van Eijsden Manon, Smits Luc J M, van der Wal Marcel F, Bonsel Gouke J
Department of Epidemiology, Documentation and Health Promotion, Municipal Health Service, Amsterdam, The Netherlands.
Am J Clin Nutr. 2008 Jul;88(1):147-53. doi: 10.1093/ajcn/88.1.147.
Maternal folate depletion has been proposed as a primary explanation for the excess risk of fetal growth restriction associated with short interpregnancy intervals.
We aimed to evaluate the folate depletion hypothesis in a community-based cohort of pregnant women.
Using a subsample of the cohort (multiparous participants who delivered a liveborn singleton infant, n = 3153), we investigated the relation between an increase in the interpregnancy interval (from 1 to 24 mo, natural log transformation) and birth weight and the risk of small-for-gestational-age (SGA) in 3 strata of maternal periconceptional folic acid use: nonuse, late use (begun after conception), and early use (begun before conception).
Each increase in the interpregnancy interval on the natural log (ln) scale was associated with a mean (+/-SE) increase of 63.1 +/- 20.3 g in birth weight (P = 0.002). This relation was mitigated by folic acid use: the change in birth weight was increases of 165.2 +/- 39.6 g for nonuse (P < 0.001) and 33.5 +/- 35.6 g for late use (P = 0.347) and a decrease of 5.9 +/- 33.6 g for early use (P = 0.861). The birth weight differences were directly translated into SGA risk. Odds ratios per 1-mo increase in ln(interpregnancy interval) were significant for the total group (0.61; 95% CI: 0.46, 0.82) and for nonuse (0.38; 0.24, 0.60) and nonsignificant for late (0.83; 0.48, 1.44) and early (1.28; 0.58, 2.84) use.
Folate depletion apparently contributes to the excess risk of fetal growth restriction that is associated with short interpregnancy intervals. As a preventive option, postnatal supplementation may be beneficial, but confirmation is needed.
母体叶酸缺乏被认为是与妊娠间隔短相关的胎儿生长受限风险增加的主要原因。
我们旨在评估基于社区的孕妇队列中的叶酸缺乏假说。
我们使用该队列的一个子样本（分娩单胎活产婴儿的经产妇参与者，n = 3153），研究了妊娠间隔增加（从1个月至24个月，自然对数转换）与出生体重以及小于胎龄儿（SGA）风险之间的关系，根据孕期叶酸使用情况分为3组：未使用、晚期使用（受孕后开始）和早期使用（受孕前开始）。
妊娠间隔自然对数（ln）每增加一个单位，出生体重平均增加（±标准误）63.1±20.3 g（P = 0.002）。叶酸使用减轻了这种关系：未使用叶酸时出生体重增加165.2±39.6 g（P < 0.001），晚期使用叶酸时增加33.5±35.6 g（P = 0.347），早期使用叶酸时减少5.9±33.6 g（P = 0.861）。出生体重差异直接转化为SGA风险。ln（妊娠间隔）每增加1个月的优势比在总人群中具有统计学意义（0.61；95%CI：0.46，0.82），未使用叶酸组具有统计学意义（0.38；0.24，0.60），晚期使用叶酸组无统计学意义（0.83；0.48，1.44），早期使用叶酸组也无统计学意义（1.28；0.58，2.84）。
叶酸缺乏显然导致了与妊娠间隔短相关的胎儿生长受限风险增加。作为一种预防措施，产后补充叶酸可能有益，但需要进一步证实。
