孕期运动预防妊娠期糖尿病效果的系统评价再评价
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摘要
目的对孕期运动预防妊娠期糖尿病相关的系统评价进行再评价。方法计算机检索Cochrane Library,Joanna Briggs Institute Library,PubMed,Web of Science,EMBASE,CINAHL以及中国生物医学文献摘要数据库、中国知网、万方数据库、维普中文科技期刊数据库,检索孕期运动预防妊娠期糖尿病相关的系统评价/Meta分析,2位研究者独立进行文献筛选和资料提取,分别采用AMSTAR量表和GRADE系统对纳入文献进行方法学质量和证据质量评价。结果最终共纳入14篇系统评价/Meta分析。采用AMSTAR 2工具进行方法学质量评价的结果为1篇高水平、1篇中水平、3篇低水平、9篇极低水平。采用GRADE进行证据质量评价的结果显示,14个结局指标中大部分证据质量等级为低或极低。孕期运动在降低妊娠期糖尿病发生率、控制孕期体质量增长值、降低部分不良妊娠结局的发生风险(包括早产、剖宫产、妊娠期高血压疾病、巨大儿)等方面存在一定效果。结论目前孕期运动预防妊娠期糖尿病相关的系统评价的方法学质量总体中等,但是证据质量等级不高,仍需要更多的大样本、高质量的原始研究进行进一步的探讨。孕期运动可作为控制妊娠期糖尿病发生风险的干预措施之一,在孕早期可鼓励无运动禁忌症的孕妇开始运动锻炼,由专业人员制定适宜的运动方案以保证预期的运动效果并保障母儿的安全。
Objective To overview the systematic reviews/meta-analysis(SRs/MAs) of effectiveness of exercise during pregnancy for preventing gestational diabetes mellitus(GDM).Methods Cochrane Library, Joanna Briggs Institute Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI, Wan Fang Data and VIP were searched through computer to collect systematic reviews or meta-analysis of effectiveness of exercise during pregnancy for preventing gestational diabetes mellitus. Two researchers independently conducted literature search and data extraction. The methodological quality and evidence quality of included researches were relatively evaluated using AMSTAR 2 scale and GRADE system.Results A total of 14 SRs/MAs were included. The results of AMSTAR 2 evaluation showed that 1 of included researches was of high quality, 1 was of middle quality, 3 were of low quality, and rest were of very low level. The results of GRADE evaluation showed that most of 14 outcomes were of low or very low quality.According to the results of this study, exercise during pregnancy may be effective on reducing the incidence of GDM, controlling gestational weight gain, reducing several adverse pregnancy outcomes(including preterm, caesarean section, pregnancy-induced hypertension, and macrosomia).Conclusion The methodological quality of include SRs/MAs was among the middle level, while the evidence quality was among the poor level and more large-sample and high qualify researches regarding exercise during pregnancy are needed. Exercise during pregnancy can be regarded as an intervention to control the incidence of GDM, and pregnant women can be encouraged to begin exercising at the early stage of pregnancy; meanwhile, professionals are needed to make suitable exercise plans for pregnant women to ensure the effectiveness and safety of exercising.
Objective To overview the systematic reviews/meta-analysis(SRs/MAs) of effectiveness of exercise during pregnancy for preventing gestational diabetes mellitus(GDM).Methods Cochrane Library, Joanna Briggs Institute Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI, Wan Fang Data and VIP were searched through computer to collect systematic reviews or meta-analysis of effectiveness of exercise during pregnancy for preventing gestational diabetes mellitus. Two researchers independently conducted literature search and data extraction. The methodological quality and evidence quality of included researches were relatively evaluated using AMSTAR 2 scale and GRADE system.Results A total of 14 SRs/MAs were included. The results of AMSTAR 2 evaluation showed that 1 of included researches was of high quality, 1 was of middle quality, 3 were of low quality, and rest were of very low level. The results of GRADE evaluation showed that most of 14 outcomes were of low or very low quality.According to the results of this study, exercise during pregnancy may be effective on reducing the incidence of GDM, controlling gestational weight gain, reducing several adverse pregnancy outcomes(including preterm, caesarean section, pregnancy-induced hypertension, and macrosomia).Conclusion The methodological quality of include SRs/MAs was among the middle level, while the evidence quality was among the poor level and more large-sample and high qualify researches regarding exercise during pregnancy are needed. Exercise during pregnancy can be regarded as an intervention to control the incidence of GDM, and pregnant women can be encouraged to begin exercising at the early stage of pregnancy; meanwhile, professionals are needed to make suitable exercise plans for pregnant women to ensure the effectiveness and safety of exercising.
