Ingrid Goh Y, Bollano Enkelejd, Einarson Thomas R, Koren Gideon
Department of Pharmaceutical Sciences, University of Toronto, Toronto ON; The Motherisk Program, Division of Clinical Pharmacology/Toxicology, The Hospital for Sick Children, Toronto ON.
The Motherisk Program, Division of Clinical Pharmacology/Toxicology, The Hospital for Sick Children, Toronto ON.
J Obstet Gynaecol Can. 2006 Aug;28(8):680-689. doi: 10.1016/S1701-2163(16)32227-7.
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.
We conducted a systematic review and meta-analysis to evaluate the protective effect of folic acid-fortified multivitamin supplements on other congenital anomalies.
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.
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.
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.
长期以来，含叶酸的多种维生素补充剂的使用与降低神经管缺陷风险相关。多项研究还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，此类效果从未得到系统研究。
我们进行了一项系统评价和荟萃分析，以评估含叶酸的多种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Cochrane数据库，查找1966年1月至2005年7月以各种语言发表的描述使用多种维生素补充剂的女性妊娠结局的研究。对所有收集文章的参考文献进行审查以查找其他文章。两名对文章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，将服用多种维生素补充剂的女性所生孩子的先天性异常发生率与未服用的对照组后代的发生率进行比较。
通过初步检索，识别出92项研究；其中41项符合纳入标准。使用多种维生素补充剂对神经管缺陷提供了一致的保护（病例对照研究中随机效应比值比[OR]为0.67，95%置信区间[95%CI]为0.58 - 0.77；队列研究和随机对照研究中OR为0.52，95%CI为0.39 - 0.69）、心血管缺陷（病例对照研究中OR为0.78，95%CI为0.67 - 0.92；队列研究和随机对照研究中OR为0.61，95%CI为0.40 - 0.92）以及肢体缺陷（病例对照研究中OR为0.48，95%CI为0.30 - 0.76；队列研究和随机对照研究中OR为0.57，95%CI为0.38 - 0.85）。对于腭裂，病例对照研究显示OR为0.76（95%CI为0.62 - 0.93），队列研究和随机对照研究显示OR为0.42（95%CI为0.06 - 2.84）；对于有或无腭裂的唇腭裂，病例对照研究显示OR为0.63（95%CI为0.54 - 0.73），队列研究和随机对照研究显示OR为0.58（95%CI为0.28 - 1.19）；对于泌尿系统异常，病例对照研究显示OR为0.48（95%CI为0.30 - 0.76），队列研究和随机对照研究显示OR为0.68（95%CI为0.35 - 1.31）；对于先天性脑积水，病例对照研究显示OR为0.37（95%CI为0.24 - 0.56），队列研究和随机对照研究显示OR为1.54（95%CI为0.53 - 4.50）。在预防唐氏综合征、幽门狭窄、隐睾或尿道下裂方面未显示出效果。
孕妇服用含叶酸的产前多种维生素与多种先天性异常风险降低相关，不仅是神经管缺陷。这些数据具有重大的公共卫生意义，因为迄今为止仅鼓励强化叶酸。这种方法应重新考虑。
