新冠肺炎期间孕产妇贫血防治的效果及干预措施

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.079

John Kyalo PhD

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引用次数: 0

摘要

在COVID-19大流行期间，孕妇面临许多未知因素。其中大多数可能是无声的，但致命的贫血状况可能会加剧妊娠结果的恶化。现有证据表明，一系列因素与损害母体贫血的能力有关，有些是直接的，有些是间接的。目的探讨几种贫血干预措施的综合效果。具体来说，本研究的目的是确定妊娠状态是否与以细胞因子风暴为特征的COVID-19严重程度相关。方法我们检索谷歌Scholar、PubMed、Scopus、Web of Science和Embase数据库，寻找适合纳入本meta分析的研究。包括对育龄妇女进行任何母体贫血干预的研究。使用Cochrane偏倚风险工具评估偏倚风险。使用Review Manager 5.4.1计算95% ci的比率比（rr），用森林样地描述。定量变量以总数和百分比汇总。计算并比较干预组和对照组在预防、控制、管理和/或治疗贫血方面的效果。采用Cochran Q统计量和Higgins检验评估异质性。结果共纳入文献11篇，数据6129人。通过敏感性分析，干预措施对孕产妇贫血预防和管理的效用为39%（随机效应模型RR 0.61, 95% CI 0.43, 0.87; P = 0.006）（χ26=286.98, P< 0.00001; I2=97%）。所有干预措施对孕产妇贫血的效果均为17%（固定效应模型RR 0.83, 95% CI 0.79-0.88; P< 0.00001）（χ24=2.93， P=0.57; I2=0%）。对孕妇的教育效果为28% (RR 0.72 95% CI 0.58, 0.89)，给药效果为19% (RR 0.81 95% CI 0.73, 0.90)，补铁效果为17% (RR 0.83 95% CI 0.75, 0.92)，静脉注射含铁羧基麦芽糖15% (RR 0.85 95% CI 0.74, 0.97) （I2 = 0%）。与其他地区相比，非洲地区的干预措施具有更高（16%）且显著的效果（固定效应模型RR 0.84, 95% CI 0.79-0.89; P<.001）（χ25=176.53, P<.00001; I2=97%）。与单中心研究相比，多中心研究具有显著的预测效果（16%）（固定效应模型RR 0.84, 95% CI 0.79-0.89; P< 0.00001）（χ25=176.53, P< 0.00001; I2=97%）。2020年孕产妇贫血干预效果最高，为28%（随机效应模型RR 0.72, 95% CI 0.67-0.78; P< 0.00001）（χ23=167.34, P< 0.00001; I2=98%）结论新冠肺炎出现后，孕产妇贫血干预在2020年至2022年期间呈现低效果趋势。在此期间，即使是针对产妇贫血的最有效和建议的干预措施也受到某种程度的影响。

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Effect of and Interventions in Prevention and Management of Maternal Anemia in the Advent of COVID-19

Background

There were many unknowns for pregnant women during the COVID-19 pandemic. Most of these could have been silent however lethal and anemic conditions could escalate the worsening of pregnancy outcomes. Existing evidence indicate that, array of factors is associated with the ability of compromising maternal anemia, some directly and others indirectly.

Objective

This review aimed at ascertaining the pooled effect of several anemia interventions. Specifically, the aim of this study was to establish if pregnancy status is associated with COVID-19 severity characterized by a cytokine storm.

Methods

We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to studies suitable for inclusion in this meta-analysis. Studies examining women of reproductive age on any maternal anemia intervention were included. The risk of bias was assessed using the Cochrane risk of bias tool. Review Manager 5.4.1 was used to calculate rate ratios (RRs) with 95% CIs, which were depicted using forest plots. Quantitative variables were summarized in total numbers and percentages. The effect on prevention, control, management and or treatment of anemia was calculated and compared between the intervention and the comparator arms. Heterogeneity was evaluated with the Cochran Q statistic and Higgins test.

Results

A total of 11 articles including data for 6,129 were included. With sensitivity analysis, the interventions had a utility of 39% on maternal anemia prevention and management (random effects model RR 0.61, 95% CI 0.43, 0.87; P = 0.006) (χ26=286.98, P<.00001; I2=97%). All the interventions against maternal anemia showed an effect of 17% (fixed-effect model RR 0.83, 95% CI 0.79-0.88; P<.00001) (χ24=2.93, P=0.57; I2=0%). Education to pregnant women showed a 28% effect (RR 0.72 95% CI 0.58, 0.89), medicinal administration 19% (RR 0.81 95% CI 0.73, 0.90), iron supplementation 17% (RR 0.83 95% CI 0.75, 0.92) and I.V Ferric Carboxy-maltose 15% (RR 0.85 95% CI 0.74, 0.97) (I2 = 0%). Interventions in African region had a higher (16%) and significant effect compared to other regions (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.001) (χ25=176.53, P<.00001; I2=97%). Multiple center studies had a significant predictive effect (16%) compared to single center studies (fixed-effects model RR 0.84, 95% CI 0.79-0.89; P<.00001)(χ25=176.53, P<.00001; I2=97%). The year 2020 recorded the highest effect of maternal anemia interventions at 28% (random-effects model RR 0.72, 95% CI 0.67-0.78; P<.00001) (χ23=167.34, P<.00001; I2=98%)

Conclusion

In the advent of COVID-19, maternal anemia interventions were compromised demonstrated by a low effectiveness trend from the year 2020 to the year 2022. During this period, even the most effective and recommended interventions against maternal anemia were somehow affected.

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.