促进孕产妇心理健康的营养实践证据总结

Summary of nutritional practice evidence for promoting maternal mental health

摘要

目的 系统整合国内外关于孕产妇膳食营养与心理健康的最佳证据,总结孕产期妇女心理健康营养支持的循证建议,为科学制定营养干预策略提供依据。方法 根据“6S”证据资源金字塔模型,自上而下在UpToDate临床顾问、国际指南协作网、乔安娜布里格斯研究所、英国国家卫生与临床优化研究所、苏格兰校际指南网络、世界卫生组织、国际妇产科联盟、医脉通及中英文期刊数据库中,采用“孕产期”“营养”“抑郁”“焦虑”等关键词进行系统检索.检索时间范围为1990年1月至2023年11月.纳入证据类型涵盖临床实践指南、专家共识和系统综述.采用牛津大学循证医学中心的证据等级及推荐标准,由至少2名研究人员独立进行质量评价和证据汇总,并通过交叉核对确保一致性。结果 共纳入文献20篇,其中指南8篇、专家共识2篇、系统综述10篇.证据内容可划分为膳食模式、营养素和特殊人群营养支持3大主题,共形成12条证据总结,其中75.0%的证据等级为B级及以上。结论 现有证据支持孕产妇摄入适量复合营养素及维生素D₃以减少孕产期抑郁症状(推荐等级A).同时,对于罹患精神或营养性疾病的孕产妇,应由专业人员提供个体化营养指导(推荐等级D).本研究为制定科学的孕产妇心理健康膳食营养支持方案提供了循证参考.

Abstract

Objective To systematically integrate the best evidence on maternal dietary nutrition and mental health from both domestic and international sources, summarize evidence-based recommendations for nutritional support of maternal mental health, and provide a basis for scientifically formulating nutritional intervention strategies. Methods Following the “6S” pyramid model of evidence resources, a top-down systematic search was conducted in UpToDate, the Guidelines International Network, the Joanna Briggs Institute, the National Institute for Health and Care Excellence, the Scottish Intercollegiate Guidelines Network, the World Health Organization, the International Federation of Gynecology and Obstetrics, MedLive, and Chinese and English journal databases. The search used keywords such as “perinatal” “nutrition” “depression” “anxiety”. The search period was set as January 1990 to November 2023. The included evidence consisted of clinical practice guidelines, expert consensus, and systematic reviews. The evidence level and recommendation criteria of the Oxford University Center for Evidence-Based Medicine were adopted. At least two researchers independently conducted quality evaluation and evidence aggregation, and cross-checked to ensure consistency. Results A total of 20 articles were included, including 8 guidelines, 2 expert consensus, 10 systematic reviews. The evidence content can be divided into three main themes: dietary patterns, nutrients, and nutritional support for special populations, forming a total of 12 evidence summaries, of which 75.0% of the evidence level is B or above. Conclusion Available evidence supports maternal intake of appropriate levels of multi-nutrients and vitamin D₃ to reduce maternal depressive symptoms (Grade A recommendation). Besides, individualized nutritional interventions guided by healthcare professionals are recommended for women with perinatal mental health disorders or nutritional deficiencies (Grade D recommendation). This study offers evidence-based reference for developing scientific nutritional strategies to enhance perinatal mental health.

关键词

孕产妇 / 心理健康 / 营养 / 证据总结

Key words

pregnant and postpartum women / mental health / nutrition / evidence summary

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基金资助

国家自然科学基金面上项目(72274072)

国家科技部基础资源专项(2019FY101002)

2022年澳优G佳贝艾特营养科研基金项目(RS2022G24)