Nutrition and reproductive potential of women in low- and middle-income countries: a systematic review and meta-analysis.

IF 6.1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH BMJ Global Health Pub Date : 2025-04-02 DOI:10.1136/bmjgh-2024-015713

Dongqing Wang, Christine H Nguyen, Anahita Asghari-Kamrani, Uttara Partap, Iqbal Shah, Wafaie W Fawzi

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Abstract

Introduction: Nutrition plays a critical role in key physiological processes related to reproduction. However, there is limited understanding of the impact of nutritional factors and interventions on the reproductive outcomes of women in low- and middle-income countries (LMICs).

Methods: This systematic review and meta-analysis aimed to synthesise evidence regarding the impact of nutritional factors and interventions on the reproductive outcomes of women in LMICs. Outcomes of interest included fertility and fecundity, menarche and menstrual disorders, miscarriage, stillbirth and live birth. Randomised controlled trials (RCTs) and non-randomised intervention studies with nutritional interventions, and observational cohort studies with nutritional factors, were included. Study selection, data extraction and risk of bias assessment were independently completed by two reviewers. A narrative synthesis of included studies was conducted, and meta-analyses were conducted when feasible.

Results: Systematic search identified 180 studies, including 47 intervention studies and 133 observational cohort studies. From RCTs, there was no clear evidence for an effect of prenatal multiple micronutrient supplementation on the risk of miscarriage (8 RCTs; risk ratio (RR): 0.87; 95% CI 0.75, 1.02; moderate certainty of evidence) or stillbirth (15 RCTs; RR: 0.86; 95% CI 0.73, 1.02; low certainty of evidence). From observational cohort studies, preconceptional obesity was associated with a greater risk of miscarriage (12 studies; RR: 1.27; 95% CI 1.10, 1.47; very low certainty of evidence) and stillbirth (4 studies; RR: 1.66; 95% CI 1.28, 2.14; very low certainty of evidence). Any anaemia during pregnancy was associated with a greater risk of stillbirth (10 studies; RR: 1.26; 95% CI 1.01, 1.58; very low certainty of evidence).

Conclusion: This review highlights the importance of ensuring preconceptional nutrition and preventing anaemia during pregnancy for favourable reproductive outcomes. This review calls for randomised controlled trials to evaluate the effectiveness of preconceptional and prenatal interventions on these outcomes.

Prospero registration number: CRD42023395937.

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低收入和中等收入国家妇女的营养和生殖潜力：系统回顾和荟萃分析。

营养在生殖相关的关键生理过程中起着至关重要的作用。然而，人们对营养因素和干预措施对中低收入国家妇女生殖结果的影响了解有限。方法：本系统综述和荟萃分析旨在综合有关营养因素和干预措施对中低收入国家妇女生殖结局影响的证据。研究结果包括生育力和生殖力、月经初潮和月经紊乱、流产、死产和活产。纳入了随机对照试验（RCTs）和营养干预的非随机干预研究，以及营养因素的观察性队列研究。研究选择、数据提取和偏倚风险评估由两名审稿人独立完成。对纳入的研究进行叙事综合，可行时进行meta分析。结果：系统检索了180项研究，包括47项干预研究和133项观察性队列研究。从随机对照试验来看，没有明确的证据表明产前补充多种微量营养素对流产风险有影响(8项随机对照试验；风险比（RR）： 0.87；95% ci 0.75, 1.02；中度证据确定性)或死产(15项随机对照试验；RR: 0.86;95% ci 0.73, 1.02；证据的低确定性)。从观察性队列研究来看，孕前肥胖与流产风险增加有关(12项研究；RR: 1.27;95% ci 1.10, 1.47；证据确定性极低)和死产(4项研究；RR: 1.66;95% ci 1.28, 2.14；证据的确定性非常低)。怀孕期间任何贫血都与死产风险增加有关(10项研究；RR: 1.26;95% ci 1.01, 1.58；证据的确定性非常低)。结论：本综述强调了确保孕前营养和预防妊娠期间贫血的重要性，以获得良好的生殖结果。这篇综述呼吁进行随机对照试验来评估孕前和产前干预对这些结果的有效性。普洛斯彼罗注册号：CRD42023395937。

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

BMJ Global Health Medicine-Health Policy

CiteScore

11.40

自引率

4.90%

发文量

429

审稿时长

18 weeks

期刊介绍： BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.