孕妇叶酸补充剂与儿童严重语言发育迟缓。
Folic acid supplements in pregnancy and severe language delay in children.
机构信息
Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway.
出版信息
JAMA. 2011 Oct 12;306(14):1566-73. doi: 10.1001/jama.2011.1433.
CONTEXT
Prenatal folic acid supplements reduce the risk of neural tube defects and may have beneficial effects on other aspects of neurodevelopment.
OBJECTIVE
To examine associations between mothers' use of prenatal folic acid supplements and risk of severe language delay in their children at age 3 years.
DESIGN, SETTING, AND PATIENTS: The prospective observational Norwegian Mother and Child Cohort Study recruited pregnant women between 1999 and December 2008. Data on children born before 2008 whose mothers returned the 3-year follow-up questionnaire by June 16, 2010, were used. Maternal use of folic acid supplements within the interval from 4 weeks before to 8 weeks after conception was the exposure. Relative risks were approximated by estimating odds ratios (ORs) with 95% CIs in a logistic regression analysis.
MAIN OUTCOME MEASURE
Children's language competency at age 3 years measured by maternal report on a 6-point ordinal language grammar scale. Children with minimal expressive language (only 1-word or unintelligible utterances) were rated as having severe language delay.
RESULTS
Among 38,954 children, 204 (0.5%) had severe language delay. Children whose mothers took no dietary supplements in the specified exposure interval were the reference group (n = 9052 [24.0%], with severe language delay in 81 children [0.9%]). Adjusted ORs for 3 patterns of exposure to maternal dietary supplements were (1) other supplements, but no folic acid (n = 2480 [6.6%], with severe language delay in 22 children [0.9%]; OR, 1.04; 95% CI, 0.62-1.74); (2) folic acid only (n = 7127 [18.9%], with severe language delay in 28 children [0.4%]; OR, 0.55; 95% CI, 0.35-0.86); and (3) folic acid in combination with other supplements (n = 19,005 [50.5%], with severe language delay in 73 children [0.4%]; OR, 0.55; 95% CI, 0.39-0.78).
CONCLUSION
Among this Norwegian cohort of mothers and children, maternal use of folic acid supplements in early pregnancy was associated with a reduced risk of severe language delay in children at age 3 years.
背景
产前叶酸补充剂可降低神经管缺陷的风险，并且可能对神经发育的其他方面产生有益影响。
目的
研究母亲在妊娠早期使用产前叶酸补充剂与 3 岁时孩子严重语言发育迟缓风险之间的关联。
设计、地点和患者：前瞻性观察性挪威母婴队列研究招募了 1999 年至 2008 年 12 月期间的孕妇。使用了 2008 年前出生且其母亲在 2010 年 6 月 16 日前回复了 3 年随访问卷的儿童的数据。暴露因素是母亲在受孕前 4 周到受孕后 8 周内服用叶酸补充剂的情况。使用逻辑回归分析来估算比值比（OR）及其 95%置信区间（CI）来近似相对风险。
主要结局测量
通过母亲对 6 分制语言语法量表的报告来衡量儿童 3 岁时的语言能力。语言表达能力最低（仅 1 个单词或无法理解的言语）的儿童被评定为严重语言发育迟缓。
结果
在 38954 名儿童中，有 204 名（0.5%）有严重语言发育迟缓。母亲在指定的暴露间隔内未服用任何膳食补充剂的儿童为参考组（n=9052[24.0%]，其中 81 名儿童[0.9%]有严重语言发育迟缓）。母亲膳食补充剂暴露于以下 3 种模式的调整比值比为：（1）其他补充剂，但无叶酸（n=2480[6.6%]，其中 22 名儿童[0.9%]有严重语言发育迟缓；OR，1.04；95%CI，0.62-1.74）；（2）仅叶酸（n=7127[18.9%]，其中 28 名儿童[0.4%]有严重语言发育迟缓；OR，0.55；95%CI，0.35-0.86）；和（3）叶酸与其他补充剂联合使用（n=19005[50.5%]，其中 73 名儿童[0.4%]有严重语言发育迟缓；OR，0.55；95%CI，0.39-0.78）。
结论
在挪威的这组母婴队列中，母亲在妊娠早期使用叶酸补充剂与 3 岁儿童严重语言发育迟缓风险降低有关。
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