Adherence to iron and folic acid supplementation and associated factors amongmothers receiving antenatal care in Lira district, Uganda

Background:Prenatal iron and folic acid supplementation is an economical strategy for reducing iron and folic acid deficiency anemia among expectant mothers in resource-limited countries like Uganda.This study aimed to assess the level of compliance with iron and folic acid supplementation(IFAS)and identify associated factors among mothers receiving prenatal services in Lira district,Uganda.Methods:A cross-sectional study was conducted at the antenatal clinic of Lira Regional Referral Hospital,involving 252 pregnant mothers.Adherence levels to IFAS were evaluated using a visual analogue scale,and associated factors were collected through an interviewer-administered questionnaire.The data were analyzed using SPSS software,and the results were presented in tables.Results:Only 46%of the mothers attending the antenatal clinic adhered to IFAS during the 30 days preceding the study.Participants who had good knowledge of IFAS before recruitment(odds ratio(OR)1.49,95%confidence interval(CI)1.12–1.97),utilized reminder techniques(OR 1.05,95%CI 1.02–1.09),and received support from their partners or relatives(OR 1.56,95%CI 1.07–2.29)were more likely to have good adherence.The main reasons for missing IFAS were forgetfulness and fear of taking too many tablets.Conclusions:There was a low adherence rate to IFAS among mothers attending antenatal clinics in Lira district.Further investigations are recommended to identify barriers to adherence,and comprehensive health education programs should be provided to pregnant mothers.

Periconceptional Folic Acid Supplementation in Chinese Women： A Cross-sectional Study

Objective To investigate the status of folic acid （FA） supplementation and determinants of its use inpregnant Chinese women Methods In this cross-sectional study, questionnaires were used to collect information of participantsand FA supplementation. Women were recruited between 6 and 12 weeks postpartum in Tianjin, China,between July 2015 and July 2016 Results A total of 1,921 women were recruited in the study. Approximately 93.1% of the studyparticipants used FA, while 14.4% of the women taking FA from three months prior to preconception tothree months post-conception. Women who took FA for three months prior to preconception throughat least three months into their pregnancy were more likely to be between 30 and 34 years old （OR =2.91, 95% CI： 1.15, 7.33）, employed （OR = 2.07, 95% CI： 1.17, 3.67）, primigravida （OR = 5.20, 95% CI：3.02, 8.96）, married to spouses with an intermediate education level （OR = 2.92, 95% CI： 1.45, 5.89）, andearn a high family income （OR = 3.19, 95% CI： 1.57, 6.49） Conclusion The prevalence of periconceptional FA intake was far below the requirements of theNational Health and Family Planning Commission of China; therefore, knowledge of FA supplementationshould be strengthened among women who are or planning to become pregnant.

Folic Acid Supplementation in Chinese Periconceptional Population:Results from the SPCC Study

Objective To determine the prevalence and determinants of folic acid(FA)supplementation in Chinese couples planning for pregnancy and in women during early pregnancy.Methods This was a cross-sectional study based on the Shanghai PreConception Cohort(SPCC)study.Data on FA supplementation and socio-demographic features were collected using questionnaires.Couples visiting clinics for pre-pregnancy examination and pregnant women at<14 gestational weeks were recruited in Shanghai,China,between March 2016 and September 2018.Results Among the pregnancy planners,42.4%(4,710/11,099)women and 17.1%(1,377/8,045)men used FA supplements,while 93.4%(14,585/15,615)of the pregnant women used FA supplements.FA supplement use was higher in female pregnancy planners who were older(RR:1.13,95%CI:1.08–1.18),had higher education(RR:1.71,95%CI:1.53–1.92),and were residing in urban districts(RR:1.06,95%CI:1.01–1.11)of FA supplementation;female pregnancy planners with alcohol consumption(RR:0.95,95%CI:0.90–0.99)had lower odds of FA supplementation.In early pregnancy,women with higher educational level(RR:1.04,95%CI:1.03–1.06),who underwent pre-pregnancy examination(RR:1.02,95%CI:1.01–1.03)had higher odds of using an FA supplement;older aged(RR:0.99,95%CI:0.98–0.99),and multigravida(RR:0.97,95%CI:0.96–0.98)had lower odds of FA supplementation.Conclusion Although the majority of pregnant women took FA supplements,more than half of the women planning for pregnancy did not.Urgent strategies are needed to improve pre-conception FA supplementation.

