孕期摄入不同形式叶酸与MTHFR基因多态性对妊娠结局的影响

Effects of different forms of folic acid intake during pregnancy and MTHFR gene polymorphism on pregnancy outcome

目的探讨孕期摄入不同形式叶酸与MTHFR基因多态性与妊娠结局的关系。方法选取2019年1月至2021年6月在海南省人民医院产科进行规律产检直至妊娠结束的孕妇共483例,采用开放式问卷调查的方式收集妊娠期妇女服用叶酸情况并分为两组:自备孕起至妊娠结束持续使用5-甲基四氢叶酸人群共126例,纳入甲基叶酸组;自备孕起至妊娠结束持续使用合成叶酸人群共357例纳入合成叶酸组。跟踪随访至分娩,对比两组血清叶酸水平、MTHFR基因多态性分布。统计分析检验不同叶酸类型与血清叶酸水平的相关性及发生不良妊娠事件的相关危险因素。结果合成叶酸组血清叶酸水平低于甲基叶酸组(P<0.05),并且对不良妊娠结局孕妇基因型进行比较后,发现MTHFR基因677位点基因型为TT型人群发生不良妊娠结局风险更高,OR值为3.71。两组在孕期使用不同类型叶酸后,发现孕期坚持服用5-甲基四氢叶酸,可显著降低不良妊娠结局的发病率(P<0.01)。结论MTHFR基因多态性是不良妊娠发生的相关危险因素,针对MTHFR基因677位点基因型为TT型和CT型的女性,建议孕妇在孕期坚持服用5-甲基四氢叶酸,可降低不良妊娠结局的发病率。

Objective To investigate the relationship between intake of different forms of folic acid during pregnancy,MTHFR gene polymorphism and pregnancy outcome.Methods A total of 483 pregnant women were selected from January 2019 to June 2021 who underwent regular obstetric examinations until delivery in the Hainan General Hospital.According to the open questionnaire method,the folic acid consumption of pregnant women was collected.The 483 pregnant women divided into two groups:126 people who use 5-methyltetrahydrofolate as the methylfolate group;357 people use synthetic folic acid as the synthetic folic acid group.Serum folate levels and MTHFR gene polymorphism distribution were compared between the two groups at follow-up until delivery.To test the correlation between different folic acid types and serum folic acid levels and analyze the risk factors related to adverse pregnancy events.Results In the synthetic folate group,serum folate levels were lower than those in the methylfolate group(P<0.05).When comparing the genotypes of pregnant women with adverse pregnancy outcomes,it was found that the risk of adverse pregnancy outcomes was higher in those with TT genotype at locus 677 of the MTHFR gene,with an OR of 3.71.Ater using different types of folic acid during pregnancy in both groups,it was found that adherence to 5-methyltetrahydrofolate during pregnancy significantly reduced the incidence of adverse pregnancy outcomes(P<0.01).Conclusion MTHFR gene polymorphism is a related risk factor for adverse pregnancy.For women with TT and CT genotypes at locus 677 of the MTHFR gene,it is recommended to persist in taking 5-methyltetrahydrofolate during pregnancy to reduce the incidence of adverse pregnancy outcomes rate.