母体孕前叶酸摄入量与自然流产和死胎风险的关系。
Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth.
机构信息
Departments of Nutrition, Epidemiology, Environmental Health, and Biostatistics, Harvard School of Public Health, the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, and the Department of Obstetrics, Gynecology and Reproductive Biology, the Channing Division of Network Medicine, and the Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
出版信息
Obstet Gynecol. 2014 Jul;124(1):23-31. doi: 10.1097/AOG.0000000000000343.
OBJECTIVE
To evaluate prospectively the relationship between prepregnancy folate intake and risk of spontaneous abortion and stillbirth.
METHODS
Women in the Nurses' Health Study II who self-reported a pregnancy between 1992 and 2009 were included in this analysis. Dietary folate and supplement use was assessed every 4 years, starting in 1991, by a food frequency questionnaire. Pregnancies were self-reported with case pregnancies lost spontaneously (spontaneous abortion less than 20 weeks of gestation and stillbirth 20+ weeks of gestation) and comparison pregnancies ending in ectopic pregnancy, induced abortion, or live birth.
RESULTS
Among the 11,072 women, 15,950 pregnancies were reported of which 2,756 (17.3%) ended in spontaneous abortion and 120 (0.8%) ended in stillbirth. Compared with women in the lowest quintile of prepregnancy folate intake (less than 285 micrograms/d), those in the highest quintile (greater than 851 micrograms/d) had a relative risk of spontaneous abortion of 0.91 (95% confidence interval [CI] 0.82-1.02) after multivariable adjustment (P trend=.04). This association was primarily attributable to intake of folate from supplements. Compared with women without supplemental folate intake (0 micrograms/d), those in the highest category (greater than 730 micrograms/d) had a relative risk of spontaneous abortion of 0.80 (95% CI 0.71-0.90) after multivariable adjustment (P trend <.001). The association of prepregnancy supplemental folate with risk of spontaneous abortion was consistent across gestational period of loss. A similar inverse trend was observed with the risk of stillbirth, which fell short of conventional significance (P trend=.06).
CONCLUSIONS
Higher intake of folate from supplements was associated with reduced risk of spontaneous abortion. Women at risk of pregnancy should use supplemental folate for neural tube defect prevention and because it may decrease the risk of spontaneous abortion.
LEVEL OF EVIDENCE
: II.
目的
前瞻性评估孕前叶酸摄入量与自然流产和死产风险之间的关系。
方法
本分析纳入了自 1992 年至 2009 年间报告怀孕的护士健康研究 II 中的女性。从 1991 年开始，通过食物频率问卷每 4 年评估一次膳食叶酸和补充剂的使用情况。妊娠情况由自我报告，包括自然流产（妊娠 20 周前自然流产和妊娠 20 周后死产）和异位妊娠、人工流产或活产的对照妊娠。
结果
在 11072 名女性中，报告了 15950 次妊娠，其中 2756 次（17.3%）以自然流产告终，120 次（0.8%）以死产告终。与孕前叶酸摄入量最低五分位数（<285 微克/天）的女性相比，摄入量最高五分位数（>851 微克/天）的女性自然流产的相对风险为 0.91（95%置信区间 [CI] 0.82-1.02），经多变量调整后（P 趋势=.04）。这种关联主要归因于补充剂中叶酸的摄入量。与没有补充叶酸摄入（0 微克/天）的女性相比，摄入量最高的女性（>730 微克/天）自然流产的相对风险为 0.80（95% CI 0.71-0.90），经多变量调整后（P 趋势<.001）。孕前补充叶酸与自然流产风险之间的关联在妊娠丢失的整个孕期中是一致的。与死产风险也观察到类似的负向趋势，但未达到常规显著性（P 趋势=.06）。
结论
补充剂中叶酸摄入量较高与自然流产风险降低相关。有妊娠风险的女性应使用补充叶酸来预防神经管缺陷，因为它可能降低自然流产的风险。
证据水平
II 级。
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