围孕期叶酸摄入与妊娠期高血压疾病的相关性研究

Study on correlation between folic acid intake of pregnant women in perigestational period and HDCP

目的探讨围孕期叶酸补充及膳食叶酸的摄入与妊娠期高血压疾病的相关性。方法建立出生队列研究,收集2010年2月至2012年12月在甘肃省妇幼保健院建卡定期产检并随访至正常分娩的10 542例孕妇,最终以纳入的10 322例孕妇为研究对象。根据是否患有妊娠期高血压疾病将研究对象分为病例组(570例)和对照组(9 752例);根据孕妇在围孕期是否摄入叶酸补充剂分为服用叶酸补充剂组(7 608例)和未服用组(2 714例),分析围孕期叶酸补充时间及膳食中叶酸的摄入量与妊娠期高血压疾病的关系。结果病例组与对照组在年龄、家庭人均月收入、文化程度、妊娠期间是否工作、孕前身体质量指数(BMI)、孕期体重增加、孕产史、既往妊娠期高血压疾病史、是否有妊娠期糖尿病、是否多胎方面差异均有统计学意义(χ^2值分别为均33.589、49.148、44.864、16.659、92.278、44.132、15.353、14.866、10.050、221.889,均P<0.05);服用叶酸补充剂组与未服用组在文化程度、妊娠期间是否工作、家庭人均月收入、孕前BMI、孕期体重增加、孕产史、既往妊娠期高血压疾病史、是否有妊娠期糖尿病、是否多胎方面差异均有统计学意义(χ^2值分别为290.419、554.754、193.559、135.419、64.907、415.355、40.41、8.444、15.072,均P<0.001)。与围孕期均未服用叶酸补充剂的孕妇相比,在孕期服用叶酸补充剂超过12周可显著降低妊娠期高血压疾病(OR=0.56,95%CI:0.43~0.73,P<0.05)、轻度子痫前期(OR=0.29,95%CI:0.16~0.53,P<0.05)、重度子痫前期(OR=0.60,95%CI:0.39~0.91,P<0.05)及迟发型妊娠期高血压疾病(OR=0.53,95%CI:0.40~0.70,P<0.05)的发生风险;孕期高剂量膳食叶酸的摄入可降低妊娠期高血压疾病(OR=0.92,95%CI:0.84~0.99,P<0.05),特别是重度子痫前期(OR=0.85,95%CI:0.74~0.97,P<0.05)的发生风险。结论孕期服用叶酸补充剂超过12周可降低子痫前期及迟发型妊娠期高血压疾病的发生风险,高剂量膳食叶酸的摄入可降低重度子痫前期的发病风险,建议妊娠后可长期适量服用叶酸补充剂及摄入高叶酸含量的膳食。

Objective To investigate correlation of folic acid supplementation and dietary folate intake in perigestational period with hypertensive disorder complicating pregnancy(HDCP),so as to reduce incidences of HDCP and pre-eclampsia.Methods A birth cohort study was conducted.A total of 10 542 pregnant women who received regular prenatal examination and were followed up to normal childbirth in Gansu Provincial Maternity and Child Health Hospital from February 2010 to December 2012 were selected and finally 10 322 pregnant women were enrolled as the subjects of study.According to whether the pregnant woman was suffering from HDCP,the subjects were divided into two groups:case group(n=570) and control group(n=9 752).And according to whether the pregnant woman having taken folic acid supplements in perigestational period,the subjects again were divided into the folic acid supplementation group(n=7 608) and no folic acid supplementation group(n=2 714).The correlations of folic acid supplementation time and dietary folate intake in perigestational period with HDCP were analyzed in case-control study method.Results There were significant differences in age at pregnancy,family monthly income per capita,educational background of the pregnant woman,whether having work or not during gestational period,pregestational body mass index(BMI),body weight increase during pregnancy,pregnancy and childbirth histories,past history of HDCP,whether suffering from gestational diabetes mellitus(GDM),whether having or not multiple pregnancy between the case group and the control group(χ^2=33.589,49.148,44.864,16.659,92.278,44.132,15.353,14.866,10.050 and 221.889 respectively,all P<0.05).Furthermore,there were significant differences in educational background of the pregnant woman,whether having work or not during gestational period,family monthly income per capita,pregestational body mass index(BMI),body weight increase during pregnancy,pregnancy and childbirth histories,past history of HDCP,whether suffering or not from GDM,whether having or not multiple pregnancy between the folic acid supplements group and no folic acid supplements group(χ^2=290.419,554.754,193.559,135.419,64.907,415.355,40.41,8.444 and 15.072 respectively,all P<0.001).After adjusting the confounding factors,compared with no folic acid supplements in perigestational period,folic acid supplementation during pregnancy for more than 12 weeks could reduce risks of HDCP(OR=0.56,95% CI:0.43~0.73,P<0.001),mild pre-eclampsia(OR=0.29,95% CI:0.16~0.53,P<0.001),severe pre-eclampsia(OR=0.60,95% CI:0.39~0.91,P=0.003) and late-onset HDCP(OR=0.53,95% CI:0.40~0.70,P<0.001).High dose dietary folate intake during pregnancy might reduce the risk of HDCP(OR=0.92,95% CI:0.84~0.99,P=0.039),especially the risk of severe pre-eclampsia(OR=0.85,95% CI:0.74~0.97,P=0.043).Conclusion Folic acid supplements taken during pregnancy for more than 12 weeks can reduce the risks of pre-eclampsia and late-onset HDCP,high dietary folate intake during pregnancy can reduce the risk of severe pre-eclampsia,it is recommended to take folic acid supplements and intake high dietary folate for a long time once the pregnancy begins.