Malnutrition during the critical period of pregnancy has significant health outcomes for both the mother and her offspring. Medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) may help mitigate negative health effects, although studies that support the role of the RDN have not been comprehensively evaluated. The objective was to explore the health effects of MNT by an RDN on maternal and infant outcomes in pregnant women with malnutrition. A systematic review of studies published between 2000 and 2014 that incorporated MNT by an RDN during pregnancy were retrieved from a PubMed search, using criteria established by the Academy of Nutrition and Dietetics Evidence Analysis Process. Among 94 identified studies, five controlled trials met the inclusion criteria. The initial search was extended to include one study published between 2014 and 2019. Outcomes included maternal gestational weight gain, maternal markers of glycemic control, maternal complications such as hypertension, incidence of caesarean section, infant birth weight both in grams and in clinical categories, infant gestational age, and infant complications. There was good/strong evidence that MNT by an RDN decreased gestational weight gain, although there was no effect on maternal complications, caesarean section deliveries, and gestational age among women with mixed body mass index status or those who were overweight/obese. The evidence was deemed fair in support of an effect on glycemic control, infant birth weight, and infant complications. The heterogeneity in the results are due to the variation among populations studied, types of interventions, and inconsistency among outcomes. In addition, the training and educational requirements of the RDN or the international equivalent may vary widely across the four countries in which studies were conducted. There was good evidence for MNT by an RDN during pregnancy on improving gestational weight gain among overweight/obese women. To better support the role of MNT by an RDN in the health care of pregnant women, research that clearly identifies the role of the RDN in the intervention, includes a control group, and studies more heterogeneous populations is needed.

译文

怀孕关键时期的营养不良对母亲和她的后代都有显著的健康结果。注册营养师营养师 (RDN) 的医学营养治疗 (MNT) 可能有助于减轻负面的健康影响,尽管支持RDN作用的研究尚未得到全面评估。目的是探讨RDN对营养不良孕妇的MNT对健康的影响。使用营养与饮食学会证据分析过程建立的标准,从PubMed搜索中检索了2000年发表的研究的系统综述和2014,这些研究在怀孕期间通过RDN纳入了MNT。在94项确定的研究中,有5项对照试验符合纳入标准。最初的搜索范围扩大到包括2014年和2019发表的一项研究。结果包括孕妇妊娠体重增加,母亲血糖控制指标,母亲并发症 (例如高血压),剖腹产的发生率,婴儿出生体重 (克) 和临床类别,婴儿胎龄和婴儿并发症。有良好/有力的证据表明,RDN的MNT降低了妊娠体重的增加,尽管对具有混合体重指数状态的妇女或超重/肥胖的妇女的产妇并发症,剖腹产分娩和胎龄没有影响。证据被认为是公平的,以支持对血糖控制,婴儿出生体重和婴儿并发症的影响。结果的异质性是由于研究人群之间的差异,干预类型以及结果之间的不一致。此外,在进行研究的四个国家中,RDN或国际同等机构的培训和教育要求可能相差很大。有很好的证据表明,怀孕期间通过RDN进行MNT可以改善超重/肥胖妇女的妊娠体重增加。为了更好地支持RDN在孕妇保健中的MNT作用,需要进行研究,以明确确定RDN在干预中的作用,包括对照组,并研究更多的异质人群。

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