全孕期增补叶酸与妊娠期糖尿病的关联性研究  

Association between folic acid supplementation throughout pregnancy and gestational diabetes mellitus

作　　者：从静 浦丹华 谭容容 葛晓云[2] 朱维培[3] 沈彩娥[4] 葛建芬[5] 骆秀翠[6] 刘娟[7] 吴洁 CONG Jing;PU Danhua;TAN Rongrong;GE Xiaoyun;ZHU Weipei;SHEN Cai'e;GE Jianfen;LUO Xiucui;LIU Juan;WU Jie(The State Key Laboratory of Reproductive Medicine,Department of Women's Healthcare,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Women and Children Health Hospital,Nanjing Medical University,Nanjing,Jiangsu 210000,China;Department of Obstetrics and Gynecology,Nantong Maternal and Child Health Care Hospital,Nantong,Jiangsu 226000,China;Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China;Suzhou Municipal Hospital,Department of Women's Healthcare,Suzhou Maternal and Child Health Care Center,Suzhou,Jiangsu 215000,China;Department of Women's Healthcare,Yancheng Maternity and Child Health Care Hospital,Yancheng,Jiangsu 224000,China;Department of Obstetrics and Gynecology,Lianyungang Maternal and Child Heath Hospital,Lianyungang,Jiangsu 222000,China;Department of Women's Healthcare,Yangzhou Maternal and Child Care Service Centre,Yangzhou,Jiangsu 225000,China)

机构地区：[1]南京医科大学第一附属医院,江苏省妇幼保健院妇女保健科,生殖医学国家重点实验室,江苏南京210000 [2]南通市妇幼保健院妇产科,江苏南通226000 [3]苏州大学第二附属医院妇产科,江苏苏州215000 [4]苏州市立医院,苏州市母子医疗保健中心妇女保健科,江苏苏州215000 [5]盐城市妇幼保健院妇女保健科,江苏盐城224000 [6]连云港市妇幼保健院妇产科,江苏连云港222000 [7]扬州市妇幼保健院妇女保健科,江苏扬州225000

出　　处：《安徽医药》2023年第6期1253-1258,共6页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省妇幼健康科研项目(F201613);江苏省妇幼保健协会科研项目(FYX202007)。

摘　　要：目的 探讨江苏地区孕妇全孕期增补叶酸对妊娠期糖尿病(GDM)的影响。方法 选取2017年1月至2018年12月间在江苏省分娩的胎龄≥28周的产妇。根据是否服用叶酸分为未服叶酸组和服用叶酸组。根据服用叶酸的剂量和时间分为六组:早孕期单纯0.4 mg/d叶酸(0.4 mg叶酸)组、早孕期含叶酸0.4 mg/d的复合维生素(MV+0.4 mg叶酸)组、早孕期含叶酸0.8 mg/d的复合维生素(MV+0.8 mg叶酸)组、全孕期单纯0.4 mg/d叶酸(0.4 mg叶酸)组、全孕期含叶酸0.4 mg/d的复合维生素(MV+0.4 mg叶酸)组、全孕期含叶酸0.8 mg/d的复合维生素(MV+0.8 mg叶酸)组。通过问卷调查表,由培训专员收集并记录产妇的一般情况、叶酸增补情况、孕产史、职业和环境因素及GDM等信息。应用logistic回归及χ^(2)检验等方法对全孕期叶酸增补情况与GDM的相关性进行统计分析。结果 共纳入10 662例产妇,未服叶酸组与服用叶酸组GDM的发生率分别为9.7%(100/1 028)、10.5%(1 014/9 634),差异无统计学意义。与未服叶酸组相比,无论是否校正协变量,全孕期增补叶酸的女性发生GDM的风险显著增加,尤其是年龄小于35岁、孕前体质量指数(BMI)在正常范围及有分娩史的女性。结论 孕期叶酸增补应适量,全孕期增补叶酸的女性发生GDM风险增加。Objective To investigate the effect of folic acid(FA)supplementation throughout pregnancy on gestational diabetes mellitus(GDM)in Jiangsu Province.Methods The women of gestational age≥28 weeks who gave birth in Jiangsu Province between January 2017 and December 2018 were selected.They were divided into non-FA group and FA group according to whether they took FA.According to the dose and time of taking FA,the participants were divided into six groups:0.4 mg FA(0.4 FA)in early pregnancy,multivitamins with 0.4 mg FA(MV+0.4 FA)in early pregnancy,multivitamins with 0.8 mg FA(MV+0.8 FA)in early pregnancy,0.4 mg FA(0.4 FA)in whole pregnancy,multivitamins with 0.4 mg FA(MV+0.4 FA)in whole pregnancy,multivitamins with 0.8 mg FA(MV+0.8 FA)in whole pregnancy.General information of pregnant women,health status,FA intake during the gestation,maternal history,occupational and environmental factors and GDM were collected through face-to-face interview by trained doctors or midwives.Logistic regression and chi-square test were used to analyze the relationship between the dose and time of FA supplementation and GDM.Re⁃sults A total of 10662 puerpera were included.The incidence of GDM in the non-FA group and the FA group was 9.7%(100/1028)and 10.5%(1014/9634),respectively,with no significant difference.Compared with non-FA group,the risk of GDM was significantly increased in FA group throughout pregnancy with or without adjustment for covariates,especially in women under the age of 35,with a preconception BMI in the normal range,and with a history of childbirth.Conclusion FA supplementation during pregnancy should be appropriate,and the risk of GDM is increased in pregnant women who take FA supplement daily throughout pregnancy.

关 键 词：叶酸 孕妇 妊娠初期 糖尿病 妊娠 调查和问卷 江苏省 

分 类 号：R714.256[医药卫生—妇产科学]