母亲围受孕期服用叶酸与胎儿腹壁缺陷风险关系的研究  

Association between maternal periconceptional folic acid supplementation and risk for abdominal wall defects

作　　者：黄琬桐 庞梓溪 金蕾 张杰 孟文颖 靳蕾[1] HUANG Wantong;PANG Zixi;JIN Lei;ZHANG Jie;MENG Wenying;JIN Lei(Institute of Reproductive and Child Health,Peking University/Ministry of Health Key Laboratory of Reproductive Health,Peking University,Beijing 100191,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,北京大学公共卫生学院流行病与卫生统计学系,100191 [2]北京市通州区妇幼保健院保健部,101100 [3]北京市通州区妇幼保健院产科,101100

出　　处：《中国生育健康杂志》2023年第3期201-206,共6页Chinese Journal of Reproductive Health

基　　金：国家重点研发计划(2021YFC2700700,2021YFC2700704)。

摘　　要：目的探究母亲围受孕期服用叶酸与胎儿腹壁缺陷(包括腹裂、脐膨出)风险的关系,评价实施“增补叶酸预防神经管缺陷”重大公共卫生项目对先天性腹壁畸形的预防效果。方法以北京市通州区孕期保健系统和出生缺陷系统2013—2018年63715例单胎妊娠的母子对的信息为基础,用倾向性评分逆概率加权法调整不同对比组间的人群特征差异后,以泊松对数线性模型分析母亲围受孕期叶酸补充剂服用情况与胎儿腹壁缺陷的发生风险之间的关系。结果腹裂、脐膨出的总患病率分别为3.5/万和2.8/万,与母亲围受孕期未服用叶酸组相比,母亲服用单纯叶酸片或含叶酸的复方营养素组、低频或高频服用叶酸组胎儿的腹壁缺陷总体风险分别下降了82%、88%和74%。对于单发型腹壁缺陷,母亲服用叶酸组、低频或高频服用叶酸或含叶酸的复方营养素组胎儿的患病风险也低于不服用组,调整风险比aRR(95%置信区间,95%CI)分别为0.15(95%CI:0.09~0.24),0.10(95%CI:0.04~0.20)和0.25(95%CI:0.14~0.41)。母亲围受孕期服用单纯叶酸片与服用含叶酸的复方营养素组相比,胎儿腹壁缺陷总患病率和单发缺陷的患病率差异均无统计学意义,aRR分别为0.81(95%CI:0.47~1.39)和0.56(95%CI:0.28~1.08)。结论母亲围受孕期服用叶酸可有效降低胎儿腹壁缺陷的发生风险,单纯叶酸片预防效果与含叶酸复方营养素效果类似。“增补叶酸预防神经管缺陷”重大公共卫生项目的实施有效降低了人群的腹壁缺陷的风险。Objective To investigate the association between maternal periconceptional folic acid supplementation and the risk for abdominal wall defects(including gastroschisis and omphalocele),and to evaluate the preventive effect of the major public health project"folic acid supplementation to prevent neural tube defects"on congenital abdominal wall defects.Methods The study was based on data collected during 2013 and 2018 from Prenatal Health Care System and Birth Defects Surveillance System of Tongzhou District,Beijing,China.A total of 63715 singleton birth records were included in the study.Inverse probability of weights,a method of propensity score weighting,was used to control the differences in groups with different patterns of folic acid supplementation use.Poisson loglinear model was used to estimate the effect of periconceptional folic acid supplementation on the risk for abdominal wall defects.Results The overall prevalence of gastroschisis and omphalocele was 3.5 and 2.8 per 10000 births,respectively.Compared to fetuses whose mothers did not use folic acid supplements during periconceptional period,the overall risk for abdominal wall defects among fetuses whose mothers were folic acid supplementation users,low-frequency users or high-frequency users decreased by 82%,88%and 74%,respectively.For overall isolated cases,fetuses whose mothers used folic acid supplements,used at a low or high frequency,the adjusted risk ratios(aRRs)were 0.15(95%confidence interval[CI]:0.09-0.24),0.10(95%CI:0.04-0.20)and 0.25(95%CI:0.14-0.41),respectively,compared to the fetuses whose mothers were nonusers.However,differences of risk for abdominal wall defects were not statistically significant between fetuses whose mothers used folic acid only(FAO)and multiple nutrients containing folic acid(MFA),either for the total abdominal wall defects(aRR=0.81,95%CI:0.47-1.39)or isolated abdominal wall defects(aRR=0.56,95%CI:0.28-1.08).Conclusion Maternal use of folic acid supplementation during the periconceptional period could reduce the risk

关 键 词：叶酸 腹壁缺陷 腹裂 脐膨出 回顾性队列 

分 类 号：R17[医药卫生—妇幼卫生保健]