Prevention of neural tube defects with folic acid: The Chinese experience

Neural tube defects(NTDs) are a group of congenital malformations of the central nervous system that are caused by the closure failure of the embryonic neural tube by the 28 th day of conception. Anencephaly and spina bifida are the two major subtypes. Fetuses with anencephaly are often stillborn or electively aborted due to prenatal diagnosis, or they die shortly after birth. Most infants with spina bifida are live-born and, with proper surgical treatment, can survive into adulthood. However, these children often have life-long physical disabilities. China has one of the highest prevalence of NTDs in the world. Inadequate dietary folate intake is believed to be the main cause of the cluster. Unlike many other countries that use staple fortification with folic acid as the public health strategy to prevent NTDs, the Chinese government provides all women who have a rural household registration and who plan to become pregnant with folic acid supplements, free of charge, through a nation-wide program started in 2009. Two to three years after the initiation of the program, the folic acid supplementation rate increased to 85% in the areas of the highest NTD prevalence. The mean plasma folate level of women during early and mid-pregnancy doubled the level before the program was introduced. However, most women began taking folic acid supplements when they knew that they were pregnant. This is too late for the protection of the embryonic neural tube. In a postprogram survey of the women who reported folic acid supplementation, less than a quarter of the women began taking supplements prior to pregnancy, indicating that the remaining three quarters of the fetuses remained unprotected during the time of neural tube formation. Therefore, staple food fortification with folic acid should be considered as a priority in the prevention of NTDs.

Awareness of Folic Acid Intake among Women in the Childbearing Age in Hail Region—Saudi Arabia

This study evaluated the awareness of folic acid, timing of folic acid supplementation and source of knowledge of folic acid intake in Hail region-Saudi Arabia. A sample of 300 married women in the childbearing age (19 - 45 years) in Hail in the period between October/2011 and January/2012 participated in a survey study regarding awareness and use of folic acid before and during pregnancy. Participant women were asked to respond to different questions related to age, level of education, occupation, monthly income, gravidity, and other information concerning folic acid awareness, specific knowledge, supplementation practices, and source of knowledge about the preconceptional intake of folic acid. While 91.0% of the subjects were aware of folic acid, 81.0% knew that folic acid could prevent neural tube defects and 84.0% of the subjects took folic acid prior or during a certain stage of pregnancy. Nonetheless, only 10.0% of the subjects who proclaimed that they know the proper timing for folic acid supplementation recognized that folic acid should be taken prior and during the first trimester of pregnancy. University education was the strongest predictor of folic acid knowledge and university educated subjects had significantly (P P

老年人叶酸补充现状调查及影响因素分析

目的 了解老年人补充叶酸现状并分析影响因素,为引导老年人正确补充叶酸提供参考。方法 以方便抽样法选取2023年3月1—31日于首都医科大学附属北京安贞医院就诊的60岁及以上处方含叶酸的老年人为研究对象,采用问卷调查法获取其对叶酸补充的知信行情况。统计老年人对于叶酸认识程度以及服用叶酸的现状;以被调查者平均每日叶酸补充剂量是否合理分为合理补充组和不合理补充组,比较2组调查对象特征;通过Logistic回归分析方法分析合理补充叶酸的影响因素。结果 共发放问卷673份,回收有效问卷595份。595例被调查者中男359例、女236例,年龄(70±6)岁;合理补充组280例,不合理补充组315例。合理补充组的男性比例、文化程度、合并高血压病比例、检测过血清同型半胱氨酸、检测过血清叶酸、知晓过量补充叶酸可能带来健康风险的比例及叶酸知识的获取途径为医师主动处方的比例高于不合理补充组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示年龄小于70岁(比值比=0.014,95%置信区间:0.013~0.128)、本科及以上的文化程度(比值比=0.147,95%置信区间:0.060~0.356)、知晓过量补充叶酸带来的健康风险(比值比=0.029,95%置信区间:0.009~0.091)、叶酸补充由医师主动处方(比值比=0.062,95%置信区间:0.024~0.175)对老年人合理补充叶酸有明显积极影响(均P<0.05)。结论 加强叶酸补充相关知识的健康教育,由医师进行个体化叶酸处方更有利于老年人合理补充叶酸,从而得到相关获益,避免健康风险。

