动态监测孕期叶酸、维生素B_(12)和同型半胱氨酸变化对妊娠结局的影响

The Impact of Dynamic Monitoring of Changes in Folic Acid,Vitamin B_(12) and Homocysteine During Pregnancy on Pregnancy Outcomes

目的探究妊娠期内动态监测孕妇血清叶酸(FA)、维生素B_(12)(VitB_(12))和同型半胱氨酸(Hcy)水平在预测妊娠结局中的临床意义。方法前瞻性纳入2020年2月至2022年3月期间在本院接受全孕期产检并分娩的200例孕妇作为研究对象,记录人口学资料并分别于孕早期、孕中期和孕晚期检测血清FA、VitB_(12)和Hcy水平。随访至分娩并记录妊娠结局,根据有无不良妊娠结局将其分为对照组(无不良妊娠结局,102例)和观察组(有不良妊娠结局,98例)。比较两组孕妇不同时期FA、VitB_(12)和Hcy水平。结果对照组血清FA和VitB_(12)水平随妊娠时间呈显著下降趋势,孕中期Hcy水平显著低于孕早期,孕晚期Hcy水平虽高于孕中期但低于孕早期(P<0.05)。观察组孕中期和孕晚期血清FA、VitB_(12)水平比较差异无统计学意义(P>0.05),但均显著低于孕早期(P<0.05),Hcy水平随妊娠时间呈显著下降趋势(P<0.05)。观察组孕早期和孕中期血清FA、ViB_(12)水平均显著低于对照组,Hcy水平均显著高于对照组(P<0.05)。两组孕晚期血清FA、VitB_(12)和Hcy水平以及FA缺乏、VitB缺乏以及高Hcy血症比例比较,差异均无统计学意义(P>0.05)。孕早期和孕中期FA缺乏、VitB缺乏以及高Hcy血症均能显著增加不良妊娠风险(P<0.05)。结论孕早期和孕中期FA缺乏、VitB_(12)缺乏与高Hcy血症均能提高不良妊娠结局发生风险。

Objective To explore the clinical significance of dynamically monitoring maternal serum folate(FA),vitamin B12(VitB_(12))and homocysteine(Hcy)levels during pregnancy in predicting pregnancy outcomes.Methods A prospective study was conducted on 200 pregnant women who underwent full pregnancy prenatal examination and delivery at our hospital from February,2020 to March,2022.Demographic data were recorded and serum FA,VitB_(12)and Hcy levels were measured in early,mid,and late pregnancy,respectively.Follow-up was conducted until delivery and we recorded pregnancy outcomes,and then divided them into a control group(102 cases with no adverse pregnancy outcomes)and an observation group(98 cases with adverse pregnancy outcomes)based on the presence or absence of adverse pregnancy outcomes.We compared levels of FA,VitB_(12)and Hcy between two groups of pregnant women at different stages.Results Serum levels of FA and VitB_(12)in the control group showed a significant downward trend with pregnancy time.Hcy level in mid pregnancy was significantly lower than that in early pregnancy.Although Hcy level in late pregnancy was significantly higher than that in mid pregnancy,it was significantly lower than that in early pregnancy(P<0.05).There was no significant difference in serum FA and VitB_(12)levels between the observation group in mid and late pregnancy(P>0.05),but they were significantly lower than those in early pregnancy(P<0.05).Hcy levels showed a significant downward trend with pregnancy time(P<0.05).Serum FA and ViB_(12)levels in the early and mid-pregnancy of the observation group were significantly lower than those in the control group,and Hcy levels were significantly higher than those in the control group(P<0.05).There was no statistically significant difference in levels of serum FA,VitB_(12)and Hcy,as well as the proportion of FA deficiency,VitB deficiency,and high Hcy in the late pregnancy between the two groups(P>0.05).FA deficiency,VitB deficiency,and high Hcy in early and mid-pregnancy were able to significantly increase the risk of adverse pregnancy(P<0.05).Conclusion FA deficiency,VitB_(12)deficiency,and high Hcy in early and mid-pregnancy can all increase the risk of adverse pregnancy outcomes.