Jin L, Wang C, Zhang J, Meng W Y, Zhang J Y, Yu J H, Lin G Y, Tong M K, Jin L
Department of Maternal Health Care, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing 101100, China.
Institute of Reproductive and Child Health, Peking University; Key Laboratory of Reproductive Health, the National Health Commission of the People's Republic of China; Department of Epidemiology and Biostatistics, Peking University School of Public Health; Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Aug 18;52(4):719-725. doi: 10.19723/j.issn.1671-167X.2020.04.024.
To find out the status of folic acid supplementation among women, to evaluate the prevention effects on neural tube defects (NTDs), and to explore the factors impact on folic acid supplementation compliance.
Based on the routine data of 92 121 women in prenatal health care and birth defect surveillance system in Tongzhou District of Beijing from 2013 to 2018, we described the prevalence of periconceptional folic acid supplementation, pre-pregnancy folic acid supplementation and regularly folic acid supplementation (compliance supplementation). Trend tests were used to evaluate the change of folic acid supplementation prevalence. The prevalence difference among the women with folic acid supplementation and without supplementation were tested with Fisher's exact test. Factors asso-ciated with folic acid supplementation compliance rate were analyzed with univariate and multivariate Logistic regression model.
The prevalence of periconceptional folic acid supplementation during the six years was 90.08% and it was increased from 2013 to 2018, but the rate of pre-pregnancy and regular supplementation was only 41.5% and declined from 2013 to 2018, especially 2013 to 2015. The prevalence of NTDs among the fetuses whose mothers took folic acid during periconceptional period was 5.5/10 000, while the prevalence for the fetuses whose mothers did not take folic acid was 19.7/10 000 ( < 0.001), the rates ratio was 27.9% (=23.74, < 0.001). The difference between the prevalence of NTDs among the fetuses whose mothers took folic acid only and multiple micronutrients was not statistically significant. After controlling the confounding factors, it was found that the compliant folic acid supplementation rates in women, whose household registrations were outside Beijing and whose education levels were junior high school or below, and who were younger than 25 years old, and who were multiparas and who were pre-pregnancy underweight or obese, were lower than those of the corresponding control groups ( < 0.05).
The rate of folic acid supplementation among women in Tongzhou District of Beijing was relatively high, but their compliance was poor. Women who did not take folic acid during periconception seriously affected the prevention effect of NTDs. We should focus on women who are younger than 25 years old, lower educated, pre-pregnancy underweight or obese, multiparas and nonlocal household registers, in order to improve the periconceptional folic acid supplementation compliance and improve the effects of NTDs prevention.
了解妇女叶酸补充状况，评估其对神经管缺陷（NTDs）的预防效果，并探讨影响叶酸补充依从性的因素。
基于2013年至2018年北京市通州区产前保健和出生缺陷监测系统中92121名妇女的常规数据，描述孕前叶酸补充、孕前期叶酸补充及规律叶酸补充（依从性补充）的患病率。采用趋势检验评估叶酸补充患病率的变化。采用Fisher精确检验比较叶酸补充组与未补充组妇女的患病率差异。采用单因素和多因素Logistic回归模型分析与叶酸补充依从率相关的因素。
六年中孕前叶酸补充患病率为90.08%，且从2013年至2018年呈上升趋势，但孕前期补充率和规律补充率仅为41.5%，且从2013年至2018年呈下降趋势，尤其是2013年至2015年。孕期母亲服用叶酸的胎儿中NTDs患病率为5.5/10000，而母亲未服用叶酸的胎儿中NTDs患病率为19.7/10000（P<0.001），率比为27.9%（RR=23.74，P<0.001）。母亲仅服用叶酸的胎儿与服用多种微量营养素的胎儿中NTDs患病率差异无统计学意义。控制混杂因素后发现，户籍不在北京、初中及以下学历、年龄小于25岁、多胎妊娠以及孕前体重过轻或肥胖的妇女，其叶酸补充依从率低于相应对照组（P<0.05）。
北京市通州区妇女叶酸补充率相对较高，但依从性较差。孕前未服用叶酸的妇女严重影响了NTDs的预防效果。应关注年龄小于25岁、低学历、孕前体重过轻或肥胖、多胎妊娠及非本地户籍的妇女，以提高孕前叶酸补充依从性，改善NTDs预防效果。
