贵州省和河南省四县农村地区孕妇乳母营养状况

Nutrition status of pregnant women and lactating mothers in rural areas of four counties in Guizhou and Henan Provinces

目的分析农村地区孕妇和乳母血清铁蛋白(SF)、运铁蛋白受体(sTfR)、维生素D(VD)、叶酸(FOL)和维生素B12(VB12)、同型半胱氨酸(Hcy)水平,评价农村地区孕妇和乳母的营养状况。方法采用整群抽样的方式,抽取在2019年8月—2020年3月期间妊娠期10~20周到县妇幼保健院进行孕检的孕妇和产后(42±7)天到县妇幼保健院进行体检的乳母。采用化学发光法检测血清铁蛋白、维生素D、叶酸和维生素B12水平,采用免疫比浊法检测超敏C反应蛋白(hsCRP)、运铁蛋白受体水平,采用酶比色法测定同型半胱氨酸水平。计算铁缺乏、维生素D缺乏、叶酸缺乏、VB12缺乏和高同型半胱氨酸血症(HHcy)比例。结果本研究共纳入1050名孕妇和309名乳母,孕妇SF水平和sTfR水平分别为49.6(47.1~52.3) ng/mL和2.51(2.46~2.56) mg/L,乳母为51.0(46.6~55.9) ng/mL和3.53(3.40~3.67) mg/L,乳母铁缺乏率显著高于孕妇(33.0%vs. 24.7%)。孕妇VD水平为17.0(16.6~17.4) ng/mL,乳母为16.7(16.0~17.4) ng/mL,孕妇和乳母VD缺乏率分别为64.5%和68.9%。孕妇FOL水平显著高于乳母[11.3(10.9~11.7)vs. 5.7(5.3~6.1) ng/mL],VB12水平显著低于乳母[282.7(276.1~289.5)vs. 437.7(418.7~457.6) pg/mL],Hcy水平显著低于乳母[7.1 (7.0~7.3)vs. 10.5(10.0~10.9)μmol/L],孕妇的FOL缺乏率、VB12缺乏率和HHcy比例分别为5.0%、17.2%和5.0%。乳母分别为29.8%、2.3%和27.8%,其差异均有统计学意义(P<0.05)。在铁、VD、叶酸和VB12四种营养素中,孕妇中有75.8%个体至少有一种营养素缺乏,有28.1%至少两种营养素缺乏。乳母81.9%至少有一种营养素缺乏,41.4%至少两种营养素缺乏。结论农村地区孕妇与乳母存在着不同程度的微量营养素缺乏,孕妇和乳母铁缺乏比例均较高、VD缺乏严重,而乳母还存在较高程度的叶酸缺乏和高同型半胱氨酸血症。

OBJECTIVE To analyze the levels of serum ferritin(SF), transferrin receptor(sTfR), vitamin D(VD), folate(FOL), vitamin B12(VB12) and homocysteine(Hcy) of pregnant women and lactating mothers in rural areas, aiming to evaluate the nutritional status of pregnant women and lactating mothers. METHODS By using a cluster sampling method, the subjects were the pregnant women at 10-20 weeks’ gestation and lactating mothers at 42±7 days’ postpartum who have been to the maternal and children health hospital in the county for examination from August 2019 to March 2020. SF, VD, VB12 and FOL concentrations were determined using the chemiluminescence assay. Hypersensitive C-reactive protein(hsCRP) and sTfR levels were determined using the immunoturbidimetry assay. Hcy levels were determined using the enzymatic assay. The rates of iron, vitamin D, folic acid, VB12 deficiency and hyperhomocysteinemia(HHcy) were calculated. RESULTS There were 1050 pregnant women and 309 lactating mothers involved. The levels of ferritin and sTfR were 49.6(47.1-52.3) ng/mL and 2.51(2.46-2.56) mg/L for the pregnant women, and 51.0(46.6-55.9) ng/mL and 3.53(3.40-3.67) mg/L for the lactating mother, respectively. The prevalence of iron deficiency in lactating mothers was significantly higher than the pregnant women(33.0% vs. 24.7%).The levels of VD were 17.0(16.6-17.4) ng/mL for pregnant women and 16.7(16.0-17.4) ng/mL for lactating mothers. The prevalence of VD deficiency was 64.5% and 68.9%, respectively. The level of FOL for pregnant women was significantly higher than the lactating mothers(11.3(10.9-11.7)vs. 5.7(5.3-6.1) ng/mL). The levels of VB12 for pregnant women was significantly lower than the lactating mother(282.7(276.1-289.5) vs. 437.7(418.7-457.6) pg/mL).The levels of Hcy for pregnant women was significantly lower than the lactating mother(7.1(7.0-7.3) vs. 10.5(10.0-10.9) μmol/L). The prevalence of FOL deficiency, VB12 deficiency and HHcy were 5.0%, 17.2% and 5.0% for pregnant women and 29.8%, 2.3% and 27.8% for lactating mothers, which were significant different between pregnant women and lactating mothers(P<0.05). Among the four nutrients including iron, VD, folate and VB12, 75.8% of pregnant women were deficient in at least one nutrient and 28.1% were deficient in at least two nutrients. 81.9% of lactating mothers were deficient in at least one nutrient and 41.4% were deficient in at least two nutrients. CONCLUSION There were various degrees of nutrient deficiency. Iron deficiency rates were high and VD deficiency were severe in both pregnant women and lactating mothers. In addition, the rates of folate deficiency and HHcy were high in lactating mothers in rural areas.