孕前男性和夫妻双方共同补充叶酸的横断面调查及影响因素分析

A cross-sectional study on prevalence of paternal and parental preconception folic acid supplement use and its influencing factors

目的调查孕前男性补充叶酸的现况并分析影响孕前男性补充叶酸的因素。方法选择上海市9区16家可进行孕前检查的综合型医院或区妇幼保健院(所)作为研究现场。纳入进行孕前咨询、检查的20~50岁夫妻,自主设计形成《孕前膳食补充剂调查表》(简称问卷),夫妻在孕前咨询、检查等待时在研究现场填写问卷,填写后当场回收,问卷数据进行双遍录入后行比对和逻辑检验。使用了叶酸或复合维生素者均视为使用了叶酸补充剂(使用叶酸组),两者都未使用者视为未使用叶酸补充剂(未使用叶酸组)。按夫妻中男性、女性和双方共同使用叶酸补充剂进行分层分析,纳入分析的可能影响因素包括:年龄、学历(高和低学历)、职业(白领和蓝领)、家庭年收入(<10万元和≥10万元)、研究现场所在区(传统和新兴市区)、吸烟(是和否)、饮酒(是和否)。夫妻双方共同分层影响因素中,年龄是指家庭年龄,即夫妻双方年龄的平均值;学历是指家庭学历,即夫妻一方高学历为高学历家庭;职业是指家庭职业,即夫妻一方为白领者为白领家庭;吸烟是指夫妻一方吸烟定义为吸烟家庭;饮酒是指夫妻一方饮酒定义饮酒家庭。结果调查4 224人,进入本文分析4 122(男1 854,女2 268)人和1 762个家庭,平均年龄为(30.5±4.3)岁,高学历家庭94.5%(1 659/1 756)。男性叶酸使用率为15.8%(292/1 854),男性叶酸使用组较未使用组:学历、家庭收入、研究现场、吸烟差异均有统计学意义(P均<0.05);男性和女性使用叶酸组与未使用叶酸组的年龄、饮酒差异均无统计学意义(P>0.05)。使用叶酸组中男性和女性比较:学历、职业、家庭收入和吸烟差异有统计学意义(P<0.05)。在1 762个家庭中,271个男性使用叶酸,48个(17.8%)男性单独使用叶酸。223个男性使用叶酸其配偶同时使用叶酸,夫妻双方均服用叶酸与均未服用家庭因素比较:学历、职业、家庭年收入、研究现场所在区、吸烟差异均有统计学意义。Logistic多因素回归分析显示,男性使用叶酸的影响因素为配偶服用叶酸和研究现场所在区,女性使用叶酸的影响因素为配偶服用叶酸、学历、研究现场所在区、吸烟和饮酒,家庭使用叶酸的影响因素有家庭学历、研究现场所在区和家庭职业。结论孕前男性、夫妻双方共同叶酸补充剂使用率是女性的1/3左右,女性叶酸补充剂的使用远没有达到中国卫生与计划生育委员会《2010年增补叶酸预防神经管缺陷项目管理方案》的要求,孕前女性叶酸补充剂的使用还需要加大科普宣教。

Objective： To investigate the prevalence and determinants of paternal preconception folic acid （FA） supplement use. Methods： This study was based on cross-sectional data from sixteen maternity and child hospitals （centers） or general hospitals located in nine districts of Shanghai. Participants were enrolled from pre-pregnant physical examination clinics, aged 20-50 years. They conducted the questionnaire during the waiting time at waiting-room and restored it before they leaved. The questionnaire data entry was conducted with double times and logical test. Participants were categorized according to the use of FA or multivitamin （MV）, the group had used FA or MV supplement was named users, in contrast, the group had not used FA or MV supplement was named nonusers. The correlation between the prevalence of FA supplement use and the selected socio demographic characteristics （age, education, occupation, household annual income, area of research site）, lifestyle （smoking situation, drinking situation） Were analyzed. Variables were analyzed as determinants of FA intake using chi-square statistical test and multivariate Logistical regression, respectively. Results： Overall, 4 224 pregnancy planners were enrolled, 4 122 participants were analyzed including 2 343 women and 1 881 men and 1 762 families. Average age was 30.5±4.3, 94.5% were highly educated families. The prevalence of preconception FA supplement use was 15.8% （292/185） in man and 42.6% in women. The prevalence of FA supplement use was higher among men with higher education and income, at traditional district, and with healthy lifestyle factors such as being a nonsmoker. Within 1762 families, 223 were FA supplement user families, 551 were nonuser families. The prevalence of parental FA supplement use was higher among families with higher education and income, living in traditional district, and in families with nonsmoker. Multivariate Logistical regression indicated paternal preconception FA supplement use was more likely among the population in traditional district （OR=8.60, 95%CI： 6.12, 12.07） and with their spouse using FA supplement （OR=1.44, 95%CI： 1.08, 1.93）. Conclusion： Prevalence of paternal and parental preconception FA supplement use are approximately one third of maternal FA supplement use. Maternal FA supplement use is far below the National Health and Family Planning Commission requirements, which indicates that education of folic acid supplement knowledge is deeply needed.