妊娠糖尿病相关风险因素的系统评价再评价

The risk factors of gestational diabetes mellitus:an overview of systematic reviews

目的:对妊娠糖尿病相关风险因素的系统评价进行系统检索、评价和整合,制作证据图谱,以明确妊娠糖尿病的危险因素和保护因素。方法:采用主题词和自由词相结合在the Cochrane Library、澳大利亚Joanna Briggs Institute(JBI)循证卫生保健中心数据库、PubMed、Web of Science、EMbase、CINAHL、中国知网、维普数据库、万方数据库和中国生物医学文献数据库进行文献检索,由2名研究人员按照纳入与排除标准进行文献筛选、数据提取,采用AMSTAR对纳入文献进行质量评价。结果:共纳入了40篇系统评价,纳入文献的整体方法学质量良好。共提取57个风险因素,按因素性质分为疾病与障碍(n=21)、营养和生活方式(n=15)、生殖相关(n=9)、生物标志物(n=5)和其他因素(n=7)五大类,按风险程度分为保护性因素(10个)和危险因素(47个)。23个风险因素的异质性估计值I 2值<50%,36个风险因素评估了发表偏倚,其中,39%的报告不存在发表偏倚。结论:妊娠糖尿病是遗传与环境等多种因素共同作用的结果,其发病的危险因素多种多样,基于多种因素进行妊娠糖尿病的早期预测和管理是未来的研究重点。

Objective:To systematically search,evaluate and integrate the systematic evaluation of risk factors related to gestational diabetes,and make an evidence map to clarify the risk factors and protective factors of gestational diabetes.Methods:The Cochrane Library,Australia Joanna Briggs Institute(JBI)Evidence-based Health Care Center database,PubMed,Web of Science,EMbase,CINAHL,CNKI,VIP,WanFang Database and CBM were combined with subject words and free words to conduct document retrieval.Two researchers screened the literature and extracted the data according to the inclusion and exclusion criteria of the literature,use AMSTAR to evaluate the quality of the included literature.Results:A total of 40 systematic evaluations were included,and the overall methodological quality of the included literature was good.A total of 57 risk factors were extracted and divided into five categories based on their nature:disease and disorder(n=21),nutrition and lifestyle(n=15),reproductive factors(n=9),biomarkers(n=5),and other factors(n=7).According to the degree of risk,it is divided into protective factors(10)and risk factors(47),with an estimated heterogeneity of 23 risk factors I 2<50%,36 risk factors evaluated publication bias,of which 39%of reports did not have publication bias.Conclusion:Gestational diabetes is the result of multiple factors such as heredity and environment,and its risk factors are diverse.Early prediction and management of gestational diabetes based on multiple factors is the focus of future research.