叶酸增补与妊娠期糖尿病关系的Meta分析  

Association between folic acid supplementation and the risk for gestational diabetes mellitus:a meta-analysis

作　　者：閤爽博 张金娟 陈雪[1,2,3] 杜雨珊 刘菊芬 XIA Shuangbo;ZHANG Jinjuan;CHEN Xue;DU Yushan;LIU Jufen(Institute of Reproductive and Child Health/National Health Commission,Key Laboratory of Reproductive Health,Beijing 100191,P.R.China;Department of Epidemiology and Biostatistics,School of Public Health,Peking University,Beijing 100191,P.R.China;School of Public Health,Bengbu Medical College,Bengbu 233000,P.R.China)

机构地区：[1]北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京100191 [2]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [3]蚌埠医学院公共卫生学院,安徽蚌埠233000

出　　处：《中国循证医学杂志》2022年第12期1445-1452,共8页Chinese Journal of Evidence-based Medicine

基　　金：中国营养学会-振东国人体质与健康研究基金项目(编号:CNS-ZD2020-115);中央高校基本科研业务费资助项目(编号:BMU2021YJ034)。

摘　　要：目的系统评价孕前与孕期增补叶酸与妊娠期糖尿病(GDM)发生风险的相关性。方法计算机检索PubMed、EMbase、The Cochrane Library、SinoMed和CNKI数据库,搜集有关叶酸增补与GDM的研究,检索时限均从建库至2021年11月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入19个研究,包括53128例患者。Meta分析结果显示:妊娠妇女增补叶酸与GDM发病之间无显著关联[RR=0.98,95%CI(0.85,1.13),P=0.74]。亚组分析结果显示,在欧美地区[RR=0.81,95%CI(0.71,0.92),P<0.001]和使用叶酸强化谷物的地区[RR=0.81,95%CI(0.69,0.94),P=0.005],增补叶酸能降低妇女GDM的发生风险。结论当前研究证据显示,妊娠妇女增补叶酸与GDM发生无显著关联,但在欧美地区叶酸增补可降低GDM的发生风险。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。Objective To systematically review the association between folic acid supplementation before and/or during pregnancy and the risk for gestational diabetes mellitus(GDM).Methods The PubMed,EMbase,The Cochrane Library,SinoMed and CNKI databases were searched to collect studies on folic acid supplementation and GDM from inception to November 2021.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Meta-analysis was then performed using RevMan 5.4 software.Results A total of 19 studies involving 53128 cases were included.The results of meta-analysis showed that there was no significant association between folic acid supplementation and the risk for GDM(RR=0.98,95%CI 0.85 to 1.13,P=0.74).Subgroup analysis revealed that folic acid supplementation was associated with a decreased risk for GDM in Europe and the United States(RR=0.81,95%CI 0.71 to 0.92,P<0.001),in areas that fortified grain cereal products with folic acid(RR=0.81,95%CI 0.69 to 0.94,P=0.005).Conclusion There is no significant association between folic acid supplementation and the risk for GDM.However,supplementation may decrease the risk for GDM among women in Europe and the United States.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.

关 键 词：叶酸 妊娠期糖尿病 叶酸增补剂 META分析 观察性研究 

分 类 号：R714.256[医药卫生—妇产科学]