese Clinical Trial Registry及中国生物医学文献服务系统、中国知网、万方、维普等数据库中自建库起至2022年2月的相关文献,由2名研究员根据纳入及排除标准筛选文献,并提取资料。采用纽卡斯尔-渥太华量表评价纳入文献的质量,采用RevMan 5.4软件进行Meta分析,采用Stata 12.0软件进行Egger线性回归分析。结果 共纳入6篇文献,涉及30 027例受试者。Meta分析结果显示,与未补充叶酸的妊娠期妇女相比,所有地区妊娠期妇女补充叶酸后GDM发病风险差异不显著[OR=1.07,95%CI(0.75,1.51),P=0.72];亚洲地区以外妊娠期妇女补充叶酸可显著降低GDM的发病风险[OR=0.76,95%CI(0.67,0.86),P <0.000 1];亚洲地区妊娠期妇女补充叶酸可显著升高GDM的发病风险[OR=1.49,95%CI(1.16,1.91),P=0.002];亚洲地区妊娠期妇女孕前及孕早、中期补充叶酸有升高GDM发病风险的趋势,但差异不显著[OR=1.39,95%CI(0.99,1.96),P=0.06];亚洲地区妊娠期妇女孕前及孕期补充叶酸可显著升高GDM的发病风险[OR=1.62,95%CI(1.13,2.33),P=0.009]。结论 亚洲地区以外妊娠期妇女补充叶酸可降低GDM的发病风险,亚洲地区妊娠期妇女补充叶酸可升高GDM的发病风险,且这种趋势会随叶酸补充时间的延长而增强。

Objective To evaluate the association between the folic acid supplementation and the risk of gestational diabetes mellitus(GDM)in pregnant women from different regions.Methods The relevant studies in the PubMed,Web of Science,The Cochrane Library,Embase,ClinicalTrials.gov,Chinese Clinical Trial Registry,SinoMed,CNKI,WanFang and VIP databases from the inception to February 2022 were searched.The studies were screened according to the inclusion and exclusion criteria and the data were extracted by two researchers.The Newcastle-Ottawa Scale was used to evaluate the quality of included studies,the RevMan 5.4 software was used for Meta-analysis,and the Stata 12.0 software was used for Egger linear regression analysis.Results A total of six studies were included,involving 30027 participants.The results of Meta-analysis showed that compared with that in the pregnant women without folic acid supplementation,there was no significant difference in the risk of GDM in the pregnant women with folic acid supplementation in all regions[OR=1.07,95%CI(0.75,1.51),P=0.72];the risk of GDM in the pregnant women with folic acid supplementation outside Asia was significantly lower[OR=0.76,95%CI(0.67,0.86),P<0.0001];while the risk of GDM in the pregnant women with folic acid supplementation in Asia was significantly higher[OR=1.49,95%CI(1.16,1.91),P=0.002];the risk of GDM in the pregnant women with folic acid supplementation before pregnancy and in the first and second trimesters of pregnancy in Asia was higher,but the difference was not significant[OR=1.39,95%CI(0.99,1.96),P=0.06];the risk of GDM in the pregnant women with folic acid supplementation before and during pregnancy in Asia was significantly higher[OR=1.62,95%CI(1.13,2.33),P=0.009].Conclusion Folic acid supplementation in the pregnant women outside Asia can decrease the risk of GDM,while that in the pregnant women in Asia can increase the risk of GDM,and this trend will increase with the prolongation of folic acid supplementation.