引文
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[7] Martin C L,Brunner L R.Physical activity and hypertensive complications during pregnancy:Findings from 2004 to 2006 north Carolina pregnancy risk assessment monitoring system[J].Birth-Issues in Perinatal Care,2010,37(3):202-210.
[8] Fortner R T,Pekow P S,Whitcomb B W,et al.Physical activity and hypertensive disorders of pregnancy among Hispanic women[J].Medicine and Science in Sports and Exercise,2011,43(4):639-646.
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[12] Cordero Y,Mottola M F,Vargas J,et al.Exercise is associated with a reduction in gestational diabetes mellitus[J].Medicine and Science in Sports and Exercise,2015,47(7):1328-1333.
[13] Barakat R,Pelaez M,Lopez C,et al.Exercise during pregnancy and gestational diabetes-related adverse effects:A randomised controlled trial[J].British Journal of Sports Medicine,2013,47(10):630-636.
[14] Stafne S N,Salvesen K A,Romundstad P R,et al.Regular exercise during pregnancy to prevent gestational diabetes a randomized controlled trial[J].Obstetrics and Gynecology,2012,119(1):29-36.
[15] Nobles C,Marcus B H,Stanek E J,et al.Effect of an exercise intervention on gestational diabetes mellitus a randomized controlled trial[J].Obstetrics and Gynecology,2015,125(5):1195-1204.
[16] Callaway L K,Colditz P B,Byrne N M,et al.Prevention of gestational diabetes feasibility issues for an exercise intervention in obese pregnant women[J].Diabetes Care,2010,33(7):1457-1459.
[17] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J].中国循证医学杂志,2011,11(9):1084-1089.
[18] 陶欢,杨乐天,平安,等.随机或非随机防治性研究系统评价的质量评价工具AMSTAR 2解读[J].中国循证医学杂志,2018,18(1):101-108.
[19] 陈耀龙,姚亮,Norris S,等.GRADE在系统评价中应用的必要性及注意事项[J].中国循证医学杂志,2013,13(12):1401-1404.
[20] Yu Y,Xie R,Shen C,et al.Effect of exercise during pregnancy to prevent gestational diabetes mellitus:A systematic review and meta-analysis[J].The Journal of Maternal-fetal & Neonatal Medicine,2018,31(12):1632-1637.
[21] Sanabria-Martinez G,Garcia-Hermoso A,Poyatos-Leon R,et al.Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain:A meta-analysis[J].Bjog-an International Journal of Obstetrics and Gynaecology,2015,122(9):1167-1174.
[22] Di Mascio D,Magro-Malosso E R,Saccone G,et al.Exercise during pregnancy in normal-weight women and risk of preterm birth:A systematic review and meta-analysis of randomized controlled trials[J].American Journal of Obstetrics and Gynecology,2016,215(5):561-571.
[23] Magro-Malosso E R,Saccone G,Di Mascio D,et al.Exercise during pregnancy and risk of preterm birth in overweight and obese women:A systematic review and meta-analysis of randomized controlled trials[J].Acta Obstetricia Et Gynecologica Scandinavica,2017,96(3):263-273.
[24] Han S,Middleton P,Crowther C A.Exercise for pregnant women for preventing gestational diabetes mellitus[J].Cochrane database of systematic reviews (Online),2012,7:CD009021.
[25] Zheng J,Wang H,Ren M.Influence of exercise intervention on gestational diabetes mellitus:A systematic review and meta-analysis[J].Journal of Endocrinological Investigation,2017,40(10):1027-1033.
[26] Bennett C J,Walker R E,Blumfield M L,et al.Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus:A systematic review and meta-analysis of randomised controlled trials[J].Diabetes research and clinical practice,2018,141:69-79.
[27] Oostdam N,Van Poppel M N,Wouters M G,et al.Interventions for preventing gestational diabetes mellitus:A systematic review and meta-analysis[J].J Womens Health (Larchmt),2011,20(10):1551-11563.
[28] Silva S,Ricardo L,Evenson K,et al.Leisure-time physical activity in pregnancy and maternal-child health:A systematic review and meta-analysis of randomized controlled trials and cohort studies[J].Sports Medicine,2017,47(2):295-317.
[29] Aune D,Sen A,Henriksen T,et al.Physical activity and the risk of gestational diabetes mellitus:A systematic review and dose-response meta-analysis of epidemiological studies[J].European Journal of Epidemiology,2016,31(10):967-997.
