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.

Effect of a 12-Week Dietary Intervention with Folic Acid or Folate-Enhanced Foods on Folate Status in Healthy Egyptian Women

The Egyptian government introduced wheat-flour fortification with iron and folic acid to reduce the incidence of neural tube defects, but suspended it for technical reasons. We previously developed novel legume foods with enhanced folate content. In this study, we investigated the efficacy of 12-week intervention with folate-enhanced foods versus folic acid supplement in improving folate status in Egyptian women. A randomized, parallel intervention trial with two active groups (n = 19, n = 18) and one blinded control group (n = 20) was executed over 12 weeks. Volunteers received either germinated legume foods and orange juice (≈250 μg/d folate) or folic acid supplement (500 μg/d) or apple juice (0 μg/d folate). Folate status was assessed by erythrocyte and plasma folate and total homocysteine (tHcy) at day 0, and after 8 and 12 weeks of intervention. After 12 weeks, mean plasma folate increased by 14 (P < 0.0001) and 12 (P < 0.0001) nmoL in the folic acid and food group, respectively. Erythrocyte folate concentration increased in the folic acid group from 614 to 912 (P < 0.0001) and in the food group from 631 to 914 nmoL (P < 0.0001). After 12 weeks, 90% of subjects in the folic acid group and 70% in the food group had erythrocyte folate concentrations exceeding 906 nmol/L. tHcy concentration was decreased by 20% (P = 0.007) and 18% (P = 0.006) in the folic acid and food group, respectively, but remained unchanged in the control group during intervention. Folate-enhanced foods effectively improve folate status in women of reproductive age. These foods could be used as a complement to folic acid fortification.

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.

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。

叶酸干预对MTHFR基因型和脑卒中发生风险的相关性研究

目的:探讨叶酸干预对亚甲基四氢叶酸还原酶(MTHFR)基因型和脑卒中发生风险的相关性研究。方法:选取2022年1月至2022年12月于佳木斯大学附属第一医院就诊的100例脑卒中患者为受试者,其中包含缺血性脑卒中、H型高血压并发缺血性脑卒中等不同类型的患者,按照治疗方法不同将其分为两组。对照组受试者给予低剂量叶酸进行治疗;研究组受试者给予高剂量叶酸进行治疗。对两组受试者MTHFR基因多态性频率、MMSE评分、叶酸干预后Hcy的指标水平、脑卒中多因素回归分析以及叶酸干预是否增加脑卒中发生风险的相关性分析等指标进行观察。结果:研究组受试者MTHFR的C677T位点基因型以CT和TT为主,其中TT型和CT型基因频率高于对照组,CC型基因频率低于对照组,差异有统计学意义(P<0.05);两组受试者基线差异无统计学意义(P>0.05),研究组在第8周时MMSE评分为(28.50±0.69)分高于对照组(t=13.016,P<0.001);两组受试者干预前无统计学意义(P>0.05)。受试者经治疗后,研究组受试者Hcy水平为(11.67±1.46)μmoI/L高于对照组(t=15.363,P<0.001)将研究组=1,对照组=0,单因素分析差异显著的因素作为协变量进行逻辑回归分析,TT、CC、Hcy均是影响脑卒中的主要危险因素。Log(P)=TT×3.365+CC×5.365+Hcy×7.520-23.961;Pearson分析结果显示,脑卒中受试者疾病发生风险与叶酸干预总分呈负相关(r=-3.465,P=0.467),脑卒中受试者叶酸干预越高,即脑卒中发生风险越低。结论:Hcy是影响脑卒中患者脑卒中发生的一项重要的影响因素,对于脑卒中患者可以在适当的范围之内给予叶酸,降低Hcy水平,减少脑卒中的发生。

