The study of periconception folic acid supplementation and its relationship with pregnancy outcome
-
摘要:
目的 了解单胎妊娠围孕期叶酸补充情况和补充剂量, 探讨围孕期叶酸补充与妊娠结局的关系。 方法 以2017年10月-2019年6月期间在广州市花都区妇幼保健院分娩的6 536例单胎活产的孕妇作为研究对象。在分娩前或分娩后回顾性的调查孕妇一般人口学特征、围孕期增补叶酸情况及妊娠结局等信息。 结果 孕前半年服用叶酸坚持1个月以上的孕妇1 345人(20.18%); 围孕期每日叶酸服用剂量正常的孕妇764人(11.69%)。与未补充叶酸相比, 孕前补充叶酸可使新生儿增加74.68 g出生体重, 孕后补充增加55.05 g(P＜0.05)。在控制孕妇年龄、文化水平、孕前BMI、被动吸烟时间等相关因素后, 孕前补充叶酸可以使小于胎龄儿(small for gestational age, SGA)的发生风险降低(aOR=0.66, 95% CI: 0.46~0.95)。低出生体重(low birth weight, LBW)和自发早产与叶酸补充类型无关。围孕期高剂量补充叶酸可能增加自发早产的发生风险(aOR=1.75, 95% CI: 1.02~3.01)。SGA和LBW与叶酸补充剂量无关。 结论 围孕期补充叶酸可以促进胎儿生长, 降低SGA的发生风险。 Abstract:Objective This study aimed to investigate the situation and dosage of penconception folic acid supplementation and to explore the association between periconception folic acid supplementation and pregnancy outcome. Methods A total of 6 526 pregnant women were recruited from October 2017 to June 2019 in Huadu District of Guangzhou. R retrospective surveys before or after delivery were conducted to collect information about general demographic characteristics, periconception folic acid supplementationand pregnancy outcomes. Results There were 1 345 pregnant women (20.18%) taken folic acid for more than one month at half a year before pregnancy. 764(11.69%) pregnant women took normal daily dosage of folic acid during periconception. Preconception folic acid supplementation was associated with 74.68 g higher birth weight and the first-trimester supplementation increased 55.05 g (P < 0.05), compared to no folic acid supplementation. After adjusted maternal age, educational level, pre-gestational body mass index (BMI), passive smoking time, periconception folic acid supplementation could reduced the risk of small for gestational age (SGA) infants (aOR=0.66; 95% CI: 0.46-0.95). Low birth weight (LBW) and spontaneous preterm delivery were not related to the type of folic acid supplementation. High-dose folic acid during periconception may increased the risk of spontaneous preterm (aOR=1.75; 95% CI: 1.02-3.01). SGA and LBW were not related to folic acid dose. Conclusions Periconception folic acid supplementation was positively associated with fetal growth resulting in birth weight, and decreased risks of SGA. -
Key words:
- Folate /
- Birth weight /
- Pregnancy outcome
-
表 1 两组患者一般资料比较(x±s)
Table 1. Comparison of basic features of the two group(x±s)
变量名称 叶酸补充 χ2/F值 P 未补充(n=580) 孕后补充(n=3 663) 孕前补充(n=1 345) 年龄(岁) 28.85±5.88 28.92±4.83 30.04±4.24 28.05 ＜0.001 出生体重(g) 3 073.45±509.26 3 128.49±446.40 3 148.13±450.84 5.50 0.004 胎龄(d) 269.69±13.38 271.66±10.88 270.99±11.40 8.28 ＜0.001 产次(次) 1.91±0.75 1.73±0.63 1.57±0.55 66.15 ＜0.001 孕前BMI(kg/m2) 20.95±3.22 20.65 ±3.03 20.81±2.79 3.36 0.035 孕期体重增长(kg) 13.17±4.32 13.68±4.24 13.67±4.13 3.65 0.026 SGA发生率(%) 8.44(49/580) 9.66(354/3 663) 6.99(94/1 345) 9.64 0.047 LBW发生率(%) 8.62(50/580) 5.81(213/3 663) 6.39(86/1 345) 7.34 0.119 早产发生率(%) 12.07(70/580) 8.41(308/3 663) 8.18(110/1 345) 9.10 0.011 文化程度(%) 242.51 ＜0.001 大学及以上 5.36(53/989) 58.24(576/989) 36.40(360/989) 大专 6.77(99/1 463) 65.28(955/1 463) 27.96(409/1 463) 高中及中专 10.16(148/1 456) 68.34(995/1 456) 21.50(313/1 456) 初中及以下 16.67(280/1 680) 67.68(1 137/1 680) 15.65(263/1 680) 被动吸烟(h) 孕前期 2.49±0.32 1.69±0.09 1.18±0.11 12.508 ＜0.001 孕早期 2.38±0.32 1.46±0.08 0.97±0.11 15.703 ＜0.001 
