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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (3): 434-442. doi: 10.19723/j.issn.1671-167X.2022.03.007

• 论著 • 上一篇    下一篇

围受孕期服用微量营养增补剂与孕早期血清维生素E浓度的关系

邢云飞1,刘春毅1,孟文颖2,张杰1,焦明远3,金蕾4,靳蕾1,*()   

  1. 1. 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 100191
    2. 北京市通州区妇幼保健院产科，北京 101100
    3. 北京市通州区妇幼保健院检验科，北京 101100
    4. 北京市通州区妇幼保健院妇女保健科，北京 101100
  • 收稿日期:2022-01-28 出版日期:2022-06-18 发布日期:2022-06-14
  • 通讯作者: 靳蕾 E-mail:jinlei@bjmu.edu.cn
  • 基金资助:
    国家重点研发计划(2021YFC2700700);国家重点研发计划(2021YFC2700704);首都卫生发展基金(2020-1-5112)

Relationship between micronutrients supplementation during periconceptional period and serum concentration of vitamin E in the 1st trimester of gestational period

Yun-fei XING1,Chun-yi LIU1,Wen-ying MENG2,Jie ZHANG1,Ming-yuan JIAO3,Lei JIN4,Lei JIN1,*()   

  1. 1. Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
    2. Department of Obstetrics, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
    3. Department of Clinical Laboratory, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
    4. Department of Maternal Health Care, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
  • Received:2022-01-28 Online:2022-06-18 Published:2022-06-14
  • Contact: Lei JIN E-mail:jinlei@bjmu.edu.cn
  • Supported by:
    National Key Research and Development Program of China(2021YFC2700700);National Key Research and Development Program of China(2021YFC2700704);Capital's Funds for Health Improvement and Research(2020-1-5112)

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摘要：

目的: 探究妇女围受孕期服用微量营养增补剂对孕早期血清维生素E(vitamin E，Vit.E)水平的影响。方法: 以2016年1月至2018年12月北京市通州区妇幼保健院的孕期保健和医院信息系统中22 171位分娩妇女的孕期保健及血液检查数据为基础进行回顾性队列研究，以围受孕期服用营养增补剂[单纯叶酸(folic acid，FA)或复方微量营养增补剂(multiple micronutrients，MM)]情况为自变量，孕早期血清Vit.E浓度和血清Vit.E浓度是否≥11.2 mg/L为结局变量，分别采用广义线性回归模型和Logistic回归模型分析自变量与结局变量的关系。结果: 妇女孕早期血清Vit.E浓度为5.2~24.0 mg/L，中位浓度为10.1(8.8~11.6) mg/L。服用MM的妇女孕早期血清Vit.E过量率为0.3%，未服用营养增补剂和服用单纯FA的妇女Vit.E过量率为0.1%。关于血清Vit.E浓度，服用MM的妇女比未服用营养增补剂及服用FA者高(P均 < 0.05)，孕前开始服用FA或MM比孕后开始服用高(P均 < 0.05)，规律服用比不规律服用高(P均 < 0.05)，且服用FA和服用MM的两组妇女血清Vit.E浓度均随服用依从性提高而升高(P < 0.05)。关于孕早期血清Vit.E浓度≥11.2 mg/L的风险，服用MM的妇女风险高于未服用营养增补剂及服用单纯FA者(OR=1.36，95%CI：1.21~1.53；OR=1.39，95%CI：1.31~1.48)，孕前开始服用FA或MM者比孕后开始服用高(OR=0.86，95%CI：0.77~0.96；OR=0.88，95%CI：0.81~0.95)，规律服用较不规律服用风险高(OR=1.16，95%CI：1.05~1.29；OR=1.13，95%CI：1.04~1.22)；且随依从性提高，服用MM者该风险升高(OR=1.10，95%CI：1.07~1.14)，但服用FA者该风险未见升高(OR=1.04，95%CI：1.00~1.08)。结论: 北京地区妇女孕早期Vit.E营养状况总体较好，其中服用MM的妇女孕早期血清Vit.E过量率较高，提示围受孕期妇女应考虑自身Vit.E营养状况选择营养增补剂配方，以免导致相关健康危害。

