产前非稳态负荷与不良妊娠结局：系统综述和荟萃分析。
完整摘要 · 中文译文
背景：适应性负荷（AL）是指长期应激暴露导致的累积性生理失调。本系统评价和荟萃分析旨在评估产前适应性负荷与不良妊娠结局（APOs）之间的关联，并综合现有证据，为产前保健策略提供信息，并可能降低不良妊娠结局的发生率。 方法：本研究系统检索了PubMed、Web of Science、Embase、PsycINFO、中国知网、万方、维普和中国生物医学文献数据库，查找1993年9月至2026年6月22日发表的关于产前适应性负荷与不良妊娠结局的相关研究。两名研究者独立筛选文献、提取数据，并使用纽卡斯尔-渥太华量表评估偏倚风险。使用R软件（版本4.4.3）进行荟萃分析。研究方案已在PROSPERO注册（CRD420251076952）。 结果：共纳入8项原始研究，涉及8795名孕妇。高产前适应性负荷与早产风险增加相关（OR = 1.29，95% CI [1.04-1.60]）和先兆子痫风险增加相关（OR = 2.31，95% CI [1.42-3.76]）。与低出生体重（OR = 1.10，95% CI [0.95-1.26]）无统计学显著关联。此外，探索性亚组分析提示，妊娠期和生物标志物组成可能影响这些关联；然而，较高的方法学异质性限制了直接临床应用。 结论：产前适应性负荷升高与特定不良妊娠结局风险增加相关，部分 特别是早产和子痫前期。未来的研究应采用纵向设计，在妊娠期间重复测量AL，以阐明时间动态并揭示潜在的生物学机制。
完整摘要 · 英文原文
BACKGROUND: Allostatic load (AL) denotes the cumulative physiological dysregulation resulting from chronic stress exposure. This systematic review and meta-analysis aimed to evaluate the association between prenatal AL and adverse pregnancy outcomes (APOs), and to synthesize current evidence to inform prenatal health strategies and potentially reduce the incidence of APOs. METHODOLOGY: This study systematically searched PubMed, Web of Science, Embase, PsycINFO, China National Knowledge Infrastructure, Wanfang, VIP China Science and Technology Journal Database, and SinoMed databases for relevant studies examining prenatal AL and APOs published from September 1993 to 22 June 2026. Two researchers independently screened the literature, extracted data, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed using R software (version 4.4.3). The study protocol is registered in PROSPERO (CRD420251076952). RESULTS: Eight original studies involving 8,795 pregnant women were included. High prenatal AL was associated with an increased risk of preterm birth (OR = 1.29, 95% CI [1.04-1.60]) and preeclampsia (OR = 2.31, 95% CI [1.42-3.76]). There was no statistically significant association with low birth weight (OR = 1.10, 95% CI [0.95-1.26]). Furthermore, exploratory subgroup analyses suggested that the gestational period and biomarker composition may influence these associations; however, high methodological heterogeneity limits direct clinical application. CONCLUSIONS: Elevated prenatal AL is associated with an increased risk of specific APOs, particularly preterm birth and preeclampsia. Future studies should adopt longitudinal designs with repeated AL measurements across pregnancy to clarify temporal dynamics and elucidate underlying biological mechanisms.