孕前及孕期增补叶酸与子痫前期发生风险的研究

Folic acid supplementation before and during pregnancy and the risk of preeclampsia

目的探讨孕前及孕期增补叶酸与子痫前期(PE)发生风险的关系。方法选取2012年3月至2016年9月于山西医科大学第一医院妇产科住院分娩的9048例单胎活产孕妇为研究对象,以882例PE孕妇为病例组,8166例非PE孕妇为对照组,收集孕妇的一般人口学特征、孕前及孕期增补叶酸情况、妊娠并发症及相关影响因素等信息。采用非条件logistic回归分析增补叶酸与PE发生风险的关系及孕前BMI对增补叶酸与PE关系的影响。结果调整孕妇年龄、文化程度等因素后,与未增补叶酸者相比,增补叶酸者发生PE的风险降低(OR=0.79,95%CI:0.64~0.96)。孕前和孕期均增补叶酸可降低PE的发生风险(OR=0.63,95%CI:0.49~0.81);单纯增补叶酸片及增补叶酸片和含叶酸的复合维生素是PE的保护因素(OR=0.81,95%CI:0.66~0.99;OR=0.64,95%CI:0.49~0.85),单纯增补含叶酸的复合维生素与PE未显示关联;增补叶酸剂量<400、400及>400μg/d与PE发生风险降低有关(OR=0.62,95%CI:0.42~0.91;OR=0.81,95%CI:0.66~0.99;OR=0.68,95%CI:0.49~0.94)。按孕前BMI分层后,孕前BMI<24.0 kg/m2的孕妇增补叶酸是PE的保护因素(OR=0.75,95%CI:0.59~0.96);在孕前BMI≥24.0 kg/m2的孕妇中未发现增补叶酸与PE有关。结论孕前和孕期均增补叶酸与PE发生风险降低有关,且孕前BMI可能影响增补叶酸与PE的关系,应对不同孕前BMI人群分别提出适宜的增补叶酸建议。

Objective To investigate the relationship between folic acid supplementation and the risk of preeclampsia(PE).Methods A total of 9048 pregnant women were selected from the First Hospital of Shanxi Medical University in Taiyuan from March 2012 to September 2016.Among them,882 pregnant women with PE were divided into case group,and 8166 pregnant women without PE were divided into control group.Information on demographic characteristics,folic acid supplementation,maternal complications,and other factors were collected by face-to-face interviews after child birth in the hospital.Unconditional logistic regression analyses were used to investigate the relationship between folic acid supplementation and the risk of PE and the effects of pre-pregnancy BMI on the relationship of folic acid supplementation with the risk of PE.Results Compared with nonusers,folic acid supplement users had reduced risk of PE(OR=0.79,95%CI:0.64-0.96).Folic acid supplementation before and during pregnancy were negatively related with the risk of PE(OR=0.63,95%CI:0.49-0.81).Pregnant women who used folic acid tablets only or used both folic acid tablets and multivitamin containing folic acid had reduced risk of PE(OR=0.81,95%CI:0.66-0.99;OR=0.64,95%CI:0.49-0.85).No significant relationship was observed in the multivitamin group.Supplemental folic acid doses of<400,400,and>400μg/d were related with reduced risk of PE(OR=0.62,95%CI:0.42-0.91;OR=0.81,95%CI:0.66-0.99;OR=0.68,95%CI:0.49-0.94).After stratified by pre-pregnancy BMI,pregnant women who used folic acid supplementation,those with pre-pregnancy BMI<24.0 kg/m2 had reduced risk of PE(OR=0.75,95%CI:0.59-0.96).However,no significant relationship was observed in women with pre-pregnancy BMI≥24.0 kg/m2.Conclusions Folic acid supplementation before and during pregnancy were related with reduced risk of PE.Pre-pregnancy BMI might affect the relationship between folic acid supplementation and the risk of PE.Appropriate folic acid supplementation should be recommend for women with different pre-pregnancy BMI.