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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (4): 719-725. doi: 10.19723/j.issn.1671-167X.2020.04.024

• 论著 • 上一篇    下一篇

妇女围受孕期叶酸服用情况及其对胎儿神经管缺陷的预防效果

金蕾1,王程2,张杰2,孟文颖3,张佳煜1,于锦慧2,蔺桂银1,佟明坤2,靳蕾2,△()   

  1. 1.北京市通州区妇幼保健院妇女保健科,北京 101100
    2.北京大学生育健康研究所,国家卫生健康委员会生育健康重点实验室,北京大学公共卫生学院流行病与卫生统计学系,北京 100191
    3.北京市通州区妇幼保健院产科,北京 101100
  • 收稿日期:2019-01-07 出版日期:2020-08-18 发布日期:2020-08-06
  • 通讯作者: 靳蕾 E-mail:jinlei@bjmu.edu.cn
  • 基金资助:
    国家重点研发计划项目(2018YFC1004300);国家重点研发计划项目(2018YFC1004301)

Maternal periconceptional folic acid supplementation and its effects on the prevalence of fetal neural tube defects

Lei JIN1,Cheng WANG2,Jie ZHANG2,Wen-ying MENG3,Jia-yu ZHANG1,Jin-hui YU2,Gui-yin LIN1,Ming-kun TONG2,Lei JIN2,△()   

  1. 1. Department of Maternal Health Care, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing 101100, China
    2. Institute of Reproductive and Child Health, Peking University; Key Laboratory of Reproductive Health, the National Health Commission of the People’s Republic of China; Department of Epidemiology and Biostatistics, Peking University School of Public Health; Beijing 100191, China
    3. Department of Obstetrics, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing 101100, China
  • Received:2019-01-07 Online:2020-08-18 Published:2020-08-06
  • Contact: Lei JIN E-mail:jinlei@bjmu.edu.cn
  • Supported by:
    National Key R&D Program of China(2018YFC1004300);National Key R&D Program of China(2018YFC1004301)

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摘要：

目的: 了解北京市妇女围受孕期服用叶酸的依从性,探索服用叶酸对胎儿神经管缺陷(neural tube defects,NTDs)的预防效果,分析影响叶酸服用依从性的因素,并提出改善叶酸服用依从性的对策和建议。方法: 以通州区2013—2018年92 121例分娩妇女的常规孕期保健数据和人群出生缺陷监测数据为基础,计算妇女的叶酸服用率和依从服用率(即孕前开始且规律服用率), 并分析服用叶酸与NTDs发生率的关系,同时采用单因素及多因素Logistic回归模型分析叶酸依从服用率的影响因素,并提出改善妇女围受孕期叶酸服用依从性的对策。结果: 6年间,妇女围受孕期叶酸总服用率为90.08%,有微弱上升趋势,而叶酸依从服用率仅为41.5%,且呈明显下降趋势。服用叶酸的妇女其胎儿NTDs的发生率是(5.5/万)未服用叶酸者(19.7/万)的27.9% (χ2=23.74,P<0.001),而服用单纯叶酸片和服用含叶酸的多种微量营养素的NTDs发病率未见统计学差异。母亲围受孕期补充叶酸可以减少70%的NTDs发病风险(RR=0.28,95%CI:0.16~0.49),且对无脑畸形和脊柱裂亚型均有预防效果。控制混杂因素后,本地户籍、文化程度为高中及以上的妇女叶酸依从服用率高于外地户籍、文化程度为初中及以下的妇女(P<0.05),年龄小于25岁、孕前偏瘦或肥胖的妇女、经产妇的叶酸依从服用率低于相应对比组(P<0.05)。结论: 北京市通州区妇女围受孕期叶酸服用率较高,但服用依从性较低,妇女围受孕期未服用叶酸严重影响NTDs的预防效果。叶酸依从服用率受妇女的年龄、文化程度、职业、户籍地、产次等多种因素影响,应重点关注年龄小于25岁、体型消瘦或肥胖、文化程度较低、经产及夫妻均为外地户籍的妇女,以提高围受孕期叶酸服用的依从性,更好地发挥叶酸预防NTDs的效果。

关键词: 围受孕期, 叶酸, 依从性, 神经管缺损

Abstract:

Objective: To find out the status of folic acid supplementation among women, to evaluate the prevention effects on neural tube defects (NTDs), and to explore the factors impact on folic acid supplementation compliance. Methods: Based on the routine data of 92 121 women in prenatal health care and birth defect surveillance system in Tongzhou District of Beijing from 2013 to 2018, we described the prevalence of periconceptional folic acid supplementation, pre-pregnancy folic acid supplementation and regularly folic acid supplementation (compliance supplementation). Trend χ 2 tests were used to evaluate the change of folic acid supplementation prevalence. The prevalence difference among the women with folic acid supplementation and without supplementation were tested with Fisher’s exact test. Factors asso-ciated with folic acid supplementation compliance rate were analyzed with univariate and multivariate Logistic regression model. Results: The prevalence of periconceptional folic acid supplementation during the six years was 90.08% and it was increased from 2013 to 2018, but the rate of pre-pregnancy and regular supplementation was only 41.5% and declined from 2013 to 2018, especially 2013 to 2015. The prevalence of NTDs among the fetuses whose mothers took folic acid during periconceptional period was 5.5/10 000, while the prevalence for the fetuses whose mothers did not take folic acid was 19.7/10 000 (P<0.001), the rates ratio was 27.9% (χ2=23.74, P<0.001). The difference between the prevalence of NTDs among the fetuses whose mothers took folic acid only and multiple micronutrients was not statistically significant. After controlling the confounding factors, it was found that the compliant folic acid supplementation rates in women, whose household registrations were outside Beijing and whose education levels were junior high school or below, and who were younger than 25 years old, and who were multiparas and who were pre-pregnancy underweight or obese, were lower than those of the corresponding control groups (P<0.05). Conclusion: The rate of folic acid supplementation among women in Tongzhou District of Beijing was relatively high, but their compliance was poor. Women who did not take folic acid during periconception seriously affected the prevention effect of NTDs. We should focus on women who are younger than 25 years old, lower educated, pre-pregnancy underweight or obese, multiparas and nonlocal household registers, in order to improve the periconceptional folic acid supplementation compliance and improve the effects of NTDs prevention.