高效液相色谱法测定复合营养素补充剂中叶酸含量

目的:通过建立一种提取效率高、耐复杂基质干扰能力强的样品前处理方式结合高效液相色谱紫外(High performance liquid chromatography-ultraviolet,HPLC-UV)检测方法,解决复合营养素补充剂中叶酸的准确定量检测难题。方法:以多种维生素矿物质片为特征样品,首次采用弱碱性饱和乙二胺四乙酸二钠盐(EDTA)溶液为样品提取液并结合操作简便的超声提取前处理方法,高效提取供试品中的叶酸成分并有效屏蔽基质因素干扰,最终使用HPLC分离高灵敏检测。结果:叶酸在浓度范围0.9912~49.5615μg/mL内保持良好现行关系(r2=0.9999);加标回收率达99.08%;平行试验结果RSD=1.01%(n=6);方法定量限LOQ=0.15μg/mL。改进后的分析方法通过系统的方法学验证后发现能够针对多种维生素矿物质片中的叶酸进行准确定量,并成功应用于市面上多种剂型叶酸类保健食品的实际检测中,结果均与产品标示量保持一致。结论:本方法简便易操作、提取效率高、抗基质干扰能力强、应用范围广,适用于多种维生素矿物质片中的叶酸含量测定,并为复合营养素补充剂类保健食品中叶酸测检测提供了一条新的途径。

妇女增补叶酸预防神经管畸形推广研究五年成果和工作总结

目的 总结妇女增补叶酸预防神经管畸形推广研究五年成果和经验 ,更好地贯彻中央关于提高出生人口素质工作的意见。方法 分析成果推广的政策背景和科研背景 ,研究在市场经济条件下 ,建立完善推广机制 ,依托妇幼保健、计划生育和妇联组织的组织管理经验和成果推广模式。结果 经过几年努力 ,形成年产 5 0 0 0万瓶斯利安的生产基地 ,药品发放覆盖全国 2 7个省、110 0个县 ,创利税超过 10 0 0万元。推广示范地区 ,随斯利安发放数量增加 ,神经管畸形发生率出现下降趋势。结论 妇女增补叶酸预防神经管畸形推广研究取得了显著的社会效益和经济效益。

神经管畸形营养干预社会经济影响因素分析

目的分析社会经济因素对育龄妇女使用孕妇复合营养素的影响,为开展人群干预计划提供科学依据。方法在全国选取7个省,进行孕妇复合营养素干预引入性试验。每省在社会经济发展水平处于中等水平的县市中各抽取1个县和1个市区,在确定样本县市后再采用多阶段随机抽样的方法抽取正计划怀孕的妇女和调查时已怀孕的妇女5593人进行问卷调查。结果育龄妇女有愿意使用孕妇营养素意向者占47%,实际使用孕妇复合营养素的育龄妇女仅占3.4%。家庭成员支持是妇女孕妇复合营养素使用意愿的最关键的影响因素;妇女的社会经济地位、家庭成员的支持和社区卫生服务提供是影响孕妇复合营养素使用的关键因素。结论社会经济各因素影响育龄妇女对复合孕妇营养素的使用,家庭成员支持是妇女孕妇复合营养素使用意愿的最关键影响因素。

疫情期间“互联网+药学服务”模式干预孕妇叶酸补充效果评价

目的探讨药师如何在新型冠状病毒肺炎(COVID-19)疫情期间通过“互联网+”模式提高孕妇叶酸补充依从性,以及确保新型冠状病毒肺炎(COVID-19)疫情期间孕妇围孕期用药安全、合理。方法医院药师采用“互联网+药学服务”模式干预,通过在线免费咨询、电话形式开展叶酸代谢基因检测个体化用药指导,以及微信群管理干预孕妇的叶酸补充。结果2020年2月1日至今(截至投稿时)共接受在线咨询38条,咨询内容主要为妇科用药、高血压、糖尿病等慢病用药,其中孕妇用药为9条;以电话形式开展叶酸代谢基因检测个体化用药指导85例,实施干预调整剂量35例。药师干预后,患者叶酸补充依从性得到很大提高,妊娠结局较好。结论疫情期间采用“互联网+药学服务”模式,可为药师参与围孕期妇女用药管理、提高孕妇叶酸补充的依从性提供切实可靠的路径。

围孕期叶酸摄入与早产不同亚型的相关性研究

目的探讨孕前、孕期摄入叶酸补充剂的持续时间与早产不同亚型的相关性。方法建立出生队列研究,收集2010至2012年在甘肃省某妇幼专科医院建卡定期产检并随访到正常分娩的10 542例孕妇,最终以纳入的10 179例孕妇为研究对象,用病例对照研究方法分析孕前、孕期摄入叶酸补充剂的持续时间与不同亚型早产的相关性。结果以孕前、孕期均未服用叶酸补充剂的研究对象作为对照,在调整母亲年龄等混杂因素后,发现服用叶酸补充剂持续时间>12周可降低早产的发生风险(OR=0.72,95%CI:0.58~0.89,P=0.020),并具有显著的剂量反应关系,特别是降低了自发性早产的发生风险(OR=0.69,95%CI:0.54~0.88,P=0.000);同时发现长期持续地服用叶酸补充剂可降低早期早产的发生风险(OR=0.54,95%CI:0.34~0.85,P=0.000)。结论在孕前至孕期连续叶酸补充剂的摄入可降低早产发生的风险,而且保护效果因不同早产亚型而异,建议孕前及孕期可长期适量服用叶酸补充剂。

