妊娠期体育锻炼干预对自然分娩影响的Meta分析  

Influence of Physical Exercise Interventions during Pregnancy on Natural Childbirth:a Meta-analysis

作　　者：季谋芳 李若冰 魏克静 曾范华 JI Moufang;LI Ruobing;WEI Kejing;ZENG Fanhua(School of Physical Education,Hunan Institute of Science and Technology,Yueyang 414006,China;Physical Education College of Hunan University of Technology,Zhuzhou 412007,China;Zhuzhou Central Hospital,Zhuzhou 412007,China)

机构地区：[1]湖南理工学院体育学院,湖南省岳阳市414006 [2]湖南工业大学体育学院,湖南省株洲市412007 [3]湖南省株洲市中心医院,412007

出　　处：《中国全科医学》2022年第15期1897-1905,共9页Chinese General Practice

基　　金：教育部人文社会科学青年项目(19YJC890021)——“健康中国”背景下产后抑郁锻炼干预模式与实践研究。

摘　　要：背景自然分娩是人类繁衍的正常生理过程,中国剖宫产率超出了世界卫生组织(WHO)提出的警戒线2倍多,而体育锻炼作为一种非药物性的健康干预方式,应引起相关部门的重视。目的运用Meta分析方法检验妊娠期体育锻炼对自然分娩影响的干预效果,并提出最优的锻炼方案。方法检索中国知网(CNKI)、中国生物医学文献服务系统(CBM)、维普网中文数据库和PubMed、EMBase、Web of Science、Cochrane Library英文数据库中有关妊娠期体育锻炼干预影响自然分娩结果的随机对照试验(其中干预组以体育锻炼干预为唯一干预方式,对照组进行常规护理知识教育或不进行有规律的体育锻炼),同时追踪相关系统评价所引用的参考文献,检索时间为1990—2021年。提取纳入文献资料,并对纳入文献进行方法学质量评价,采用RevMan 5.2软件进行Meta分析,运用GRADE工具对结局指标进行质量评价。结果共纳入30篇文献。Meta分析结果显示,干预组自然分娩发生率高于对照组〔RR=1.34,95%CI(1.28,1.40),P<0.00001〕。亚组分析结果显示,锻炼开始节点对自然分娩的干预效果从高到低依次为:>24周、13~24周、≤12周;锻炼内容对自然分娩的干预效果从高到低依次为:盆底肌训练、运动课、体操、有氧运动、分娩球、瑜伽;锻炼频率对自然分娩的干预效果从高到低依次为:≥12次/周、3~5次/周、6~8次/周、9~11次/周;中等强度的锻炼较低强度的锻炼对自然分娩具有更大的影响;锻炼时长对自然分娩的干预效果从高到低依次为:30~<50 min/次、<30 min/次、≥50 min/次;锻炼周期对自然分娩的干预效果从高到低依次为:≤8周、17~24周、9~16周、25~34周。绘制体育锻炼干预对孕妇自然分娩影响的漏斗图,结果显示,漏斗图左右两侧基本对称,发表偏倚较小。运用GRADE工具对结局指标进行质量评价,结果显示,妊娠期体育锻炼影响自然分娩的评级为�Background Natural childbirth is a normal physiological approach of human reproduction,while in China,the cesarean section rate has exceeded the upper limit recommended by the WHO by more than two times.As a nonpharmaceutical intervention facilitating natural childbirth,physical exercise should be valued by relevant departments.Objective To perform a meta-analysis of studies regarding effects of physical exercise interventions on promoting natural childbirth probability,and to attempt to recommend a better exercise scheme.Methods Randomized controlled trials(RCTs)about the effect of intrapregancy physical exercise versus routine care(health duration or irregular physical exercise)improving the probability of natural childbirth published between 1990 and 2021 were searched in databases of CNKI,SinoMed,CQVIP,PubMed,EMBase,Web of Science,and Cochrane Library.Meanwhile,the references of systematic reviews on relevant RCTs were also searched and reviewed.Data extraction and methodological quality assessment were conducted for the included studies.RevMan 5.2 was used for meta-analysis.GRADE was used to rate the quality of evidence concerning an outcome.Results A total of 30 studies with 3910 subjects were included.Meta-analysis found that physical exercise interventions were superior to routine care in improving the natural childbirth rate〔RR=1.34,95%CI(1.28,1.40),P<0.00001〕.Subgroup analyses revealed that natural childbirth rate was improved the most by physical exercise intervention started later than 24 weeks of gestation,followed by that started at 13-24 weeks of gestation,and 12 or less than 12 weeks of gestation.With respect to the type of physical exercise,the natural childbirth rate was improved the most by pelvic floor muscle training,general sports lessons,gymnastics,aerobic exercise,birthing ball movement,and yoga.As for the frequency of physical exercise,the natural childbirth rate was improved the most by at least 12 times per week,followed by 3-5 times per week,6-8 times per week,and 9-11 times per we

关 键 词：孕妇 运动 体育锻炼 自然分娩 剖宫产术 META分析 

分 类 号：R-05[医药卫生]