摘要
目的探讨女性围孕期补充叶酸及膳食叶酸摄入与早产发生风险的关系及其对早产发生风险的交互作用。方法 2011年1月至2013年3月在甘肃省妇幼保健院建卡就诊并随访到分娩结局的单胎孕妇为研究对象,调查一般人口学、围孕期叶酸补充情况、围孕期膳食摄入频次、种类及其胎儿分娩时的信息。以logistic回归模型分析围孕期叶酸补充和膳食叶酸摄入与早产的发生风险及其交互效应。结果在控制相关混杂因素后,围孕期补充叶酸>12周以及膳食叶酸摄入≥209.94μg/d均可降低早产的发生风险,且存在剂量反应关系(OR=0.83,95%CI:0.72~0.96;OR=0.84,95%CI:0.76~0.94,P趋势<0.05)。交互作用分析显示,围孕期补充叶酸与膳食叶酸摄入间存在相乘及相加的交互作用[RERI(95%CI)=0.32(0.12~0.51),AP(95%CI)=0.92(0.24~1.61),S(95%CI)=0.68(0.56~0.82)]。类似的保护作用在早期与极早期早产、自发性早产、自发性早产不伴胎膜早破中均有体现,而在适度早产、干预性早产、自发性早产伴胎膜早破中无相乘及相加的交互作用。结论围孕期补充叶酸与膳食叶酸摄入对早产及部分早产亚型具有协同保护作用,故在补充叶酸的同时增加膳食中叶酸的摄入量能显著降低早产的发生风险。
Objective To assess the joint associations of folic acid supplementation and dietary folate intake during pregnancy with preterm birth and various clinical subtypes. Methods A questionnaire survey was conducted among pregnant women who did their prenatal care checkups in Gansu Provincial Maternity and Childcare Hospital from January 2011 to March 2013.They were followed up until deliveries.Unconditional logistic regression model was used to estimate adjusted odds ratio（OR）and 95% confidence interval（95%CI）for the single and joint associations of folic acid supplementation and dietary folate intake with preterm birth and various clinical subtypes. Results After adjusting the related confounding factors,the risk of preterm birth reduced significantly among pregnant women who took supplemental folic acid longer than 12 weeks or took more than 209.94μg/day dietary folate（OR=0.83,95%CI：0.72-0.96;OR=0.84,95%CI：0.76-0.94,P〈0.05）.The joint analyses of folic acid supplementation and dietary folate intake with preterm birth showed that the additive and multiplicative interactions were found between folic acid supplementation and dietary folate intake [RERI（95% CI）=0.32（0.12-0.51）,AP（95% CI）=0.92（0.24-1.61）,S（95%CI）=0.68（0.56-0.82）;ORa（95% CI）= 0.90（0.82-0.99）,P=0.038].The similar patterns were also observed in those with early preterm birth,very early preterm birth,spontaneous preterm birth,and spontaneous preterm birth without premature rupture of membrane（PPROM）. Conclusions Folic acid supplementation and dietary folate intake during pregnancy may have the synergistic protective effect for preterm birth,therefore it is suggested that pregnant women should take more dietary folate while taking supplemental folic acid in order to reduce the risk of preterm birth.
作者
毛宝宏
邵亚雯
李静
刘小晖
代伟
王剑
王文第
邱伟涛
王燕侠
MAO Bao hong;SHAO Ya-wen;LI Jing;LIU Xiao-hui;DAI Wei;WANG Jian;WANG Wen-di;QIU Wei-tao;WANG Yan-xia(Gansu Provincial Maternity and Childcare Hospital,Lanzhou,Gansu 730050,Chin)
出处
《中国预防医学杂志》
CAS
CSCD
2018年第7期491-497,共7页
Chinese Preventive Medicine
基金
中国疾病预防控制中心妇幼保健中心合生元母婴营养与健康研究项目(2018FYH007)
甘肃省省自然科学研究基金计划(1208RJZA122)
兰州市科技计划项目(2015-2-34)
关键词
叶酸
膳食营养
早产
自发性早产
干预性早产
病例对照研究
交互作用
Folic Acid
Folate
Preterm Birth
Spontaneous preterm
Medically indicated preterm
Case control study
Interaction
