Dietary Patterns and Diet Quality before and/or during Pregnancy and How These Affect Birth Outcomes: A Systematic Review and Meta-analysis

IF 9.2 1区医学 Q1 NUTRITION & DIETETICS

Advances in Nutrition Pub Date : 2025-08-12 DOI:10.1016/j.advnut.2025.100490

Cristal Salatas , Anja Bronnert , Robyn Lawrence , Tanith Alexander , Clare Wall , Frank H Bloomfield , Luling Lin

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引用次数: 0

Abstract

Limited consistent evidence exists on how diet quality before and during pregnancy influences preterm birth and low birthweight risk. This study aims to assess whether diet quality based on dietary patterns before and during pregnancy affects preterm birth and low birthweight risk. We systematically searched 3 electronic databases and 4 registries for randomized controlled trials (RCTs) and quasi-RCTs without restrictions on publication date or language until 22 November, 2024. Included RCTs evaluated dietary patterns to enhance diet quality before/during pregnancy compared with a usual diet or placebo. Results were synthesized using random-effects meta-analyses with risk ratios (RRs) and 95% confidence intervals. Study quality was assessed using the Cochrane Risk of Bias 1 tool, and certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. Twenty-nine RCTs (7367 participants) were included. Improved diet quality through dietary patterns providing the recommended macronutrient intake or high unsaturated fats before and during pregnancy reduced the incidence of low birthweight (<2500 g) (7 RCTs, 2178 participants, RR 0.53 [0.37, 0.77], low certainty of evidence) and have potential benefit for reducing preterm birth (15 RCTs, 4949 participants, RR 0.79 [0.62, 1.02], low certainty of evidence) compared with usual diet. The data available support interventions starting in the first trimester (RR 0.30 [0.11, 0.80]), lasting 4–7 mo (RR 0.52 [0.37, 0.73]), with similar effects in both high-/upper-middle-income [RR 0.44 (0.19, 10.04)] and lower-middle-income (RR 0.44 [0.31, 0.63]) populations, especially in low-risk women (RR 0.52 [0.37, 0.73]). Diets providing the recommended macronutrient intake or high in unsaturated fats significantly reduced risk of low birthweight when initiated in the first trimester and maintained for 4–7 mo, regardless of country-level socioeconomic context. Healthcare providers should consider recommending dietary patterns emphasizing whole foods and high-quality fats as part of early prenatal care.

This trial was registered at PROSPERO as CRD42023462517.

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怀孕前和/或怀孕期间的饮食模式和饮食质量以及它们如何影响分娩结果：一项系统回顾和荟萃分析。

背景：关于孕前和孕期饮食质量如何影响早产和低出生体重风险的证据有限。目的：评估基于孕前和孕期饮食模式的饮食质量是否影响早产和低出生体重风险。方法：系统检索3个电子数据库和4个注册库的随机对照试验（rct）和准rct，不限制发表日期和语言，截止日期为2024年11月22日。纳入的随机对照试验评估了与常规饮食或安慰剂相比，在怀孕前/怀孕期间提高饮食质量的饮食模式。结果采用随机效应荟萃分析，采用风险比（rr）和95%置信区间进行综合分析。采用Cochrane Risk of Bias 1工具评估研究质量，采用分级推荐评估、发展和评价（GRADE）方法评估证据的确定性。结果：纳入29项随机对照试验（7,367名受试者）。通过在怀孕前和怀孕期间提供推荐的大量营养素摄入量或高不饱和脂肪的饮食模式改善饮食质量，降低了低出生体重的发生率(结论：在妊娠早期开始并保持4-7个月的饮食中，提供推荐的大量营养素摄入量或高不饱和脂肪显著降低了低出生体重的风险，无论国家层面的社会经济背景如何。医疗保健提供者应考虑推荐强调天然食物和高质量脂肪的饮食模式，作为早期产前护理的一部分。本系统评价在PROSPERO注册为CRD42023462517。意义声明：我们的综述提供了在怀孕早期开始饮食干预的潜在重要性的证据，特别是在妊娠早期提供推荐的大量营养素摄入或高不饱和脂肪饮食，在降低不同社会经济背景下早产和低出生体重的风险方面。此外，通过探索基线风险状态如何潜在地改变干预效果，本综述提供了对影响出生结果的背景因素的更全面的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Nutrition 医学-营养学

CiteScore

17.40

自引率

2.20%

发文量

117

审稿时长

56 days

期刊介绍： Advances in Nutrition (AN/Adv Nutr) publishes focused reviews on pivotal findings and recent research across all domains relevant to nutritional scientists and biomedical researchers. This encompasses nutrition-related research spanning biochemical, molecular, and genetic studies using experimental animal models, domestic animals, and human subjects. The journal also emphasizes clinical nutrition, epidemiology and public health, and nutrition education. Review articles concentrate on recent progress rather than broad historical developments. In addition to review articles, AN includes Perspectives, Letters to the Editor, and supplements. Supplement proposals require pre-approval by the editor before submission. The journal features reports and position papers from the American Society for Nutrition, summaries of major government and foundation reports, and Nutrient Information briefs providing crucial details about dietary requirements, food sources, deficiencies, and other essential nutrient information. All submissions with scientific content undergo peer review by the Editors or their designees prior to acceptance for publication.