Is there a reduction of congenital abnormalities in the offspring of diabetic pregnant women after folic acid supplementation? A population-based case-control study
Is there a reduction of congenital abnormalities in the offspring of diabetic pregnant women after folic acid supplementation? A population-based case-control study
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DOI：
10.1111/j.1741-4520.2010.00302.x
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发表时间：
2011-06-01
影响因子：
1.3
通讯作者：
Czeizel, Andrew A. E.
中科院分区：
文献类型：
--
作者：
Banhidy, Ferenc;Dakhlaoui, Abdallah;Czeizel, Andrew A. E.
本研究的目的是评估叶酸对1型糖尿病（DM-1）孕妇后代的结构性出生缺陷（即先天性异常[CAs]）的预防作用。在以人群为基础的匈牙利先天性异常病例-对照监测系统中，对有畸形胎儿/新生儿（病例）和生下健康婴儿（对照组）的孕妇中医学记录的DM-1的发生率进行了比较。病例组有22 843例子代，其中DM-1孕妇79例（0.35%），对照组有38 151例新生儿，母亲为DM-1者88例（0.23%）。与非糖尿病母亲的后代总CAs发生率相比，患有DM-1的母亲其后代总CAs发生率的风险更高（OR 95% CI: 1.5, 1.1-2.0）。这种较高的风险可以通过四种特定类型/组的ca来解释：孤立性肾a/发育不良；尿道梗阻性CA；心血管CAs;和多个CAs，即尾端发育不良序列。然而，补充叶酸后，DM-1孕妇的孩子中总CAs的比率并没有增加；此外，未发生神经管缺损和肾脏发育不良。然而，这种益处不能用叶酸在主要CAs关键时期的CA还原作用来解释。综上所述，孕期补充叶酸后，DM-1对母体的致畸作用有一定的降低，但这种作用的解释有待进一步研究。
The objective of the present study was to estimate the preventive effect of folic acid for structural birth defects (i.e. congenital abnormalities [CAs]) in the offspring of pregnant women with diabetes mellitus type 1 (DM-1). The occurrence of medically recorded DM-1 in pregnant women who had malformed fetuses/newborns (cases) and delivered healthy babies (controls) with or without folic acid supplementation was compared in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. The case group included 22 843 offspring, and there were 79 (0.35%) pregnant women with DM-1, while the control group comprised of 38 151 newborns, and 88 (0.23%) had mothers with DM-1. Case mothers with DM-1 associated with a higher risk of total rate of CAs in their offspring (OR with 95% CI: 1.5, 1.1-2.0) compared to the total rate of CAs in the offspring of non-diabetic case mothers. This higher risk can be explained by four specific types/groups of CAs: isolated renal a/dysgenesis; obstructive CA of the urinary tract; cardiovascular CAs; and multiple CAs, namely caudal dysplasia sequence. However, there was no higher rate of total CAs in the children of pregnant women with DM-1 after folic acid supplementation; in addition, neural-tube defect and renal a/dysgenesis did not occur. However, this benefit cannot be explained by the CA reduction effect of folic acid during the critical period of major CAs. In conclusion, there was a certain reduction in maternal teratogenic effect of DM-1 after folic acid supplementation during pregnancy, but the explanation of this effect requires further study.