Catov Janet M, Bodnar Lisa M, Ness Roberta B, Markovic Nina, Roberts James M
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Am J Epidemiol. 2007 Aug 1;166(3):296-303. doi: 10.1093/aje/kwm071. Epub 2007 May 11.
The authors' objective was to determine the relation between periconceptional multivitamin use and the risk of small-for-gestational-age (SGA: <5th percentile; 5th-<10th percentiles) or preterm (<34 weeks; 34-<37 weeks) births. Women in the Pregnancy Exposures and Preeclampsia Prevention Study (1997-2001) reported at enrollment their regular multivitamin use in the past 6 months (n=1,823). Women were classified as users or nonusers in multinomial logistic models. After adjustment for race, age, education, enrollment gestational age, and household density, periconceptional multivitamin use was associated with a reduced risk of preterm births (<34 weeks) (odds ratio (OR)=0.29, 95% confidence interval (CI): 0.13, 0.64) and spontaneous preterm births (<34 weeks) (OR=0.40, 95% CI: 0.16, 0.99). Risk of SGA (<5th percentile) was marginally lower (OR=0.64, 95% CI: 0.40, 1.03) after adjustment for smoking, education, parity, enrollment gestational age, and body mass index. Prepregnancy body mass index modified this relation. Nonobese users had a reduction (OR=0.54, 95% CI: 0.32, 0.91) in risk of SGA (<5th percentile); there was no effect among obese women. There was no effect of multivitamin use on risk of preterm births (34-<37 weeks) or SGA (5th-<10th percentiles). Sensitivity analysis for unmeasured confounding by folate intake supported these findings. Study results indicate lower rates of severe preterm births and extreme SGA in women who report periconceptional vitamin use, although these should be considered cautiously until replicated.
作者的目的是确定孕期前使用多种维生素与小于胎龄儿（SGA：<第5百分位数；第5 - <第10百分位数）或早产（<34周；34 - <37周）分娩风险之间的关系。参与“孕期暴露与子痫前期预防研究”（1997 - 2001年）的女性在入组时报告了她们在过去6个月内常规使用多种维生素的情况（n = 1823）。在多项逻辑模型中，女性被分类为使用者或非使用者。在调整种族、年龄、教育程度、入组时的孕周和家庭密度后，孕期前使用多种维生素与早产（<34周）风险降低相关（比值比（OR）= 0.29，95%置信区间（CI）：0.13，0.64）以及自发性早产（<34周）风险降低相关（OR = 0.40，95% CI：0.16，0.99）。在调整吸烟、教育程度、产次、入组时的孕周和体重指数后，小于胎龄儿（<第5百分位数）的风险略有降低（OR = 0.64，95% CI：0.40，1.03）。孕前体重指数改变了这种关系。非肥胖使用者小于胎龄儿（<第5百分位数）的风险降低（OR = 0.54，95% CI：0.32，0.91）；肥胖女性中则无此影响。使用多种维生素对早产（34 - <37周）或小于胎龄儿（第5 - <第10百分位数）的风险没有影响。对叶酸摄入量未测量的混杂因素进行敏感性分析支持了这些发现。研究结果表明，报告孕期前使用维生素的女性中，严重早产和极低小于胎龄儿的发生率较低，不过在这些结果被重复验证之前应谨慎看待。