关键词: 微量营养素, 维生素E, 叶酸, 围受孕期, 妇女

Abstract:

Objective: To explore the association of maternal periconceptional folic acid or multiple micronutrients supplementation during periconceptional period and the serum vitamin E (Vit.E) concentration in the 1st trimester of gestational period. Methods: A retrospective cohort study was conducted based on the prenatal health care system and clinical laboratory information system. Totally, 22 171 pregnant women who had their prenatal health care and gave birth in Tongzhou Maternal & Child Health Hospital of Beijing from Jan. 2016 to Dec. 2018 were recruited. The usage patterns of nutritional supplements [folic acid (FA) or multiple micronutrients (MM)] during periconceptional period were independent variables, and serum Vit.E concentration and serum Vit.E concentration≥11.2 mg/L in the 1st trimester of gestational period were outcome variables for generalized linear regression model and Logistic regression model, respectively, to analyze the relationships between the independent and outcome variables. Results: The range of the serum Vit.E concentration in the 1st trimester of gestational period was 5.2-24.0 mg/L, and the median concentration was 10.1 (8.8-11.6) mg/L; the excess rate of the serum Vit.E of those who took MM supplementation was 0.3%, and the rates for the groups of FA only or no nutritional supplements used were both 0.1%. Compared with women without nutritional supplement or the women taking FA, the women who took MM had higher serum Vit.E levels in the 1st trimester of gestational period (both P < 0.05). The women taking FA or MM initiated before the conception showed that the serum Vit.E concentration in the 1st trimester of gestational period was higher than that after the conception (P < 0.05), and the serum Vit.E concentration of women who took regularly was higher than that of irregular taking (P < 0.05); with taking compliance elevated, the serum Vit.E concentration of the two groups of women taking FA or MM increased (P < 0.05). The risk of serum Vit.E concentration≥11.2 mg/L among the women taking MM was higher than that of the women without nutritional supplements or taking FA only [odds ratio (OR)=1.36, 95% confidence interval (95%CI): 1.21-1.53; OR=1.39, 95%CI: 1.31-1.48)]; women who took FA or MM showed a lower risk for serum Vit.E concentration≥11.2 mg/L of taking it after the conception than before, the ORs (95%CI) were 0.86 (95%CI: 0.77-0.96) and 0.88 (95%CI: 0.81-0.95), respectively; the women taking the two supplements regularly had higher risk for serum Vit.E concentration≥11.2 mg/L than irregular taking, the ORs (95%CI) were 1.16 (95%CI: 1.05-1.29) and 1.13 (95%CI: 1.04-1.22) for FA and MM users, respectively; with the compliance increasing, the women taking MM had a higher risk of serum Vit.E levels≥11.2 mg/L in the 1st trimester [OR (95%CI) was 1.10 (1.07-1.14)], but for FA users, the OR (95%CI) was 1.04(1.00-1.08). Conclusion: Vit.E nutritional status in women in early gestational period in Beijing was generally good, and the excess rate of serum Vit.E was higher in women who took MM during periconceptional period than those without nutritional supplement or taking FA only, suggesting that women need to consider their own Vit.E nutritional status to choose the type of nutritional supplements during periconceptional period, so as to avoid related health hazards.

Key words: Micronutrients, Vitamin E, Folic acid, Periconceptional period, Pregnant women

中图分类号: 

  • R169

图1

研究对象的选择流程图"

表1

研究对象的基本特征"

