围受孕期服用微量营养增补剂与孕早期血清维生素E浓度的关系

Relationship between micronutrients supplementation during periconceptional period and serum concentration of vitamin E in the 1st trimester of gestational period

目的:探究妇女围受孕期服用微量营养增补剂对孕早期血清维生素E(vitamin E,Vit.E)水平的影响。方法:以2016年1月至2018年12月北京市通州区妇幼保健院的孕期保健和医院信息系统中22171位分娩妇女的孕期保健及血液检查数据为基础进行回顾性队列研究,以围受孕期服用营养增补剂[单纯叶酸(folic acid,FA)或复方微量营养增补剂(multiple micronutrients,MM)]情况为自变量,孕早期血清Vit.E浓度和血清Vit.E浓度是否≥11.2 mg/L为结局变量,分别采用广义线性回归模型和Logistic回归模型分析自变量与结局变量的关系。结果:妇女孕早期血清Vit.E浓度为5.2~24.0 mg/L,中位浓度为10.1(8.8~11.6)mg/L。服用MM的妇女孕早期血清Vit.E过量率为0.3%,未服用营养增补剂和服用单纯FA的妇女Vit.E过量率为0.1%。关于血清Vit.E浓度,服用MM的妇女比未服用营养增补剂及服用FA者高(P均<0.05),孕前开始服用FA或MM比孕后开始服用高(P均<0.05),规律服用比不规律服用高(P均<0.05),且服用FA和服用MM的两组妇女血清Vit.E浓度均随服用依从性提高而升高(P<0.05)。关于孕早期血清Vit.E浓度≥11.2 mg/L的风险,服用MM的妇女风险高于未服用营养增补剂及服用单纯FA者(OR=1.36,95%CI:1.21~1.53;OR=1.39,95%CI:1.31~1.48),孕前开始服用FA或MM者比孕后开始服用高(OR=0.86,95%CI:0.77~0.96;OR=0.88,95%CI:0.81~0.95),规律服用较不规律服用风险高(OR=1.16,95%CI:1.05~1.29;OR=1.13,95%CI:1.04~1.22);且随依从性提高,服用MM者该风险升高(OR=1.10,95%CI:1.07~1.14),但服用FA者该风险未见升高(OR=1.04,95%CI:1.00~1.08)。结论:北京地区妇女孕早期Vit.E营养状况总体较好,其中服用MM的妇女孕早期血清Vit.E过量率较高,提示围受孕期妇女应考虑自身Vit.E营养状况选择营养增补剂配方,以免导致相关健康危害。

Objective:To explore the association of maternal periconceptional folic acid or multiple micronutrients supplementation during periconceptional period and the serum vitamin E(Vit.E)concentration in the 1st trimester of gestational period.Methods:A retrospective cohort study was conducted based on the prenatal health care system and clinical laboratory information system.Totally,22171 pregnant women who had their prenatal health care and gave birth in Tongzhou Maternal&Child Health Hospital of Beijing from Jan.2016 to Dec.2018 were recruited.The usage patterns of nutritional supplements[folic acid(FA)or multiple micronutrients(MM)]during periconceptional period were independent variables,and serum Vit.E concentration and serum Vit.E concentration≥11.2 mg/L in the 1st trimester of gestational period were outcome variables for generalized linear regression model and Logistic regression model,respectively,to analyze the relationships between the independent and outcome variables.Results:The range of the serum Vit.E concentration in the 1st trimester of gestational period was 5.2-24.0 mg/L,and the median concentration was 10.1(8.8-11.6)mg/L;the excess rate of the serum Vit.E of those who took MM supplementation was 0.3%,and the rates for the groups of FA only or no nutritional supplements used were both 0.1%.Compared with women without nutritional supplement or the women taking FA,the women who took MM had higher serum Vit.E levels in the 1st trimester of gestational period(both P<0.05).The women taking FA or MM initiated before the conception showed that the serum Vit.E concentration in the 1st trimester of gestational period was higher than that after the conception(P<0.05),and the serum Vit.E concentration of women who took regularly was higher than that of irregular taking(P<0.05);with taking compliance elevated,the serum Vit.E concentration of the two groups of women taking FA or MM increased(P<0.05).The risk of serum Vit.E concentration≥11.2 mg/L among the women taking MM was higher than that of the women without nutritional supplements or taking FA only[odds ratio(OR)=1.36,95%confidence interval(95%CI):1.21-1.53;OR=1.39,95%CI:1.31-1.48)];women who took FA or MM showed a lower risk for serum Vit.E concentration≥11.2 mg/L of taking it after the conception than before,the ORs(95%CI)were 0.86(95%CI:0.77-0.96)and 0.88(95%CI:0.81-0.95),respectively;the women taking the two supplements regularly had higher risk for serum Vit.E concentration≥11.2 mg/L than irregular taking,the ORs(95%CI)were 1.16(95%CI:1.05-1.29)and 1.13(95%CI:1.04-1.22)for FA and MM users,respectively;with the compliance increasing,the women taking MM had a higher risk of serum Vit.E levels≥11.2 mg/L in the 1st trimester[OR(95%CI)was 1.10(1.07-1.14)],but for FA users,the OR(95%CI)was 1.04(1.00-1.08).Conclusion:Vit.E nutritional status in women in early gestational period in Beijing was generally good,and the excess rate of serum Vit.E was higher in women who took MM during periconceptional period than those without nutritional supplement or taking FA only,suggesting that women need to consider their own Vit.E nutritional status to choose the type of nutritional supplements during periconceptional period,so as to avoid related health hazards.