Sutton Marie, Mills James L, Molloy Anne M, Troendle James F, Brody Lawrence C, Conley Mary, Mc Donnell Robert, Scott John M, Kirke Peadar N
Child Health Epidemiology Unit, Health Research Board, Dublin, Ireland.
Birth Defects Res A Clin Mol Teratol. 2011 Jul;91(7):610-5. doi: 10.1002/bdra.20817. Epub 2011 May 17.
Periconceptional use of folic acid prevents most neural tube defects (NTDs). Whether folic acid and/or multivitamins can prevent other congenital anomalies is not clear. This study tested whether maternal blood levels of folate and vitamin B12 in pregnancies affected by congenital malformations excluding NTDs are lower when compared to non-affected pregnancies.
We measured pregnancy red cell folate (RCF), vitamin B12, and homocysteine (tHcy) concentrations in blood samples taken at the first antenatal clinic in Dublin maternity hospitals in 1986–1990 when vitamin supplementation was rare. The cases were mothers who delivered a baby with a congenital malformation other than NTD identified by the Dublin EUROCAT Registry; controls were a systematic sample of mothers of offspring without congenital malformations from the same hospitals in the same time period.
The median maternal levels of RCF and tHcy did not differ significantly between cases and controls for any of the congenital malformation groups examined (RCF: all malformations 275.9 ug/L v controls 271.2; p=0.77; tHcy: all malformations 7.5 umol/L v controls 7.6; p=0.57). In an unadjusted analysis vitamin B12 was significantly higher in case-mothers whose babies had cleft palate only (p=0.006), musculoskeletal malformations (p=0.034) and midline defects (p=0.039) but not after adjustment for multiple testing.
Our data suggest that low maternal folate and B12 levels or high tHcy levels in early pregnancy are not associated with all congenital malformations excluding NTDs. Fortification with folic acid or B12 may not have a beneficial effect in the prevention of these anomalies.
孕期补充叶酸可预防大多数神经管缺陷（NTDs）。叶酸和/或多种维生素能否预防其他先天性异常尚不清楚。本研究旨在测试与未受影响的妊娠相比，受先天性畸形（不包括NTDs）影响的妊娠中孕妇血液中的叶酸和维生素B12水平是否较低。
我们测量了1986 - 1990年在都柏林妇产医院首次产前检查时采集的血样中的妊娠红细胞叶酸（RCF）、维生素B12和同型半胱氨酸（tHcy）浓度，当时维生素补充剂很少见。病例为都柏林EUROCAT登记处确定的分娩患有除NTDs以外先天性畸形婴儿的母亲；对照组是同一时期来自同一家医院的无先天性畸形后代母亲的系统样本。
在所检查的任何先天性畸形组中，病例组和对照组的孕妇RCF和tHcy中位数水平无显著差异（RCF：所有畸形275.9微克/升，对照组271.2；p = 0.77；tHcy：所有畸形7.5微摩尔/升，对照组7.6；p = 0.57）。在未经调整的分析中，仅婴儿患有腭裂（p = 0.006）、肌肉骨骼畸形（p = 0.034）和中线缺陷（p = 0.039）的病例母亲中，维生素B12显著更高，但在进行多重检验调整后并非如此。
我们的数据表明，孕早期孕妇叶酸和维生素B12水平低或同型半胱氨酸水平高与除NTDs以外的所有先天性畸形无关。叶酸或维生素B12强化可能对预防这些异常没有有益作用。
