母乳喂养 4 至 6 个月妇女的腰椎骨矿物质密度:系统回顾和荟萃分析

IF 2.9 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Larissa Brazolotto Ferreira, Keny Gonçalves Tirapeli, Carla Cristiane Silva, Tamara Beres Lederer Goldberg
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引用次数: 0

摘要

在母乳喂养期间,为了满足母乳生产对钙的需求,母体骨骼中的钙平衡发生了重要的短暂变化。关于纯母乳喂养(4 至 6 个月)导致骨密度测量受影响的原因和百分比,文献尚无定论。本文旨在系统回顾相关文献,以确定纯母乳喂养 4 至 6 个月期间产妇骨质密度(BMD)变化的发生率、强度和相关因素。2023 年 6 月,在虚拟健康图书馆、Scielo(科学电子图书馆在线)、CAPES Periodicals Portal、LILACS、Embase、PubMed/Medline、Cochrane、Scopus 和 Web of Science 等电子数据库中使用了 "妇女"、"母乳喂养"、"母乳 "和 "骨矿物质密度 "等检索描述符。母乳喂养母亲的纳入标准是:年龄在 40 岁以下、初产妇、纯母乳喂养、使用双能 X 光吸收测量法(DXA)评估 BMD,并在基线和产后 4 至 6 个月期间显示数值。研究采用 Jadad 量表、纽卡斯尔-渥太华量表和牛津循证医学中心证据等级来评估研究质量。在荟萃分析研究中,进行了统计计算。通过搜索策略初步找到了 381 篇文章,并全文阅读了 26 篇。经过偏倚风险分析,16 篇文章被保留在系统综述中,4 篇文章被纳入荟萃分析。这些研究表明,与较长时间的母乳喂养(12-18 个月)相比,产后头几个月(4-6 个月)腰椎的骨量有所减少。在荟萃分析中,母乳喂养组比对照组(非母乳喂养、怀孕或产后立即喂养)的影响更大,腰椎骨密度减少了-0.18 克/平方厘米(-0.36,-0.01 克/平方厘米);95% 置信区间,从 0 到 10。我们的研究结果表明,在 4 到 6 个月的纯母乳喂养期间,腰椎的骨密度测量会出现暂时性降低,但在产后会逐渐恢复。要更好地理解这一主题,还需要更多的前瞻性研究。PROSPERO 平台(编号 CRD42021279199),2021 年 11 月 12 日。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lumbar spine bone mineral density in women breastfeeding for a period of 4 to 6 months: systematic review and meta-analysis
During the breastfeeding period, important transient changes in calcium homeostasis are verified in the maternal skeleton, to meet the demand for calcium for breastmilk production. The literature is inconclusive regarding the causes and percentages of involvement of bone densitometry resulting from exclusive breastfeeding (4 to 6 months). This article aims to systematically review the literature, to determine the occurrence, intensity, and factors involved in alterations in maternal bone mineral density (BMD), during a period of 4 to 6 months of exclusive breastfeeding. The search descriptors “woman”, “breastfeeding”, “human milk”, and “bone mineral density” were used in the electronic databases of the Virtual Health Library, Scielo (Scientific Electronic Library Online), CAPES Periodicals Portal, LILACS, Embase, PubMed/Medline, Cochrane, Scopus, and Web of Science in June 2023. Inclusion criteria for breastfeedingmothers were; aged to 40 years, primigravida, exclusively breastfeeding, with BMD assessments using dual-energy X-ray absorptiometry (DXA), with values expressed at baseline and from 4 to 6 months postpartum. The Jadad scale, Newcastle–Ottawa Scale, and Oxford Centre for Evidence-based Medicine – levels of evidence were adopted to assess the quality of the studies. For the meta-analytical study, statistical calculations were performed. Initially, 381 articles were found using the search strategy and 26 were read in full. After risk of bias analysis, 16 articles remained in the systematic review and four were included in the meta-analysis. The studies showed a reduction in bone mass in the lumbar spine in the first months postpartum (4 – 6 months), when compared with a longer period of breastfeeding (12–18 months). The breastfeeding group presented a greater impact in the meta-analysis than the control group (non-breastfeeding, pregnant, or immediate postpartum), with a reduction in BMD in the lumbar spine of -0.18 g/cm2 (-0.36, -0.01 g/cm2); 95% Confidence Interval, on a scale from 0 to 10. Our results demonstrated a transitory reduction in bone densitometry of the lumbar spine during exclusive breastfeeding for 4 to 6 months, which was gradually restored later in the postpartum period. More prospective studies are needed to better understand the topic. PROSPERO platform (nº CRD42021279199), November 12th, 2021.
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来源期刊
International Breastfeeding Journal
International Breastfeeding Journal Medicine-Obstetrics and Gynecology
CiteScore
6.30
自引率
11.40%
发文量
76
审稿时长
32 weeks
期刊介绍: Breastfeeding is recognized as an important public health issue with enormous social and economic implications. Infants who do not receive breast milk are likely to experience poorer health outcomes than breastfed infants; mothers who do not breastfeed increase their own health risks. Publications on the topic of breastfeeding are wide ranging. Articles about breastfeeding are currently published journals focused on nursing, midwifery, paediatric, obstetric, family medicine, public health, immunology, physiology, sociology and many other topics. In addition, electronic publishing allows fast publication time for authors and Open Access ensures the journal is easily accessible to readers.
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