[30] Yin Y N,Li X L,Tao T J,et al.Physical activity during pregnancy and the risk of gestational diabetes mellitus:A systematic review and meta-analysis of randomised controlled trials[J].British Journal of Sports Medicine,2014,48(4):290-295.
[31] Russo L M,Nobles C,Ertel K A,et al.Physical activity interventions in pregnancy and risk of gestational diabetes mellitus a systematic review and meta-analysis[J].Obstetrics and Gynecology,2015,125(3):576-582.
[32] Madhuvrata P,Govinden G,Bustani R,et al.Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes:A systematic review and meta-analysis of randomised trials[J].Obstetric Medicine,2015,8(2):68-85.
[33] 吴奇云,冯世萍,周瑜.孕期运动干预对妊娠结局影响的系统评价[J].解放军护理杂志,2018,35(1):1-7.
[34] 王晨,杨慧霞.孕期运动在妊娠期糖尿病预防和管理中的作用[J].中华妇幼临床医学杂志(电子版),2014,10(5):104-107.
[35] Redden S L,Lamonte M J,Freudenheim J L,et al.The association between gestational diabetes mellitus and recreational physical activity[J].Matern Child Health J,2011,15(4):514-519.
[36] Harizopoulou V C,Kritikos A,Papanikolaou Z,et al.Maternal physical activity before and during early pregnancy as a risk factor for gestational diabetes mellitus[J].Acta diabetologica,2010,47(Suppl 1):83-89.
[37] Dempsey J C,Butler C L,Sorensen T K,et al.A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus[J].Diabetes Res Clin Pract,2004,66(2):203-215.
[38] Retnakaran R,Qi Y,Sermer M,et al.Pre-gravid physical activity and reduced risk of glucose intolerance in pregnancy:The role of insulin sensitivity[J].Clinical endocrinology,2009,70(4):615-622.
[39] Oken E,Ning Y,Rifas-Shiman S L,et al.Associations of physical activity and inactivity before and during pregnancy with glucose tolerance[J].Obstet Gynecol,2006,108(5):1200-1207.
[40] Barakat R,Cordero Y,Coteron J,et al.Exercise during pregnancy improves maternal glucose screen at 24-28 weeks:A randomised controlled trial[J].Br J Sports Med,2012,46(9):656-661.
[41] Stafne S N,Salvesen K A,Romundstad P R,et al.Regular exercise during pregnancy to prevent gestational diabetes:A randomized controlled trial[J].Obstet Gynecol,2012,119(1):29-36.
[42] Barakat R,Pelaez M,Lopez C,et al.Exercise during pregnancy and gestational diabetes-related adverse effects:A randomised controlled trial[J].Br J Sports Med,2013,47(10):630-636.
[43] Ramirez-Velez R.A 12-week exercise program performed during the second trimester does not prevent gestational diabetes in healthy pregnant women[J].J Physiother,2012,58(3):198.
[44] 王子莲.妊娠期糖尿病运动治疗[J].中国实用妇科与产科杂志,2013,29(4):250-252.
[45] Hui A,Back L,Ludwig S,et al.Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial[J].BJOG:An International Journal of Obstetrics and Gynaecology,2012,119(1):70-77.
[46] Nascimento S L,Surita F G,Parpinelli M A,et al.The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women:A randomised clinical trial[J].BJOG-an International Journal of Obstetrics and Gynaecology,2011,118(12):1455-1463.
[47] Songoygard K M,Stafne S N,Evensen K A,et al.Does exercise during pregnancy prevent postnatal depression?A randomized controlled trial[J].Acta Obstet Gynecol Scand,2012,91(1):62-67.
[2] Bellamy L,Casas J P,Hingorani A D,et al.Type 2 diabetes mellitus after gestational diabetes:A systematic review and meta-analysis[J].Lancet,2009,373(9677):1773-1779.
[3] Leiferman J,Swibas T,Koiness K,et al.My Baby,My move:Examination of perceived barriers and motivating factors related to antenatal physical activity[J].Journal of Midwifery & Womens Health,2011,56(1):33-40.
[4] Price B B,Amini S B,Kappeler K.Exercise in pregnancy:Effect on fitness and obstetric outcomes-a randomized trial[J].Medicine and Science in Sports and Exercise,2012,44(12):2263-2269.
[5] Hui A,Back L,Ludwig S,et al.Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial[J].Bjog-an International Journal of Obstetrics and Gynaecology,2012,119(1):70-77.
