Milunsky A, Jick H, Jick S S, Bruell C L, MacLaughlin D S, Rothman K J, Willett W
Center for Human Genetics, Boston University School of Medicine, MA 02118-2394.
JAMA. 1989 Nov 24;262(20):2847-52. doi: 10.1001/jama.262.20.2847.
We examined the relation of multivitamin intake in general, and folic acid in particular, to the risk of neural tube defects in a cohort of 23,491 women undergoing maternal serum alpha-fetoprotein screening or amniocentesis around 16 weeks of gestation. Complete questionnaires and subsequent pregnancy outcome information was obtained in 22,776 pregnancies, 49 of which ended in a neural tube defect. The prevalence of neural tube defect was 3.5 per 1000 among women who never used multivitamins before or after conception or who used multivitamins before conception only. The prevalence of neural tube defects for women who used folic acid-containing multivitamins during the first 6 weeks of pregnancy was substantially lower--0.9 per 1000 (prevalence ratio, 0.27; 95% confidence interval, 0.12 to 0.59 compared with never users). For women who used multivitamins without folic acid during the first 6 weeks of pregnancy and women who used multivitamins containing folic acid beginning after 7 or more weeks of pregnancy, the prevalences were similar to that of the nonusers and the prevalence ratios were close to 1.0.
我们在一组23491名妊娠16周左右接受母血清甲胎蛋白筛查或羊膜穿刺术的女性中，研究了一般多种维生素摄入量，尤其是叶酸摄入量与神经管缺陷风险之间的关系。在22776例妊娠中获取了完整的调查问卷及后续妊娠结局信息，其中49例以神经管缺陷告终。在受孕前后从未使用过多种维生素或仅在受孕前使用过多种维生素的女性中，神经管缺陷患病率为每1000人中有3.5例。在妊娠前6周使用含叶酸多种维生素的女性中，神经管缺陷患病率显著较低——每1000人中有0.9例（患病率比为0.27；95%置信区间为0.12至0.59，与从未使用者相比）。在妊娠前6周使用不含叶酸多种维生素的女性以及在妊娠7周或更晚开始使用含叶酸多种维生素的女性中，患病率与未使用者相似，患病率比接近1.0。