下载: 导出CSV
表 2 围孕期补充叶酸与妊娠结局的非条件Logistic回归分析
Table 2. Logistic regression analysis of folic acid supplementation and pregnancy outcome
分组 SGA LBW 早产 发生率(%) cOR(95% CI)a值 aOR(95% CI)b值 发生率(%) cOR(95% CI)a值 aOR(95% CI)b值 发生率(%) cOR(95% CI)a值 aOR(95% CI)b值 未增补 9.48 1.00 1.00 8.84 1.00 1.00 10.21 1.00 1.00 孕后增补 10.23 1.11(0.81~1.47)d 1.05(0.77~1.43)d 5.97 0.65(0.47~0.90)c 0.97(0.57~1.67)d 7.09 0.67(0.50~0.91)c 0.91(0.66~1.26)d 孕前增补 6.71 0.69(0.48~0.98)c 0.66(0.46~0.95)c 6.54 0.72(0.50~0.96)c 0.98(0.53~1.80)d 6.93 0.66(0.46~0.92)c 0.92(0.63~1.35)d 注: acOR: crude odds ratio, 粗比值比; baOR: adjusted odds ratio, 调整比值比, SGA和LBW组为调整孕妇年龄、文化程度、孕前期被动吸烟、孕早期被动吸烟、产次、孕前健康教育、产检大于5次、妊娠高血压疾病、妊娠糖尿病、孕前BMI、孕期体重增长、胎龄等因素的结果; 早产组为调整孕妇年龄、文化程度、孕前期被动吸烟、孕早期被动吸烟、产次、孕前健康教育、产检大于5次、妊娠高血压疾病、妊娠糖尿病、孕前BMI、孕期体重增长等因素的结果; c: P < 0.05; d: P>0.05。
下载: 导出CSV
表 3 围孕期叶酸补充剂量与妊娠结局的非条件Logistic回归分析
Table 3. Logistic regression analysis of folic acid dose and pregnancy outcome
分组(μg/d) SGA LBW 早产 发生率(%) cOR(95% CI)值a aOR(95% CI)值b 发生率(%) cOR(95% CI)值a aOR(95% CI)值b 发生率(%) cOR(95% CI)值a aOR(95% CI)值b 正常 9.13 1.00 1.00 5.35 1.00 1.00 5.83 1.00 1.00 缺乏 9.77 1.08(0.82~1.42)d 1.10(0.83~1.46)d 6.42 1.22(0.86~1.71)d 1.10(0.66~1.82)d 7.80 1.37(0.99~1.90)d 1.25(0.89~1.75)d 不足 9.35 1.03(0.76~1.39)d 1.07(0.79~1.46)d 6.22 1.17(0.80~1.71)d 1.33(0.77~2.30)d 6.76 1.17(0.82~1.68)d 1.20(0.83~1.73)d 高剂量 7.87 0.85(0.49~1.48)d 0.89(0.51~1.56)d 10.60 2.10(1.23~3.59)c 1.47(0.66~3.29)d 10.55 1.91(1.12~3.23)c 1.75(1.02~3.01)c 注: acOR: crude odds ratio, 粗比值比; baOR: adjusted odds ratio, 调整比值比, SGA和LBW组为调整孕妇年龄、文化程度、孕前期被动吸烟、孕早期被动吸烟、产次、孕前健康教育、产检大于5次、妊娠高血压疾病、妊娠糖尿病、孕前BMI、孕期体重增长、胎龄等因素的结果; 早产组为调整孕妇年龄、文化程度、孕前期被动吸烟、孕早期被动吸烟、产次、孕前健康教育、产检大于5次、妊娠高血压疾病、妊娠糖尿病、孕前BMI、孕期体重增长等因素的结果; c: P < 0.05; d: P>0.05。
下载: 导出CSV
-
[1] Yu J, Flatley C, Greer RM, et al. Birth-weight centiles and the risk of serious adverse neonatal outcomes at term[J]. J Perinat Med, 2018, 46(9):1048-1056. DOI: 10.1515/jpm-2017-0176. [2] Anderson SE, Mcnamara K, Andridge R, et al. Executive function and mealtime behavior among preschool-aged children born very preterm[J]. Eat Behav, 2015, 19(12):110-114. DOI: 10.1016/j.eatbeh.2015.07.006. [3] Gur Z, Tsumi E, Wainstock T, et al. Association between delivery of small-for-gestational age neonate and long-term pediatric ophthalmic morbidity[J]. Arch Gynecol and Obstet, 2018, 298(6):1095-1099. DOI: 10.1007/s00404-018-4901-7. [4] 赵曼丽.孕早期血清叶酸、同型半胱氨酸水平检测的临床意义及预防妊娠并发症、胎儿出生缺陷的临床疗效分析[J].中国妇幼保健, 2019, 34(6):1249-1251. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.06.13.Zhao ML. Clinical significance of serum folic acid homocysteine levels in early pregnancy and prevention of pregnancy complications Clinical effect analysis of fetal birth defects[J]. Maternal and Child Health Care of China, 2019, 34(6):1249-1251. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.06.13. [5] 任爱国.叶酸预防神经管缺陷[J].北京大学学报(医学版), 2014, (3):343-346. DOI: 10.3969/j.issn.1671-167x.2014.03.002.Ren AG. Folic acid prevents neural tube defects[J]. Journal of Peking University (Medical Edition), 2014, (3):343-346. DOI: 10.3969/j.issn.1671-167x.2014.03.002. [6] Li Z, Ye R, Zhang L, et al. Periconceptional folic acid supplementation and the risk of preterm births in China: a large prospective cohort study[J]. Int J Epidemio, 2014, 43(4):1113-1132.DOI: 10.1093/ije/dyu020. [7] Zheng JS, Guan Y, Zhao Y, et al. Pre-conceptional intake of folic acid supplements is inversely associated with risk of preterm birth and small-for-gestational-age birth a prospective cohort study[J]. Brit J Nutr, 2016, 115(3):509-516. DOI: 10.1017/S0007114515004663. [8] 李佳媚, 屈鹏飞, 党少农, 等.