McMahon Daria M, Liu Jihong, Zhang Hongmei, Torres Myriam E, Best Robert G
Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA.
Birth Defects Res A Clin Mol Teratol. 2013 Feb;97(2):115-22. doi: 10.1002/bdra.23113.
We investigated the association between maternal obesity (body mass index [BMI] ≥ 30) and the risk of a neural tube defect affected pregnancy (NTD). We also studied relationships between perinatal folate intake from food and the NTD risk by maternal BMI.
Data came from a state-wide case-control study conducted between 1992 and 1997 in South Carolina including 179 women with NTD-affected pregnancies and 288 women without NTD-affected births. A majority of case mothers (77%) and controls (86%) were interviewed within 6 months after delivery or pregnancy termination. Logistic regression models were used to examine the association between maternal obesity and the NTD risk after adjusting for maternal race, age, education, smoking, alcohol/drug use, chronic conditions, and multivitamin use within six periconceptional months. Stratified analysis by maternal BMI (≥25 vs. <25) was conducted for the association between food folate and the NTD risk.
After adjustment for confounders, obese women (BMI ≥ 30) had twice higher odds of having an NTD-affected pregnancy (odds ratios [OR] = 2.06, 95% confidence interval [CI] = 1.12, 3.81) than normal weight women (BMI: 18.0-24.9). Compared to the lowest quartile of average daily folate intake from food, the upper three quartiles had lower odds of NTDs in offspring. The NTD-protective association was stronger in overweight/obese women (BMI ≥ 25) than in normal/underweight women (BMI < 25).
These results support previous studies suggesting maternal obesity as a risk factor for NTDs. Higher intakes of dietary folate were associated with decreased NTD risk that was stronger in overweight and obese women.
我们研究了孕妇肥胖（体重指数[BMI]≥30）与神经管缺陷妊娠（NTD）风险之间的关联。我们还研究了孕期从食物中摄入叶酸与孕妇BMI所对应的NTD风险之间的关系。
数据来自1992年至1997年在南卡罗来纳州进行的一项全州范围的病例对照研究，包括179名有神经管缺陷妊娠的妇女和288名无神经管缺陷分娩的妇女。大多数病例母亲（77%）和对照者（86%）在分娩或终止妊娠后6个月内接受了访谈。使用逻辑回归模型，在调整了孕妇种族、年龄、教育程度、吸烟、饮酒/吸毒、慢性病以及受孕前六个月内多种维生素的使用情况后，检验孕妇肥胖与NTD风险之间的关联。对食物叶酸与NTD风险之间的关联，按孕妇BMI（≥25与<25）进行分层分析。
在对混杂因素进行调整后，肥胖女性（BMI≥30）发生神经管缺陷妊娠的几率是正常体重女性（BMI：18.0 - 24.9）的两倍（优势比[OR]=2.06，95%置信区间[CI]=1.12，3.81）。与食物中平均每日叶酸摄入量的最低四分位数相比，较高的三个四分位数使后代患NTD的几率降低。超重/肥胖女性（BMI≥25）中NTD的保护关联比正常/体重过轻女性（BMI<25）更强。
这些结果支持了先前的研究，表明孕妇肥胖是NTD的一个风险因素。饮食中叶酸摄入量较高与NTD风险降低相关，在超重和肥胖女性中这种关联更强。