江门市育龄及孕期妇女增补叶酸预防NTDs的KAP现况调查

目的了解江门地区育龄及孕期妇女增补叶酸预防神经管畸形(NTDs)的知、信、行现况。方法随机选取我市育龄及孕期妇女为调查对象,采用自行编制的问卷对其叶酸增补的知、信、行状况进行调查,并对数据进行单因素分析。结果获得1 003份有效调查问卷,愿意服用叶酸的比率为98.60%,763名妊娠期妇女的叶酸服用率为79.16%。既往怀孕和生育次数可显著影响妇女对叶酸增补知识的知晓率和增补行为,文化程度高者和年龄高者对叶酸增补知识的知晓率更高、增补行为更正确科学,但本科学历以上者对于基层医院提供免费叶酸的知晓率最低。结论实施出生缺陷"三级干预措施",加强叶酸增补预防NTDs的宣教,普及优生知识有待进一步提高。

甘肃省5县基层妇幼保健人员增补叶酸知信行调查分析

目的调查甘肃省5县所有乡、村妇幼专干和计生专干增补叶酸预防神经管缺陷知识认知情况，客观评价出生缺陷干预效果，为指导神经管畸形的有效干预提供科学依据。方法对甘肃省永靖县、泾川县、徽县、渭源县、敦煌市的所有乡、村妇幼专干和计生专干进行普查，分析其对增补叶酸的知识、态度和行为。结果共回收有效问卷1409份，调查显示，基层妇幼保健人员对“神经管缺陷发生的时间、神经管缺陷的诊断、生育神经管缺陷儿的高危人群、增补叶酸人群”等问题的知晓率较低，均不到50％；其中35～44岁的工作人员在“接受培训、知道健康妇女需要补充叶酸、认为有必要向育龄妇女介绍叶酸重要性、对妇女进行宣传教育、免费发放叶酸、指导并监督服用叶酸”方面知识欠缺，知晓率分别为36．2％、36．2％、37．4％、37．2％、37．2％、35．0％。结论甘肃省基层妇幼保健人员对增补叶酸知识知晓率普遍较低，需进一步加强基层妇幼保健人员的培训，以提高其专业知识水平。

围孕期补充叶酸的益处及疑惑

目前叶酸对围孕期的重要作用已得到广泛关注,但对于围孕期补充叶酸的益处、安全性等方面仍存在一些疑惑。本文简要综述了叶酸对先天畸形和妊娠结局的影响,叶酸补充的推荐剂量,体内叶酸状态监测以及补充叶酸时肿瘤、维生素B12缺乏和双胎的影响,为围孕期妇女补充叶酸提供参考。

影响育龄妇女叶酸增补的因素

出生缺陷已经成为影响新生儿健康和生命的主要疾病 ,神经管畸形及多种出生缺陷的发生与妇女孕早期叶酸缺乏有关 ,孕期前后增补叶酸可以降低胎儿多种出生缺陷的危险性。叶酸增补形式中最方便、经济而有效的是服用叶酸增补剂 ,但由于多种因素影响 ,育龄妇女叶酸增补剂服用率较低。可能影响育龄妇女叶酸增补的因素包括人口、经济及社会学特征 ,生理、心理事件 ,对叶酸的知识、态度和信念 ,以及行为干预等几个方面。

陕西省千阳县妇女围孕期叶酸增补及影响因素

目的了解陕西省千阳县围孕期妇女叶酸增补情况及叶酸增补的影响因素，为有效开展增补叶酸的工作提供依据。方法采用定量和定性研究结合的方法，对千阳县近3年分娩的948名妇女进行问卷调查；对就诊于县级医院的孕产妇和2岁以内儿童的母亲进行了个人访谈。结果①农村妇女孕期的叶酸增补率为38．2％，8．5％的妇女从孕前3个月开始增补叶酸；②多元Logistics回归结果显示，妇女教育水平高中及以上vs小学及以下（OR=2．11，P=0．004）、产检次数≥5次 vs 〈5次（OR=1．51，P=0．011）、早孕期进行首次产检vs中晚孕期进行首次产检（OR=1．62，P=0．020）等因素与叶酸增补有关；③不增补叶酸的原因包括“没有人宣传过要吃叶酸”占62％、“认为叶酸是药，害怕有副作用”占47％、“觉得不需要吃叶酸”占2l％等。结论千阳县妇女的叶酸增补率较低，产前检查利用与叶酸增补有关。建议充分结合产前检查及婚前检查服务，多部门合作提高人群叶酸增补率。

