Beijing Obstetrics and Gynecology Hospital.
J Pharm Pharm Sci. 2021;24:174-190. doi: 10.18433/jpps31500.
Although folic acid (FA) supplementation has been shown to reduce general cardiovascular risks, its impact on hypertensive disorders of pregnancy (HDP) is unclear. We performed a systematic review and meta-analysis to clarify the association between FA and the risk of HDP (pre-eclampsia (PE) and gestational hypertension (GH)).
PubMed, EmBase, and Cochrane Library were searched up to June 18, 2020, stratified by type of disease, initiation time of FA, form of FA and pre-conception Body Mass Index (BMI). The quality assessment of included studies was evaluated using Newcastle-Ottawa Scale (NOS) for cohort studies and Cochrane Collaboration's Risk of Bias Assessment Tool for randomized controlled trials (RCTs). Between-study heterogeneity was quantified using Cochran's Q-statistic and I2 statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed using funnel plots.
Twenty studies with 359041 patients were identified for inclusion in the meta-analysis which included 3 RCTs and 17 cohort studies. Pooled estimates showed RR of 0.83 (95%CI 0.74-0.93, P=0.0008) for association between low dose FA (LD-FA) and the risk of PE, but LD-FA was not associated with GH (RR 1.05, 95% CI 0.97-1.13, P=0.20). In addition, the results of subgroup analysis showed that post-conception LD-FA had a 31% decreased risk of PE (RR 0.69, 95% CI 0.59-0.80, P<0.00001), and LD-FA in patients with pre-conception BMI<25 kg/m2 had a 32% decreased risk of PE (RR 0.68, 95% CI 0.56-0.81, P<0.0001) Conclusions: LD-FA significantly decreased the risk of PE but not GH, and post-conception LD-FA and pre-conception BMI<25 kg/m2 were considered as protective factors to reduce the risk of PE.
尽管叶酸（FA）补充已被证明可降低一般心血管风险，但它对妊娠高血压疾病（HDP）的影响尚不清楚。我们进行了系统评价和荟萃分析，以阐明 FA 与 HDP（子痫前期（PE）和妊娠期高血压（GH））风险之间的关系。
截至 2020 年 6 月 18 日，通过疾病类型、FA 起始时间、FA 形式和孕前体重指数（BMI）对 PubMed、EmBase 和 Cochrane Library 进行了分层搜索。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量评估队列研究和 Cochrane 协作随机对照试验（RCTs）的偏倚风险评估工具。使用 Cochran's Q 统计量和 I2 统计量量化研究间异质性。通过逐个排除研究进行敏感性分析，并使用漏斗图分析发表偏倚。
共有 20 项研究纳入荟萃分析，共纳入 359041 名患者，其中包括 3 项 RCT 和 17 项队列研究。汇总估计显示，低剂量 FA（LD-FA）与 PE 风险之间的关联 RR 为 0.83（95%CI 0.74-0.93，P=0.0008），但 LD-FA 与 GH 无关（RR 1.05，95%CI 0.97-1.13，P=0.20）。此外，亚组分析结果表明，妊娠后 LD-FA 降低了 31%的 PE 风险（RR 0.69，95%CI 0.59-0.80，P<0.00001），而孕前 BMI<25 kg/m2 的患者 LD-FA 降低了 32%的 PE 风险（RR 0.68，95%CI 0.56-0.81，P<0.0001）。结论：LD-FA 显著降低了 PE 的风险，但对 GH 没有影响，妊娠后 LD-FA 和孕前 BMI<25 kg/m2 被认为是降低 PE 风险的保护因素。