陕西省育龄妇女围孕期增补叶酸对新生儿出生体重的影响[J].中华流行病学杂志, 2016, 37(7):1017-1020. DOI: 10.3760/cma.j.issn.0254-6450.2016.07.022.Li JM, Qu PF, Dang SN, et al. Effect of folic acid supplementation in childbearing aged women during pregnancy on neonate birth weight in Shaanxi province[J]. Chin J Epidemiol, 2016, 37(7):1017-1020. DOI: 10.3760/cma.j.issn.0254-6450.2016.07.022. [9] 朱丽.中国不同胎龄新生儿出生体重曲线研制[J].中华儿科杂志, 2015, 2(53):97-103. DOI: 10.3760/cma.Jissn.0578.1310.2015.02.007.Zhu L. Chinese neonatal birth weight curve for different gestational age[J]. Chin J Pediatr, 2015, 2(53):97-103. DOI: 10.3760/cma.Jissn.0578.1310.2015.02.007. [10] Bukowski R, Malone FD, Porter FT, et al. Preconceptional folate supplementation and the risk of spontaneous preterm birth a cohort study[J]. PLos Med, 2009, 6(5):e1000061. DOI: 10.1371/journal.pmed.1000061. [11] Fueness DF, Yasin N, Dekker GA, et al. Maternal red blood cell folate concentration at 10-12 weeks gestation and pregnancy outcome[J]. J Mater Fetal Neo M, 2012, 25(8):1142-1423. DOI: 10.3109/14767058.2011.636463. [12] 谢幸, 孔北华, 段涛.妇产科学[M].第9版.北京:人民卫生出版社, 2018:43-43.Xie X, Kong BH, Duan T. Obstetrics and gynecology[M]. 9th ed. Beijing: People's Medical Publishing House, 2018:43-43. [13] Xing X, Tao F, Hao J, et al. Periconceptional folic acid supplementation among women attending antenatal clinic in Anhui, China: data from a population-based cohort study[J]. Midwifery, 2012, 28(3):291-297. DOI: 10.1016/j.midw.2011.04.002. [14] Liu J, Jin L, Meng Q, et al. Changes in folic acid supplementation behaviour among women of reproductive age after the implementation of a massive supplementation programme in China[J]. Public Health Nutr, 2015, 18(4):582-588. DOI: 10.1017/S1368980014000950. [15] 陈京, 张世琨, 王巧梅, 等. 2010至2012年中国农村孕早期妇女叶酸服用状况调查[J].中华医学杂志, 2016, 96(15):1215-1219. DOI: 10.3760/cma.j.issn.0376-2491.2016.15.016.Chen J, Zhang SK, Wang QM, et al. Investigation on folic acid supplementation status among Chinese women in the first trimester of pregnancy[J]. Natl Med J Chin, 2016, 96(15):1215-1219. DOI: 10.3760/cma.j.issn.0376-2491.2016.15.016. [16] Relton CL, Pearce MS, Parker L. The influence of erythrocyte folate and serum vitamin B-12 status on birth weight[J]. Br J Nutr, 2005, 93(5):593-599. DOI: 10.1079/BJN20041395. [17] Hodgetts VA, Morris RK, Francis A, et al. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of small-for-gestational age neonates: a population study, systematic review and meta-analysis[J]. Bjog-Int J Obstet Gy, 2015, 122(4):478-490. DOI: 10.1111/1471-0528.13202. [18] Sengpiel V, Bacelis J, Myhre R, et al. Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study[J]. BMC Pregnancy Childb, 2014, 14(1):375-388. DOI: 10.1186/s12884-014-0375-1. [19] 郭华棋.围孕期叶酸摄入方式对早产、低出生体重和小于胎龄儿的影响研究[D].兰州: 兰州大学, 2018.Guo HQ. The effect of folic acid intake on preterm birth, low birth weight and small gestational age during the perinatal period[D]. Lanzhou: Lanzhou University, 2018. [20] Christian P. Micronutrients, birth weight, and survival[J]Annu Rev Nutr, 2010: 83-104. DOI: 10.1146/annurev.nutr.012809.104813. -