[6] Streuling I,Beyerlein A,Rosenfeld E,et al.Physical activity and gestational weight gain:A meta-analysis of intervention trials[J].Bjog-an International Journal of Obstetrics and Gynaecology,2011,118(3):278-284.
[7] Martin C L,Brunner L R.Physical activity and hypertensive complications during pregnancy:Findings from 2004 to 2006 north Carolina pregnancy risk assessment monitoring system[J].Birth-Issues in Perinatal Care,2010,37(3):202-210.
[8] Fortner R T,Pekow P S,Whitcomb B W,et al.Physical activity and hypertensive disorders of pregnancy among Hispanic women[J].Medicine and Science in Sports and Exercise,2011,43(4):639-646.
[9] American Diabetes Association.Standards of medical care in diabetes-2018[J].Diabetes Care,2018,41(Suppl 1):S1-S159.
[10] 中华医学会妇产科学分会产科学组,围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].糖尿病临床,2014,8(11):489-498.
[11] Wang C,Wei Y,Zhang X,et al.Effect of regular exercise commenced in early pregnancy on the incidence of gestational diabetes mellitus in overweight and obese pregnant women:A randomized controlled trial[J].Diabetes Care,2016,39(10):E163-E164.
[12] Cordero Y,Mottola M F,Vargas J,et al.Exercise is associated with a reduction in gestational diabetes mellitus[J].Medicine and Science in Sports and Exercise,2015,47(7):1328-1333.
[13] Barakat R,Pelaez M,Lopez C,et al.Exercise during pregnancy and gestational diabetes-related adverse effects:A randomised controlled trial[J].British Journal of Sports Medicine,2013,47(10):630-636.
[14] Stafne S N,Salvesen K A,Romundstad P R,et al.Regular exercise during pregnancy to prevent gestational diabetes a randomized controlled trial[J].Obstetrics and Gynecology,2012,119(1):29-36.
[15] Nobles C,Marcus B H,Stanek E J,et al.Effect of an exercise intervention on gestational diabetes mellitus a randomized controlled trial[J].Obstetrics and Gynecology,2015,125(5):1195-1204.
[16] Callaway L K,Colditz P B,Byrne N M,et al.Prevention of gestational diabetes feasibility issues for an exercise intervention in obese pregnant women[J].Diabetes Care,2010,33(7):1457-1459.
[17] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J].中国循证医学杂志,2011,11(9):1084-1089.
[18] 陶欢,杨乐天,平安,等.随机或非随机防治性研究系统评价的质量评价工具AMSTAR 2解读[J].中国循证医学杂志,2018,18(1):101-108.
[19] 陈耀龙,姚亮,Norris S,等.GRADE在系统评价中应用的必要性及注意事项[J].中国循证医学杂志,2013,13(12):1401-1404.
[20] Yu Y,Xie R,Shen C,et al.Effect of exercise during pregnancy to prevent gestational diabetes mellitus:A systematic review and meta-analysis[J].The Journal of Maternal-fetal & Neonatal Medicine,2018,31(12):1632-1637.
[21] Sanabria-Martinez G,Garcia-Hermoso A,Poyatos-Leon R,et al.Effectiveness of physical activity interventions on preventing gestational diabetes mellitus and excessive maternal weight gain:A meta-analysis[J].Bjog-an International Journal of Obstetrics and Gynaecology,2015,122(9):1167-1174.
[22] Di Mascio D,Magro-Malosso E R,Saccone G,et al.Exercise during pregnancy in normal-weight women and risk of preterm birth:A systematic review and meta-analysis of randomized controlled trials[J].American Journal of Obstetrics and Gynecology,2016,215(5):561-571.
[23] Magro-Malosso E R,Saccone G,Di Mascio D,et al.Exercise during pregnancy and risk of preterm birth in overweight and obese women:A systematic review and meta-analysis of randomized controlled trials[J].Acta Obstetricia Et Gynecologica Scandinavica,2017,96(3):263-273.
[24] Han S,Middleton P,Crowther C A.Exercise for pregnant women for preventing gestational diabetes mellitus[J].Cochrane database of systematic reviews (Online),2012,7:CD009021.
[25] Zheng J,Wang H,Ren M.Influence of exercise intervention on gestational diabetes mellitus:A systematic review and meta-analysis[J].Journal of Endocrinological Investigation,2017,40(10):1027-1033.
