Prenatal Multivitamin Supplementation and Rates of Congenital Anomalies: A Meta-Analysis
Prenatal Multivitamin Supplementation and Rates of Congenital Anomalies: A Meta-Analysis
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DOI：
10.1016/s1701-2163(16)32227-7
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发表时间：
2006-08-01
影响因子：
1.8
通讯作者：
Koren, Gideon
中科院分区：
文献类型：
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作者：
Goh, Y. Ingrid;Bollano, Enkelejd;Koren, Gideon
背景：长期以来，叶酸强化复合维生素补充剂的使用与降低神经管缺陷的风险有关。一些研究也提出了这些补充剂在预防其他出生缺陷方面的有效性;然而，这种效果从未被系统地检查过。目的：我们进行了一项系统回顾和荟萃分析，以评估叶酸强化复合维生素补充剂对其他先天性异常的保护作用。我们检索了Medline、PubMed、EMBASE、Toxline、Healthstar，和科克伦数据库，用于描述使用多种维生素补充剂的妇女怀孕结果的研究，这些研究从1月起以所有语言发表1966年至2005年7月。对所有收集到的文献中的参考文献进行了审查，以确定是否有其他文献。两名对文章的来源和身份不知情的独立评审员根据预先确定的纳入和排除标准提取数据。使用随机效应模型，出生的妇女服用多种维生素补充剂的婴儿先天性畸形率进行了比较，在对照组的后代谁是not.Results：从最初的搜索，92项研究被确定，其中41符合纳入标准。使用多种维生素补充剂提供了对神经管缺陷的一致保护（病例对照研究中随机效应比值比[OR] 0.67，95%可信区间[95% CI] 0.58-0.77; OR 0.52，队列和随机对照研究中的95% CI 0.39-0.69），心血管缺陷（病例对照研究中OR 0.78，95% CI 0.67-0.92;队列和随机对照研究中OR 0.61，95% CI 0.40-0.92），和肢体缺损（病例对照研究OR 0.48，95% CI 0.30-0.76;队列和随机对照研究OR 0.57，95% CI 0.38-0.85）。对于腭裂，病例对照研究显示OR为0.76（95% CI 0.62-0.93），队列和随机对照研究显示OR 0.42（95% CI 0.06-2.84）;病例对照研究显示，口唇腭裂或无腭裂的OR为0.63（95%CI 0.54-0.73），队列和随机对照研究显示OR 0.58（95% CI 0.28-1.19）;泌尿系畸形的病例对照研究显示OR为0.48（95%CI 0.30-0.76），队列和随机对照研究显示OR 0.68（95% CI 0.35-1.31）;先天性脑积水病例对照研究显示OR为0.37（95% CI 0.24-0.56），队列和随机对照研究显示OR 1.54（95% CI 0.53-4.50）。在预防唐氏综合征，幽门狭窄，隐睾，或尿道下裂。结论：母亲消费含叶酸的产前多种维生素与几个先天性异常的风险降低，不仅神经管缺陷。这些数据具有重大的公共卫生意义，因为到目前为止，只鼓励强化叶酸。应重新考虑这一做法。
Background: The use of folic acid-fortified multivitamin supplements has long been associated with decreasing the risk of neural tube defects. Several studies have also proposed the effectiveness of these supplements in preventing other birth defects; however, such effects have never been systematically examined.Objective: We conducted a systematic review and meta-analysis to evaluate the protective effect of folic acid-fortified multivitamin supplements on other congenital anomalies.Methods: We searched Medline, PubMed, EMBASE, Toxline, Healthstar, and Cochrane databases for studies describing the outcome of pregnancies in women using multivitamin supplements that were published in all languages from January 1966 to July 2005. The references from all collected articles were reviewed for additional articles. Two independent reviewers who were blinded to the source and identity of the articles extracted data based on predetermined inclusion and exclusion criteria. Using a random effects model, rates of congenital anomalies in babies born to women who were taking multivitamin supplements were compared with rates in the offspring of controls who were not.Results: From the initial search, 92 studies were identified; 41 of these met the inclusion criteria. Use of multivitamin supplements provided consistent protection against neural tube defects (random effects odds ratio[OR] 0.67, 95% confidence intervals [95% CI] 0.58-0.77 in case control studies; OR 0.52, 95% CI 0.39-0.69 in cohort and randomized controlled studies), cardiovascular defects (OR 0.78, 95% CI 0.67-0.92 in case control studies; OR 0.61, 95% CI 0.40-0.92 in cohort and randomized controlled studies), and limb defects (OR 0.48, 95% CI 0.30-0.76 in case control studies; OR 0.57, 95% CI 0.38-0.85 in cohort and randomized controlled studies). For cleft palate, case control studies showed OR 0.76 (95% CI 0.62-0.93), and cohort and randomized controlled studies showed OR 0.42 (95% CI 0.06-2.84); for oral cleft with or without cleft palate, case control studies showed OR 0.63 (95% CI 0.54-0.73), and cohort and randomized controlled studies showed OR 0.58 (95% CI 0.28-1.19); for urinary tract anomalies, case control studies showed OR 0.48 (95% CI 0.30-0.76), and cohort and randomized controlled studies showed OR 0.68 (95% CI 0.35-1.31); and for congenital hydrocephalus case control studies showed OR 0.37 (95% CI 0.24-0.56), and cohort and randomized controlled studies showed OR 1.54 (95% CI 0.53-4.50). No effects were shown in preventing Down syndrome, pyloric stenosis, undescended testis, or hypospadias.Conclusion: Maternal consumption of folic acid-containing prenatal multivitamins is associated with decreased risk for several congenital anomalies, not only neural tube defects. These data have major public health implications, because until now fortification of only folic acid has been encouraged. This approach should be reconsidered.