Key words: Periconception, Folic acid, Compliance, Neural tube defects

中图分类号: 

  • R714.7

表1

2013—2018年北京市通州区妊娠妇女的基本特征a"

Characteristics n (%)
Ethnicity
Han 80 954 (94.6)
Other 4 589 (5.4)
Age/years
14- 18 326 (19.9)
25- 42 002 (45.6)
30- 24 819 (26.9)
35-56 6 974 (7.6)
Education
Junior high school and below 10 241 (11.5)
High school or equivalent 17 441 (19.5)
College school 26 111 (29.3)
Bachelor degree or above 35 459 (39.7)
Occupation
Manager of a unit 9 782 (11.3)
Professional 16 641 (19.2)
Clerical personnel 13 216 (15.3)
Commercial or service personnel 15 091 (17.4)
Unemployment 15 318 (17.7)
Other occupations 16 468 (19.0)
Household registration
Couples both with non-local household registration 36 298 (39.8)
Couples both with local household registration 40 283 (44.2)
Couples only the husband had local household
registration		 14 574 (16.0)
Pre-pregnancy BMI/(kg/m2)
10- 7 766 (11.3)
18.5- 42 865 (62.6)
24.0- 13 292 (19.4)
28.0-45 4 542 (6.6)
Gestational week age/weeks
<37 4 387 (4.8)
≥37 86 233 (95.2)
Parity
Primiparity 55 840 (62.5)
Multiparity 33 553 (37.5)
Get pregnancy with assisted reproductive technology
Yes 1 362 (1.5)
No 90 759 (98.5)
Delivery year
2013 7 586 (8.2)
2014 12 033 (13.1)
2015 14 334 (15.6)
2016 17 548 (19.1)
2017 21 076 (22.9)
2018 19 544 (21.2)

图1

北京市通州区2013—2018年妇女围受孕期叶酸服用率和依从服用率变化趋势"

图2

妇女围受孕期服用叶酸和未服用叶酸胎儿神经管缺陷及其亚型的发生率"

图3

妇女围受孕期服用叶酸对胎儿神经管缺陷及其亚型发生风险的影响"

表2

北京市通州区2015—2018年妊娠妇女叶酸依从服用率的影响因素a"

Characteristics Compliant supplementation Univariate analysis Multivariate analysis
n Rate/% OR (95%CI) P OR (95%CI) P
Ethnicity
Han 26 059 43.0 0.95 (0.89-1.02) 0.147 0.99 (0.92-1.07) 0.838
Others 1 558 43.2 1.00 1.00
Age/years
14- 3 716 35.0 1.00 1.00
25- 13 534 45.4 1.64 (1.57-1.72) <0.001 1.59 (1.59-1.76) <0.001
30- 8 315 44.0 1.56 (1.49-1.64) <0.001 2.00 (1.88-2.11) <0.001
35-56 2 249 41.4 1.35 (1.27-1.44) <0.001 2.02 (1.87-2.17) <0.001
Education
Junior high school and below 2 142 33.4 1.00 1.00
High school or equivalent 4 386 38.3 1.40 (1.32-1.49) <0.001 1.14 (1.06-1.22) <0.001
College school 8 036 42.6 1.80 (1.70-1.90) <0.001 1.29 (1.21-1.37) <0.001
Bachelor degree or above 12 950 47.4 2.27 (2.15-2.40) <0.001 1.43 (1.34-1.53) <0.001
Occupation
Manager of a unit 2 931 44.3 1.00 1.00
Professional 6 322 47.4 1.13 (1.07-1.20) <0.001 1.32 (1.23-1.40) <0.001
Clerical personnel 4 150 41.1 0.88 (0.82-0.93) <0.001 1.03 (0.96-1.09) 0.973
Commercial or service personnel 4 816 42.9 0.94 (0.89-1.00) 0.061 1.21 (1.13-1.29) <0.001
Unemployment 3 755 37.1 0.74 (0.70-0.79) <0.001 1.08 (1.01-1.16) 0.100
Other occupations 5 066 43.5 0.97 (0.91-1.03) 0.282 1.18 (1.11-1.26) <0.001
Household registration
Couples both with non-local household registration 10 703 37.7 0.65 (0.63-0.67) <0.001 0.62 (0.60-0.65) <0.001
Couples both with local household registration 12 868 48.1 1.00 1.00
Couples only the husband had local household
registration		 4 243 44.2 0.86 (0.82-0.90) <0.001 0.84 (0.80-0.88) <0.001
Pre-pregnancy BMI/(kg/m2)
10- 2 721 38.8 0.85 (0.81-0.89) <0.001 0.84 (0.79-0.88) <0.001
18.5- 16 675 43.0 1.00 1.00
24.0- 5 245 44.0 1.02 (0.98-1.07) 0.245 1.05 (1.01-1.10) 0.017
28.0-45.0 1 655 41.5 0.90 (0.85-0.96) 0.001 0.92 (0.86-0.99) 0.022
Parity
Primiparity 17 681 48.2 1.00 1.00
Multiparity 9 179 34.9 0.54 (0.52-0.56) <0.001 0.48 (0.46-0.49) <0.001
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ISSN 1671-167X
CN 11-4691/R
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