[26] Bennett C J,Walker R E,Blumfield M L,et al.Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus:A systematic review and meta-analysis of randomised controlled trials[J].Diabetes research and clinical practice,2018,141:69-79.
[27] Oostdam N,Van Poppel M N,Wouters M G,et al.Interventions for preventing gestational diabetes mellitus:A systematic review and meta-analysis[J].J Womens Health (Larchmt),2011,20(10):1551-11563.
[28] Silva S,Ricardo L,Evenson K,et al.Leisure-time physical activity in pregnancy and maternal-child health:A systematic review and meta-analysis of randomized controlled trials and cohort studies[J].Sports Medicine,2017,47(2):295-317.
[29] Aune D,Sen A,Henriksen T,et al.Physical activity and the risk of gestational diabetes mellitus:A systematic review and dose-response meta-analysis of epidemiological studies[J].European Journal of Epidemiology,2016,31(10):967-997.
[30] Yin Y N,Li X L,Tao T J,et al.Physical activity during pregnancy and the risk of gestational diabetes mellitus:A systematic review and meta-analysis of randomised controlled trials[J].British Journal of Sports Medicine,2014,48(4):290-295.
[31] Russo L M,Nobles C,Ertel K A,et al.Physical activity interventions in pregnancy and risk of gestational diabetes mellitus a systematic review and meta-analysis[J].Obstetrics and Gynecology,2015,125(3):576-582.
[32] Madhuvrata P,Govinden G,Bustani R,et al.Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes:A systematic review and meta-analysis of randomised trials[J].Obstetric Medicine,2015,8(2):68-85.
[33] 吴奇云,冯世萍,周瑜.孕期运动干预对妊娠结局影响的系统评价[J].解放军护理杂志,2018,35(1):1-7.
[34] 王晨,杨慧霞.孕期运动在妊娠期糖尿病预防和管理中的作用[J].中华妇幼临床医学杂志(电子版),2014,10(5):104-107.
[35] Redden S L,Lamonte M J,Freudenheim J L,et al.The association between gestational diabetes mellitus and recreational physical activity[J].Matern Child Health J,2011,15(4):514-519.
[36] Harizopoulou V C,Kritikos A,Papanikolaou Z,et al.Maternal physical activity before and during early pregnancy as a risk factor for gestational diabetes mellitus[J].Acta diabetologica,2010,47(Suppl 1):83-89.
[37] Dempsey J C,Butler C L,Sorensen T K,et al.A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus[J].Diabetes Res Clin Pract,2004,66(2):203-215.
[38] Retnakaran R,Qi Y,Sermer M,et al.Pre-gravid physical activity and reduced risk of glucose intolerance in pregnancy:The role of insulin sensitivity[J].Clinical endocrinology,2009,70(4):615-622.
[39] Oken E,Ning Y,Rifas-Shiman S L,et al.Associations of physical activity and inactivity before and during pregnancy with glucose tolerance[J].Obstet Gynecol,2006,108(5):1200-1207.
[40] Barakat R,Cordero Y,Coteron J,et al.Exercise during pregnancy improves maternal glucose screen at 24-28 weeks:A randomised controlled trial[J].Br J Sports Med,2012,46(9):656-661.
[41] Stafne S N,Salvesen K A,Romundstad P R,et al.Regular exercise during pregnancy to prevent gestational diabetes:A randomized controlled trial[J].Obstet Gynecol,2012,119(1):29-36.
[42] Barakat R,Pelaez M,Lopez C,et al.Exercise during pregnancy and gestational diabetes-related adverse effects:A randomised controlled trial[J].Br J Sports Med,2013,47(10):630-636.
[43] Ramirez-Velez R.A 12-week exercise program performed during the second trimester does not prevent gestational diabetes in healthy pregnant women[J].J Physiother,2012,58(3):198.
[44] 王子莲.妊娠期糖尿病运动治疗[J].中国实用妇科与产科杂志,2013,29(4):250-252.
[45] Hui A,Back L,Ludwig S,et al.Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial[J].BJOG:An International Journal of Obstetrics and Gynaecology,2012,119(1):70-77.
[46] Nascimento S L,Surita F G,Parpinelli M A,et al.The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women:A randomised clinical trial[J].BJOG-an International Journal of Obstetrics and Gynaecology,2011,118(12):1455-1463.
[47] Songoygard K M,Stafne S N,Evensen K A,et al.Does exercise during pregnancy prevent postnatal depression?A randomized controlled trial[J].Acta Obstet Gynecol Scand,2012,91(1):62-67.