Periconceptional folic acid supplementation and the risk of preterm births in China: a large prospective cohort study
Periconceptional folic acid supplementation and the risk of preterm births in China: a large prospective cohort study
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中国围孕叶酸补充与早产风险：一项大型前瞻性队列研究
DOI：
10.1093/ije/dyu020
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发表时间：
2014-08-01
影响因子：
7.7
通讯作者：
Ren, Aiguo
中科院分区：
文献类型：
--
作者：
Li, Zhiwen;Ye, Rongwei;Ren, Aiguo
背景：含叶酸的多种维生素与降低早产风险有关。我们检查了围孕期单独使用叶酸是否可以降低这种风险。方法：数据来源于在中国进行的一项大型人群队列研究，旨在评估补充叶酸对神经管缺陷的预防作用。该样本包括来自中国南方两个省份的 207 936 名胎龄为 20-42 周的单胎活产婴儿。医护人员每月前瞻性地记录叶酸摄入量。孕周的计算是根据末次月经的第一天计算的。早产分为三种临床亚型：医源性早产、胎膜早破（PPROM）和自发性早产。使用Logistic回归评估叶酸使用与早产风险之间的关联，并调整潜在的混杂因素。结果：叶酸使用者（5.28%）的早产发生率显着低于未使用者（6.10%）。使用叶酸可使早产总体风险降低 14% [调整后风险比 (RR) = 0.86，95% 置信区间 (CI) 0.82-0.90]。这种关联在自发性早产（调整后 RR = 0.81，95% CI 0.78-0.86）中最为明显，而在医源性早产（调整后 RR = 0.97，95% CI 0.88-1.07）或未足月胎膜早破（调整后 RR = 1.07，95% CI 0.93-1.23）中不显着。结论：每日摄入围孕期单独服用 400 lg 叶酸可降低自发性早产风险。
Background: Folic acid-containing multivitamins have been associated with a reduced risk of preterm birth. We examined whether periconceptional use of folic acid alone reduced this risk.Methods: Data were derived from a large population-based cohort study conducted in China to evaluate the prevention of neural tube defects with folic acid supplementation. The sample comprised 207 936 singleton live births delivered at gestational ages of 20-42 weeks to women from two provinces in southern China. Healthcare workers recorded folic acid intake prospectively each month. Gestational age calculation was based on the first day of the last menstrual period. Preterm births were categorized into three clinical subtypes: iatrogenic preterm birth, preterm premature rupture of membranes (PPROM) and spontaneous preterm birth. Logistic regression was used to evaluate the association between folic acid use and the risk of preterm birth, adjusting for potential confounders.Results: The incidence of preterm birth was significantly lower among folic acid users (5.28%) than among non-users (6.10%). Folic acid use showed a 14% risk reduction for preterm birth overall [adjusted risk ratio (RR) = 0.86, 95% confidence interval (CI) 0.82-0.90]. This association was strongest for spontaneous preterm birth (adjusted RR = 0.81, 95% CI 0.78-0.86) and was not significant for iatrogenic preterm birth (adjusted RR = 0.97, 95% CI 0.88-1.07) or PPROM (adjusted RR = 1.07, 95% CI 0.93-1.23).Conclusions: Daily intake of 400 lg folic acid alone during the periconceptional period was associated with a reduced risk of spontaneous preterm birth.