PREVENTION OF THE 1ST OCCURRENCE OF NEURAL-TUBE DEFECTS BY PERICONCEPTIONAL VITAMIN SUPPLEMENTATION
PREVENTION OF THE 1ST OCCURRENCE OF NEURAL-TUBE DEFECTS BY PERICONCEPTIONAL VITAMIN SUPPLEMENTATION
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DOI：
10.1056/nejm199212243272602
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发表时间：
1992-12-24
影响因子：
158.5
通讯作者：
DUDAS, I
中科院分区：
文献类型：
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作者：
CZEIZEL, AE;DUDAS, I
背景在围受孕期服用叶酸或含叶酸的多种维生素的妇女，复发性神经管缺陷的风险降低。这种补充可以减少缺陷的首次发生的程度尚不清楚。我们进行了一项随机对照试验，围受孕期补充多种维生素，以测试这种治疗在降低首次发生神经管缺陷的发生率方面的疗效。计划妊娠的女性（大多数情况下是第一次）被随机分配接受一片维生素补充剂（含12种维生素，其中叶酸0.8毫克; 4种矿物质;和3种微量元素）或微量元素补充剂（含铜、锰、锌、和非常低剂量的维生素C），每天至少一个月，直到第二次错过月经或更晚。结果在4753名妇女中确认怀孕。2104名接受维生素补充剂的妇女和2052名接受微量元素补充剂的妇女的妊娠结局（胎儿或婴儿是否有神经管缺陷或先天畸形）是已知的。接受微量元素补充剂组的先天性畸形发生率明显高于维生素补充剂组（22.9/1000 vs. 13.3/1000，P = 0.02）。补充微量元素组有6例神经管缺损，而补充维生素组无一例（P = 0.029）。唇腭裂的患病率并没有降低围绝经期维生素补充。围孕期使用维生素可降低首次发生神经管缺陷的发生率。
Background. The risk of recurrent, neural-tube defects is decreased in women who take folic acid or multivitamins containing folic acid during the periconceptional period. The extent to which such supplementation can reduce the first occurrence of defects is not known.Methods. We conducted a randomized,controlled trial of periconceptional multivitamin supplementation to test the efficacy of this treatment in reducing the incidence of a first occurrence of neural-tube defects. Women planning a pregnancy (in most cases their first) were randomly assigned to receive a single tablet of a vitamin supplement (containing 12 vitamins, including 0.8 mg of folic acid; 4 minerals; and 3 trace elements) or a trace-element supplement (containing copper, manganese, zinc, and a very low dose of vitamin C ) daily for at least one month before conception and until the date of the second missed menstrual period or later.Results. Pregnancy was confirmed in 4753 women. The outcome of the pregnancy (whether the fetus or infant had a neural-tube defect or congenital malformation) was known in 2104 women who received the vitamin supplement and in 2052 who received the trace-element supplement. Congenital malformations were,significantly more prevalent in the group receiving the trace-element supplement than in the vitamin-supplement group (22.9 per 1000 vs. 13.3 per 1000, P = 0.02). There were six cases of neural-tube defects in the group receiving the trace-element supplement, as compared with none in the vitamin-supplement group (P = 0.029). The prevalence of cleft lip with or without cleft palate was not reduced by periconceptional vitamin supplementation.Conclusions. Periconceptional vitamin use decreases the incidence of a first occurrence of neural-tube defects.