Characteristics Total, n(%) No-use, n(%) FA, n(%) MM, n(%) χ2 P
Delivery year 174.44 < 0.001
  2016 7 113 (32.1) 439 (25.7) 3 002 (36.9) 3 672 (29.8)
  2017 7 692 (34.7) 647 (37.8) 2 767 (34.0) 4 278 (34.7)
  2018 7 366 (33.2) 624 (36.5) 2 364 (29.1) 4 378 (35.5)
Ethnic groups 4.05 0.132
  Han 20 853 (94.1) 1 624 (95.0) 7 662 (94.2) 11 567 (93.8)
  Others 1 318 (5.9) 86 (5.0) 471 (5.8) 761 (6.2)
Maternal age 31.11 < 0.001
  17 years- 1 965 (8.9) 194 (11.3) 703 (8.6) 1 068 (8.7)
  25 years- 10 470 (47.2) 714 (41.8) 3 897 (48.0) 5 859 (47.5)
  30 years- 7 266 (32.8) 589 (34.4) 2 614 (32.1) 4 063 (33.0)
  35-51 years 2 470 (11.1) 213 (12.5) 919 (11.3) 1 338 (10.9)
Education level 349.16 < 0.001
  Middle school or lower 1 882 (8.5) 275 (16.1) 781 (9.6) 826 (6.7)
  High school or technical school 4 162 (18.8) 463 (27.1) 1 545(19.0) 2 154 (17.5)
  College 7 148 (32.2) 501 (29.3) 2 616 (32.2) 4 031 (32.7)
  University or above 8 979 (40.5) 471 (27.5) 3 191 (39.2) 5 317 (43.1)
Household registration 56.97 < 0.001
  Both of couple are local 8 340 (37.6) 534 (31.2) 3 121 (38.4) 4 685 (38.0)
  The women are local 9 765 (44.0) 828 (48.4) 3 415 (42.0) 5 522 (44.8)
  Only the spouses are local 4 066 (18.3) 348 (20.4) 1 597 (19.6) 2 121 (17.2)
Occupation 231.64 < 0.001
  Government agency 1 954 (8.8) 223 (13.0) 598 (7.4) 1 133 (9.2)
  Professional technicians 4 834 (21.8) 237 (13.9) 1 851 (22.8) 2 746 (22.3)
  Office clerk or related personnel 3 613 (16.3) 207 (12.1) 1 258 (15.5) 2 148 (17.4)
  Business / services 4 529 (20.4) 308 (18.0) 1 665 (20.5) 2 556 (20.7)
  Unemployment 2 985 (13.5) 286 (16.7) 1 115 (13.7) 1 584 (12.8)
  Others 4 256 (19.2) 449 (26.3) 1 646 (20.2) 2 161 (17.5)
Pre-pregnancy BMI 17.30 0.008
  Normal (18.5-23.9 kg/m2) 13 120 (59.2) 960 (56.1) 4 882 (60.0) 7 278 (59.0)
  Underweight (< 18.5 kg/m2) 2 317 (10.5) 166 (9.7) 823 (10.1) 1 328 (10.8)
  Overweight (24.0-27.9 kg/m2) 5 062 (22.8) 432 (25.3) 1 846 (22.7) 2 784 (22.6)
  Obesity (≥28.0 kg/m2) 1 672 (7.5) 152 (8.9) 582 (7.2) 938 (7.6)
Parity 210.67 < 0.001
  Nulliparity 12 005 (54.1) 639 (37.4) 4 544 (55.9) 6 822 (55.3)
  Multiparity 10 166 (45.9) 1 071 (62.6) 3 589 (44.1) 5 506 (44.7)

表2

妇女孕早期Vit.E营养状况"

Nutritional supplements use n(%) Vit.E concentration/(mg/L), median (P25-P75) Vit.E nutritional status
Normal, n(%) Excessive, n(%)
No-use 1 710 (7.7) 9.9 (8.7-11.5) 1 709 (99.9) 1 (0.1)
FA 8 133 (36.7) 9.9 (8.6-11.3) 8 126 (99.9) 7 (0.1)
MM 12 328 (55.6) 10.3 (8.9-11.8) 12 293 (99.7) 35 (0.3)
Total 22 171 (100.0) 10.1 (8.8-11.6) 22 128 (99.8) 43 (0.2)

表3

妇女围受孕期服用营养增补剂与孕早期血清Vit.E浓度的关系"

