女性在懷孕期間自然會增加體重，並於產後逐漸減重；然而，部分女性難以在分娩後一至兩年內減重，可能會對她們的健康造成隱患。懷孕時的增重若持續可能會導致肥胖，並因肥胖提高罹患糖尿病、心臟病及高血壓的風險，有研究指出，產後 6 個月內恢復孕前體重的女性，於 10 年後體重過重的風險較低。本文搜尋了隨機對照研究來評估節食、運動、或兩者並用，對女性分娩後幾個月內減重的影響，亦特別注意哺乳女性，確保不會干擾母乳哺育。我們對此文獻回顧的試驗進行審查，共找到 14 篇研究，其中 12 篇有 910 位產後體重超重的女性參與，為此分析提供了數據。研究結果顯示，節食配合運動或單純節食，相較於常規護理似乎更有助於產後減重，這些干預措施對未來產婦肥胖的預防可能是有效的。另外，已納入的研究中沒有指出運動或節食會干擾哺乳，但尚無足夠證據可驗證此論點。透過節食與運動結合的減重方式，與單純節食相比可能更為合適，因運動普遍被認為可改善血液循環與心臟健康、以及儲存瘦體組織 (lean body mass)。未來仍需進一步的研究來佐證。
Evidence from this review suggests that both diet and exercise together and diet alone help women to lose weight after childbirth. Nevertheless, it may be preferable to lose weight through a combination of diet and exercise as this improves maternal cardiorespiratory fitness and preserves fat-free mass, while diet alone reduces fat-free mass. This needs confirmation in large trials of high methodological quality. For women who are breastfeeding, more evidence is required to confirm whether diet or exercise, or both, is not detrimental for either mother or baby.
Weight retention after pregnancy may contribute to obesity. It is known that diet and exercise are recommended components of any weight loss programme in the general population. However, strategies to achieve healthy body weight among postpartum women have not been adequately evaluated.
The objectives of this review were to evaluate the effect of diet, exercise or both for weight reduction in women after childbirth, and to assess the impact of these interventions on maternal body composition, cardiorespiratory fitness, breastfeeding performance and other child and maternal outcomes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2012) and LILACS (31 January 2012). We scanned secondary references and contacted experts in the field. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 30 April 2013 and added the results to the awaiting classification section of the review.
All published and unpublished randomised controlled trials (RCTs) and quasi-randomised trials of diet or exercise or both, among women during the postpartum period.
Both review authors independently assessed trial quality and extracted data. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data. Data were analysed with a fixed-effect model. A random-effects model was used in the presence of heterogeneity.
Fourteen trials were included, but only 12 trials involving 910 women contributed data to outcome analysis. Women who exercised did not lose significantly more weight than women in the usual care group (two trials; n = 53; MD -0.10 kg; 95% confidence interval (CI) -1.90 to 1.71). Women who took part in a diet (one trial; n = 45; MD -1.70 kg; 95% CI -2.08 to -1.32), or diet plus exercise programme (seven trials; n = 573; MD -1.93 kg; 95% CI -2.96 to -0.89; random-effects, T² = 1.09, I² = 71%), lost significantly more weight than women in the usual care group. There was no difference in the magnitude of weight loss between diet alone and diet plus exercise group (one trial; n = 43; MD 0.30 kg; 95% CI -0.06 to 0.66). The interventions seemed not to affect breastfeeding performance adversely.
翻譯者：范君郁 Chun-Yu Fann 【本翻譯計畫由臺北醫學大學考科藍臺灣研究中心(Cochrane Taiwan)及東亞考科藍聯盟(EACA)統籌執行。聯絡E-mail：firstname.lastname@example.org】