文章摘要
郭玲玲,申嘉欣,汝首杭,王颖,李玫,冯永亮,张萍,邬惟为,王素萍,张亚玮,杨海澜.孕前体质指数对围孕期增补叶酸与小于胎龄儿关系影响的研究[J].中华流行病学杂志,2017,38(9):1263-1268
孕前体质指数对围孕期增补叶酸与小于胎龄儿关系影响的研究
Association between periconceptional folic acid supplementation and small for gestational age birth based on pre-pregnancy body mass index
收稿日期:2017-01-19  出版日期:2017-09-09
DOI:10.3760/cma.j.issn.0254-6450.2017.09.024
中文关键词: 小于胎龄儿;体质指数;叶酸
英文关键词: Small for gestational age;Body mass index;Folic acid
基金项目:山西医科大学十人计划项目;山西省青年科技研究基金(2013021033-2);山西省普通高校特色重点学科建设项目;国家自然科学基金(81473061)
作者单位E-mail
郭玲玲 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
申嘉欣 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
汝首杭 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
王颖 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
李玫 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
冯永亮 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
张萍 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
邬惟为 030001 太原, 山西医科大学 公共卫生学院流行病学教研室  
王素萍 030001 太原, 山西医科大学 公共卫生学院流行病学教研室 spwang88@163.com 
张亚玮 030001 太原, 山西医科大学 公共卫生学院流行病学教研室
耶鲁大学公共卫生学院环境健康科学系 
yawei.zhang@yale.edu 
杨海澜 030001 太原, 山西医科大学第一医院妇产科  
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中文摘要:
      目的 探讨孕前不同BMI状态下,围孕期增补叶酸与小于胎龄儿(SGA)的关系。方法 以2012年3月至2016年9月在山西医科大学第一医院产科分娩的8 523例单胎活产孕妇以1 066例SGA作为病例组,以7 457例适于胎龄儿(AGA)作为对照组,收集孕妇一般人口学特征、孕前和孕期增补叶酸情况及新生儿基本信息等资料。通过非条件logistic回归分析孕前BMI对围孕期增补叶酸与SGA关系的影响。结果 SGA发生率为12.51%(1 066/8 523)。调整孕妇年龄等因素后,孕前体重较低者是SGA发生的危险因素(OR=1.22,95%CI:1.01~1.47),孕前超重/肥胖者可降低SGA的发生风险(OR=0.81,95%CI:0.68~0.97);调整孕妇年龄等因素后,围孕期增补叶酸是SGA的保护因素(OR=0.82,95%CI:0.68~0.98)。按孕前BMI分层后显示,孕前超重者围孕期增补叶酸可降低SGA的发生风险(OR=0.55,95%CI:0.36~0.85),未发现其他各BMI组围孕期增补叶酸与SGA有关。进一步按增补的叶酸种类分组后显示,围孕期单纯增补400 μg叶酸片是SGA的保护因素(OR=0.82,95%CI:0.69~0.99),且孕前超重者围孕期单纯增补400 μg叶酸片能降低SGA的发生风险(OR=0.56,95%CI:0.36~0.86)。未发现围孕期单纯增补含400 μg叶酸的复合维生素与SGA有关。结论 孕前超重者围孕期增补400 μg叶酸片能降低SGA的发生,而在其他各BMI组中未发现关联;孕前BMI可能影响围孕期增补叶酸与SGA的关系。
英文摘要:
      Objective To investigate the association between periconceptional folic acid supplementation and small for gestational age (SGA) birth based on maternal pre-pregnancy body mass index (BMI) and provide evidence for the development of comprehensive prevention programs on SGA birth. Methods Between March, 2012 and September, 2016, a total of 8 523 pregnant women delivering in the First Affiliated Hospital of Shanxi Medical University were surveyed to collect the information about their demographic characteristics, folic acid supplementation before and during pregnancy and about their infants. Among their infants, 1 066 were small for gestational age (case group), 7 457 were appropriate for gestational age (AGA) (control group). Unconditional logistic regression model was used to evaluate the association between periconceptional folic acid supplementation and SGA birth in the context of different pre-pregnancy BMI. Results The overall incidence of SGA birth was 12.51% (1 066/8 523). After adjusting the confounding factors, pre-pregnancy BMI<18.5 kg/m2 was a risk factor for SGA birth (OR=1.22, 95%CI:1.01-1.47), pre-pregnancy BMI ≥ 24.0 kg/m2 was associated with a reduced risk of SGA birth (OR=0.81, 95%CI:0.68-0.97). After adjusting confounding factors, periconceptional folic acid supplementation was a protective factor for SGA birth (OR=0.82, 95%CI:0.68-0.98). After stratified by pre-pregnancy BMI, periconceptional folic acid supplementation was associated with the reduced risk of SGA birth in overweight group (24.0 kg/m2 ≤ BMI<28.0 kg/m2) with OR of 0.55 (95%CI:0.36-0.85). No significant association was observed in other groups. When examined by folic acid supplement type, periconceptional single folic acid supplementation (400 μg per tablet) was a protective factor for SGA birth (OR=0.82, 95%CI:0.69-0.99). After stratified by pre-pregnancy BMI, periconceptional single folic acid supplementation (400 μg per tablet) was associated with the reduced risk of SGA birth in overweight groups (OR=0.56, 95%CI:0.36-0.86). No association was observed between periconceptional folic acid containing multivitamin supplementation and SGA birth. Conclusions Periconceptional folic acid supplementation (400 μg) was associated with reduced risk of SGA birth in women with pre-pregnancy BMI ≥ 24.0 kg/m2 and <28.0 kg/m2. No association between folic acid supplementation and SGA was observed in other groups. This study suggests that pre-pregnancy BMI might modify the influence of folic acid supplementation on the risk of SGA birth.
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