霍邱县2022年孕妇叶酸服用现状及其影响因素

目的了解霍邱县孕妇对增补叶酸知识的掌握及服用情况及其影响因素。方法选取本县516例孕产妇为研究对象,通过问卷调查了解孕产妇对叶酸相关知识知晓、服用现状及影响因素。结果孕妇叶酸知识答对3题及以上的有472例,叶酸知识知晓率为91.47%。年龄、家庭住址、职业、不良孕产史是增补叶酸相关知识知晓率的影响因素(P<0.05)。孕妇叶酸服用率为96.71%、服用依从率为32.46%、规范服用率为29.84%。文化程度、分娩史是叶酸服用率的影响因素(P<0.05)。年龄、家庭住址、职业是服用依从率的影响因素(P<0.05)。年龄、家庭住址、职业是规范服用率的影响因素(P<0.05)。结论霍邱县孕妇增补叶酸服用率较高,但叶酸服用依从率、叶酸规范服用率均低于国家标准,可通过在医院、妇幼保健计生机构内设立独立的孕前咨询门诊或围孕期保健门诊,甚至通过基层妇幼计生专干上门对育龄妇女进行一对一宣教,扩大育龄妇女增补叶酸知识的宣教范围,提高孕妇叶酸服用依从率和叶酸规范服用率,提升出生人口质量。

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。

专业人员叶酸认知及行为干预对孕妇叶酸服用依从性的影响

目的了解专业人员对孕妇服用叶酸的行为干预及其自身对叶酸预防知识的掌握情况,探讨专业人员对孕妇服用叶酸行为依从性的影响,为提高育龄妇女叶酸服用依从性提供科学依据。方法选择甘肃省两个县妊娠后3个月至产后1年的妇女为研究对象,通过面对面的问卷调查及对专业人员的小组访谈获取相关资料。结果专业人员告知叶酸服用时间、剂量及定期督导对孕妇服用叶酸依从行为程度的比较,差异均有统计学意义(P<0.01)。专业人员在叶酸推广中宣传工作不到位、向育龄妇女通知不到位、专业人员队伍不稳定、专业人员培训不到位及素质偏低、对工作重视不够、工作不够积极和态度差及其他因素对叶酸服用依从性的影响率比较,差异均有统计学意义(P<0.01)。结论提高医生等专业人员的叶酸预防知识,加强对育龄妇女叶酸服用知识的宣传及督导作用是提高妇女叶酸有效依从行为降低无效依从行为的重要保证。

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。

复方硫酸亚铁叶酸片在妊娠合并缺铁性贫血中的干预作用

目的探讨复方硫酸亚铁叶酸片在妊娠合并缺铁性贫血(IDA)中的干预作用。方法选择2014年1月至2015年2月天门市妇幼保健院接诊的80例妊娠合并IDA患者为研究对象,按随机数字表法分为对照组和观察组,各40例。对照组口服琥珀酸亚铁进行治疗,每次100~200 mg,每日3次;观察组口服复方硫酸亚铁叶酸片进行治疗,每次0.8 g,每日3次。比较两组患者治疗后的红细胞、血红蛋白(Hb)、血清铁蛋白(SF)、临床疗效以及出现的不良反应。结果治疗后,观察组红细胞、Hb以及SF高于对照组[(3.9±1.1)×1012/L比(2.5±0.8)×1012/L,(97.8±14.2)g/L比(81.8±2.8)g/L,(4.4±5.2)μg/L比(9.4±5.3)μg/L],差异有统学意义(P<0.01);观察组治疗中总不良反应发生率低于对照组[12.5%(5/40)比55.0%(22/40)],差异有统计学意义(P<0.05);观察组患者的总有效率高于对照组[90.0%(36/40)比72.5%(29/40)],差异有统计学意义(P<0.05)。结论复方硫酸亚铁叶酸片治疗妊娠合并IDA有良好的效果,且安全性高,不良反应少,值得在临床推广和应用。

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。

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。

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。

妊娠前干预的方法及效果评价

妊娠前干预是孕前期保健的重要组成部分。对妊娠前风险的准确评估和有效干预可显著改善妊娠结局。目前证明有效的干预方式包括,生活方式改变、环境改善、叶酸补充、遗传咨询以及慢性和感染性疾病控制等。对于生活方式和环境中的危险因素,开展大量的干预研究,效果显著。为保证围妊娠期妇女的叶酸摄入量,普遍采用补充叶酸制剂和食物叶酸强化两种方法。孕前遗传咨询是妊娠前干预的重要手段之一,其涉及生物医学、伦理道德、社会经济等多方面问题,目前还存在一些不足,但发展迅速。对患有慢性或传染性疾病的妇女采取一系列规范化的干预措施,可明显改善妊娠结局。

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。