备孕夫妇烟草暴露和饮酒对血清叶酸水平的影响

The effect of tobacco exposure and alcohol drinking on serum folate levels in child-bearing couples

背景现阶段备孕人群(夫妻双方)孕前叶酸补充剂的使用率和不良生活方式对叶酸水平影响不清楚。目的了解江苏省昆山市备孕人群的叶酸水平,分析烟草暴露和饮酒对血清叶酸水平的影响。设计横断面调查。方法以江苏省昆山市妇幼保健所(我所)婚前检查和孕前检查门诊为调查现场,以参加孕前检查、处于备孕状态的夫妻双方为研究对象(女方年龄<45岁)。行现场问卷调查并采血,分析备孕人群烟草暴露(近3个月有过吸烟或被动暴露于烟草烟雾环境中)和饮酒(过去30 d至少喝过1杯含有酒精的饮料)对血清叶酸水平的影响。由于尚无备孕人群特异的夫妻双方血清叶酸水平参考值,为确保样本统计效能最大,根据本研究人群血清叶酸检测值的P_(50)百分位数,<P_(50)和≥P_(50)分别定义为叶酸偏低组和叶酸正常组。协变量包括年龄、性别、BMI、学历和孕前是否使用叶酸补充剂。主要结局指标血清叶酸水平。结果2019年4月至2021年6月符合本文纳入排除标准的备孕期夫妻3990对,共计7980人进入本文分析。男性和女性年龄分别为(28.5±3.8)和(27.4±3.5)岁,烟草暴露比例分别为31.3%和0.9%,饮酒暴露比例分别为27.9%和6.0%,孕前服用叶酸补充剂分别占0.7%和2.7%,血清叶酸水平(中位数,ng·mL^(-1))分别为12.7(9.5,17.0)和18.8(14.0,26.1)。调整了年龄、性别、BMI、学历及孕前叶酸补充等协变量后,烟草暴露在总体人群(OR=1.48,95%CI:1.28~1.72)和男性(OR=1.46,95%CI:1.26~1.71)中与叶酸水平偏低显著相关;饮酒暴露在总体人群(OR=1.24,95%CI:1.09~1.42)、男性(OR=1.21,95%CI:1.05~1.42)和女性(OR=1.34,95%CI:1.02~1.76)中与叶酸水平偏低均显著相关。结论烟草暴露、饮酒与血清叶酸水平偏低存在关联且存在性别差异。

Background It is unclear about the effect of the rate of folic acid supplementation and unhealthy life habits in child-bearing couples on the level of serum.Objective To describe the serum folate levels in child-bearing couples in Kunshan City and investigate the associations of tobacco exposure and alcohol drinking with serum folate levels.Design Cross-sectional study.Methods The couples with the age of wife below 45 were enrolled from the premarital or pre-pregnancy examination clinic in Maternal and Child Health Center in Kunshan City.The questionnaires and blood samples were collected to analyze the relationship of the tobacco exposure defined as smoking or being passively exposed to tobacco smoke in the past 3 months and alcohol drinking defined as drinking alcoholic drink for at least one time in the past 30 days with serum folate levels.As there is no standard reference levels of serum folate for the child-bearing couples,we used the P_(50) of serum folate level in this study to define the low folate group(<P_(50))and normal group(≥P_(50))to ensure a maximum statistic power.The covariates included age,sex,BMI,education,and the use of folic acid supplementation.Main outcome measures Serum folate levels.Results A total of 3990 couples were enrolled from April 2019 to June 2021.The mean age were 28.5±3.8 and 27.4±3.5 years for the males and females.The prevalence of tobacco exposure,drinking and folic acid supplementation before pregnancy for males and females were 31.3%and 0.9%,27.9%and 6.0%,0.7%and 2.7%,respectively.Median serum folate levels in fathers and mothers were 12.7 ng·mL^(-1)(14.0,26.1)and 18.8 ng·mL^(-1)(9.5,17.0)correspondingly.After adjustment for covariates,the tobacco smoke exposure was associated with higher odds of low serum folate in whole population(OR=1.48,95%CI:1.28-1.72),and this association was further observed in males(OR=1.46,95%CI:1.26-1.71),but not in females.Alcohol drinking was significantly associated with low serum folate levels in the whole population(OR=1.24,95%CI:1.09-1.42),males(OR=1.21,95%CI:1.05-1.42),and females(OR=1.34,95%CI:1.02-1.76).Conclusion Tobacco exposure and alcohol drinking before pregnancy were associated with low serum folate,which may exist gender difference.