Folic Acid Use and Nonsyndromic Orofacial Clefts in China A Prospective Cohort Study
Folic Acid Use and Nonsyndromic Orofacial Clefts in China A Prospective Cohort Study
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DOI：
10.1097/ede.0b013e31824d0349
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发表时间：
2012-05-01
期刊：
影响因子：
5.4
通讯作者：
Berry, Robert J.
中科院分区：
文献类型：
--
作者：
Li, Song;Chao, Ann;Berry, Robert J.
背景：关于叶酸预防口面裂的有效性、剂量和时机仍然存在疑问。病例对照研究报告了相互矛盾的结果。目前还没有关于口面裂和使用叶酸而不使用其他维生素的队列研究。方法：在1993年至1995年期间在中国北方1省和南方2省登记的240 244名妇女的前瞻性队列中，我们研究了非综合征性唇腭裂（CL/P）和单纯腭裂（CP）的风险，与母亲使用400微克叶酸而不使用其他维生素有关。结果：每天使用400微克叶酸，不含其他维生素，在末次月经前开始，与CL/P风险降低相关，校正率比（aRR）为0.69（95%置信区间= 0.55-0.87）。在北方，在LMP之前开始服用叶酸片的每日服用者中观察到风险降低最大（aRR = 0.21 [0.10-0.44]）;在南方，风险略有降低（aRR = 0.81 [0.63-1.05]）。在LMP期间或之后开始服用叶酸片的女性中，没有观察到CL/P风险降低的证据。没有令人信服的证据，减少CP的风险被认为与叶酸丸使用在任何时间。结论：每天的母亲消费400亩的叶酸，没有其他维生素，开始前母亲的LMP，与CL/P的风险降低在中国的高患病率地区出生的婴儿。
Background: Questions remain about the effectiveness, dose, and timing of folic acid in preventing orofacial clefts. Case-control studies report conflicting results. There have been no cohort studies of orofacial clefts and the use of folic acid without other vitamins.Methods: In a prospective cohort of 240,244 women enrolled between 1993 and 1995 in 1 northern and 2 southern provinces in China, we examined the risk of nonsyndromic cleft lip with or without cleft palate (CL/P) and cleft palate alone (CP) in relation to maternal use of 400 mu g of folic acid without other vitamins.Results: Daily use of 400 mu g of folic acid without other vitamins, started before the last menstrual period (LMP), was associated with reduced risk of CL/P with adjusted rate ratio (aRR) of 0.69 (95% confidence interval = 0.55-0.87). The greatest reduction in risk was observed in the north among daily users who began taking folic acid pills before LMP (aRR = 0.21 [0.10-0.44]); in the south there was marginal reduction in risk (aRR = 0.81 [0.63-1.05]). No evidence of reduced CL/P risk was observed among women who started folic acid pills on or after their LMP. No persuasive evidence for reduction in CP risk was seen with folic acid pill use at any time.Conclusion: Daily maternal consumption of 400 mu g of folic acid without other vitamins, started before mother's LMP, was associated with a reduced risk of CL/P in babies born in a high-prevalence region of China.