Use of nutritional supplements n (%) Vit.E concentration/(mg/L), median (P25-P75) Mann-Whitney U test, P Adjusted βa
Nutritional supplements
  No-use 1 710 (7.7) 9.9 (8.7-11.5) 0
  FA 8 133 (36.7) 9.9 (8.6-11.3) 0.205 -0.031
  MM 12 328 (55.6) 10.3 (8.9-11.8) < 0.001 0.375#
Supplements formula < 0.001
  FA 8 133 (39.7) 9.9 (8.6-11.3) 0
  MM 12 328 (60.3) 10.3 (8.9-11.8) 0.406#
Timing of supplementation initiation
  FA 0.037
    Before the conception 5 091 (62.6) 9.9 (8.7-11.3) 0
    After the conception 3 042 (37.4) 9.8 (8.6-11.2) -0.165#
  MM 0.007
    Before the conception 5 331 (43.2) 10.3 (9.0-11.9) 0
    After the conception 6 997 (56.8) 10.3(8.9-11.8) -0.155#
Frequency (in 10 d)
  FA 0.084
    Irregular(< 8 d) 3 569 (43.9) 9.8 (8.6-11.2) 0
    Regular(≥8 d) 4 564 (56.1) 9.9 (8.7-11.4) 0.144*
  MM 0.003
    Irregular(< 8 d) 7 555 (61.3) 10.3 (8.9-11.8) 0
    Regular(≥8 d) 4 773 (38.7) 10.3 (9.0-11.9) 0.152#

表4

妇女围受孕期服用FA或MM的依从性得分与孕早期血清Vit.E浓度的关系"

Compliance score n Vit.E concentration/(mg/L) β Adjusted βa
$\bar x \pm s$ Median (P25-P75)
FA 0.012 0.037*
  0 1 710 10.19±2.20 9.9 (8.7-11.5)
  1 3 040 10.03±2.10 9.8 (8.6-11.2)
  2 529 10.14±2.02 9.95 (8.6-11.3)
  3 4 562 10.15±2.17 9.9 (8.7-11.4)
MM 0.115# 0.118#
  0 1 710 10.19±2.20 9.9 (8.7-11.5)
  1 6 988 10.48±2.26 10.3 (8.9-11.7)
  2 567 10.57±2.57 10.2 (8.8-12.0)
  3 4 764 10.64±2.38 10.3 (9.0-11.9)

表5

妇女围受孕期服用营养增补剂与孕早期血清Vit.E浓度≥11.2 mg/L的关系"

Use of nutritional supplements n Vit.E concentration ≥11.2 mg/L, n(%) Crude OR (95%CI) Adjusted OR (95%CI)a
Nutritional supplements
  No-use 1 710 495 (28.9) 1 1
  FA 8 133 2 212 (27.2) 0.92 (0.82-1.03) 0.99 (0.88-1.12)
  MM 12 328 4 289 (34.8) 1.31 (1.17-1.46)# 1.36 (1.21-1.53)#
Supplements formula
  FA 8 133 2 212 (27.2) 1 1
  MM 12 328 4 289 (34.8) 1.43 (1.34-1.52)# 1.39 (1.31-1.48)#
Timing of initiation
  FA
    Before the conception 5 091 1 422 (27.9) 1 1
    After the conception 3 042 790 (26.0) 0.91 (0.82-1.00) 0.86 (0.77-0.96)*
  MM
    Before the conception 5 331 1 943 (36.4) 1 1
    After the conception 6 997 2 346 (33.5) 0.88 (0.82-0.95)* 0.88 (0.81-0.95)*
Frequency (10 in days)
  FA
    Irregular(< 8 d) 3 569 930 (26.1) 1 1
    Regular(≥8 d) 4 564 1 282 (28.1) 1.11 (1.00-1.22)* 1.16 (1.05-1.29)*
  MM
    Irregular(< 8 d) 7 555 2 547 (33.7) 1 1
    Regular(≥8 d) 4 773 1 742 (36.5) 1.13 (1.05-1.22)* 1.13 (1.04-1.22)*

图2

围受孕期单纯服用FA(A)和服用MM(B)的依从性得分与孕早血清Vit.E浓度≥11.2 mg/L关系"

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