Liu Yingying, Li Nan, Mei Zuguo, Li Zhiwen, Ye Rongwei, Zhang Le, Li Hongtian, Zhang Yali, Liu Jian-Meng, Serdula Mary K
Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Matern Child Nutr. 2021 Jul;17(3):e13157. doi: 10.1111/mcn.13157. Epub 2021 Feb 16.
In this secondary analysis of data from a double-blind randomized controlled trial (clinicaltrials.gov identifier: NCT00133744) of micronutrient supplementation (multiple micronutrients [MMN], iron-folic acid [IFA] and folic acid [FA] alone), we examined the potential modifying effect of gestational age at enrolment on the association of antenatal supplementation and pregnancy-induced hypertension (PIH). We included 18,775 nulliparous pregnant women with mild or no anaemia who were enrolled at 20 weeks of gestation or earlier from five counties of northern China. Women were randomly assigned to receive daily FA, IFA or MMN from enrolment until delivery. We used logistic regression to evaluate the association between PIH and timing of micronutrient supplementation. The incidence of PIH was statistically significantly lower among women who began MMN supplementation before 12 gestational weeks compared with women who began MMN supplementation at 12 weeks or later (RR = 0.74, 95% CI: 0.60-0.91). A similar protective effect was observed for both early-onset (<28 weeks, RR 0.45, 0.21-0.96) and late-onset of PIH (≥28 weeks, RR 0.77, 0.63-0.96). No statistically significant association was observed between PIH occurrence and timing of supplementation for FA or IFA. Maternal MMN supplementation and antenatal enrolment during the first trimester of pregnancy appeared to be of importance in preventing both early- and late-onset of PIH.
在这项对一项关于微量营养素补充剂（多种微量营养素[MMN]、铁叶酸[IFA]和单独的叶酸[FA]）的双盲随机对照试验（clinicaltrials.gov标识符：NCT00133744）数据的二次分析中，我们研究了入组时的孕周对产前补充剂与妊娠高血压（PIH）关联的潜在修正作用。我们纳入了18775名初产孕妇，她们患有轻度贫血或无贫血，于妊娠20周或更早从中国北方五个县入组。妇女从入组直到分娩被随机分配接受每日的FA、IFA或MMN。我们使用逻辑回归来评估PIH与微量营养素补充剂时间的关联。与在妊娠12周或更晚开始补充MMN的妇女相比，在妊娠12周之前开始补充MMN的妇女中PIH的发生率在统计学上显著更低（RR = 0.74，95% CI：0.60 - 0.91）。对于早发型（<28周，RR 0.45，0.21 - 0.96）和晚发型PIH（≥28周，RR 0.77，0.63 - 0.96）都观察到了类似的保护作用。在PIH发生与FA或IFA补充剂时间之间未观察到统计学上显著的关联。孕期前三个月的母体MMN补充剂和产前入组在预防早发型和晚发型PIH方面似乎都很重要。