孕期微量元素和维生素的合理补充

妊娠是妇女特殊的生理时期,需要更多的营养物质,尤其是微量元素和维生素。微量元素和维生素在这一特殊时期对人体的细胞代谢、生物合成及生理功能起着重要作用,对妊娠期妇女的健康和胎儿体格、智力发育具有非常重要的意义。该文对孕期如何合理补充微量元素和维生素作一综述,以促进妊娠期妇女营养素的合理使用。

基因检测指导个体化叶酸补充预防新生儿缺陷性疾病效果

目的:探讨亚甲基四氢叶酸还原酶(MTHFR)、甲硫氨酸合成还原酶(MTRR)基因检测指导个体化补充叶酸预防新生儿缺陷性疾病的临床价值。方法:选择2015年1月—2018年10月4621例于本院优生优育门诊咨询计划妊娠的育龄妇女,根据自愿原则分为两组,观察组(2745例)妊娠前采集静脉血检测MTHFR C677T、A1298C位点、MTRR A66G位点基因多态性,根据基因突变情况评估叶酸利用能力风险等级,并给予个性化叶酸补充指导;对照组(1876例)采用传统叶酸补充方式。观察两组新生儿缺陷性疾病、不良妊娠结局发生情况。结果:观察组MTRR A66G位点基因分型、等位基因与中国常模比较无差异,2745例叶酸利用能力正常549例(20.0%),略差247例(9.0%),较差823例(30.0%),很差1126例(41.0%);获得随访4431例(96.0%),观察组妊娠后(2732例)发生自然流产(0.11%)、早产(0.15%)、21-三体(0.09%)、神经管畸形(0.09%)、唇腭裂(0.09%)、胎儿生长发育受限(0.06%)、先心病发生率(0.09%)均低于对照组(P<0.05)。结论:MTHFR C→T检测指导个体化补充叶酸可降低新生儿缺陷性疾病的发生,提高出生人口质量。

陕西省育龄妇女围孕期服用叶酸与产儿先天性心脏病的关系

目的探讨围孕期妇女服用叶酸与产儿先天性心脏病的关系,为采取有针对性的干预措施提供科学依据。方法应用分层随机整群抽样方法,抽取陕西省30个区县。对2010年1月至2013年11月间曾经怀孕、符合纳入标准、已知生育结局并知情同意的育龄妇女及其生育子女进行入户调查。采用Logistic回归模型控制相关影响因素分析妇女叶酸服用与产儿先天性心脏病发生的风险关系。结果本研究共纳入28 354名育龄妇女,其活产儿先天性心脏病患病率为7.3‰,育龄妇女围孕期叶酸服用率为64.4%,但其中按照规范服用叶酸的妇女仅占17.2%。围孕期妇女规范服用叶酸可能是产儿先天性心脏病的保护因素,单因素分析结果显示OR为0.502(95%CI:0.279~0.902);在控制了家庭背景因素,母亲因素以及孕期接触危险因素后多因素分析发现,叶酸规范服用仍然是先天性心脏病的保护性因素(调整OR=0.512,P=0.046)。然而,尚未发现不规范服用叶酸对产儿先天性心脏病发生的保护作用。结论按照规范时间和剂量服用叶酸(孕前3个月至孕早期3个月,每天服用0.4mg,且累计服用时间超过90d),可能预防先天性心脏病的发生。

MTHFR C677T多态性及叶酸补充情况与先兆流产的相关性分析

目的:探析MTHFR C677T基因多态性及叶酸补充情况与先兆流产的相关性。方法:采集先兆流产患者153例和各项指标正常孕妇200例的全血,用实时荧光定量PCR法检测MTHFR C677T基因位点多态性,比较两组基因型的频率分布;并对研究对象孕期叶酸补充情况进行调查,分析MTHFR C677T基因多态性及叶酸补充情况与先兆流产的关系。结果:先兆流产组MTHFR C677T的TT型分布频率高于健康对照组,CC型分布频率低于健康对照组,差异有统计学意义(P<0.05)。先兆流产组孕前补充叶酸的比例低于健康对照组,差异有统计学意义(P<0.05)。先兆流产组孕前未补充叶酸的TT型比例高于健康对照组,差异有统计学意义(P<0.05)。结论:叶酸代谢相关MTFHR基因C677T位点的突变可能与先兆流产有关,MTHFR 677TT基因型的围孕期妇女应在孕前补充叶酸。