Institute of Reproductive and Child Health, Peking University/ National Health Commission Key Laboratory, Peking University, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Paediatr Perinat Epidemiol. 2021 Nov;35(6):645-653. doi: 10.1111/ppe.12775. Epub 2021 May 31.
Associations between the periconceptional folic acid only (FAO) or multiple micronutrients containing folic acid (MMFA) supplementation and risk for limb defects are inconsistent.
To explore the association between periconceptional folic acid supplements use and risk for limb defects, including clubfoot, polydactyly, syndactyly, and limb deficiencies.
Data were derived from a cohort based on a pregnancy registry in a district of Beijing, China, from 2013 to 2018. Information on maternal periconceptional FAO and MMFA supplementation was collected via face-to-face interviews at first trimester. Pregnancy outcomes including limb defects were ascertained in livebirths, stillbirths, and elective pregnancy terminations and were recorded into the system. Propensity score methods were used to adjust for potential confounders.
A total of 63 969 women with a singleton delivery were included. The overall prevalence of limb defects was 47.5 per 10 000 (n = 63 969) singleton deliveries. Decreased prevalence of limb defects was found among FAO/MMFA users compared with women who did not take supplements (nonusers) (46.1 vs. 61.9 per 10 000 births, adjusted risk ratio [RR] 0.80, 95% confidence interval [CI] 0.56, 1.12). Compared with nonusers (n = 6462, 10.2%), women who took either FAO (n = 26 567, 42.0%) or MMFA (n = 30 259, 47.8%) had a lower risk for total clubfoot (RR 0.40, 95% CI 0.20, 0.84), and for isolated clubfoot (RR 0.41, 95% CI 0.17, 0.97). For other limb defects except clubfoot, FAO supplementation did not appear to be associated with reduced risk, while MMFA supplementation group had 30%-50% reduced risks for other limb defects. A lower risk for limb defects or isolated limb defects was found with MMFA supplementation when FAO supplementation was used as a control.
Maternal periconceptional supplements with either FAO or MMFA had inverse association with clubfoot in offspring, and MMFA was associated with lower risk for isolated limb defects compared with FAO.
单纯补充叶酸（FAO）或含叶酸的多种微量营养素（MMFA）与肢体缺陷风险之间的关联并不一致。
探讨围孕期补充叶酸与肢体缺陷（包括马蹄足、多指/趾、并指/趾和肢体缺失）风险之间的关系。
数据来自于 2013 年至 2018 年期间中国北京市某区妊娠登记处的一项队列研究。通过在孕早期的面对面访谈收集孕产妇围孕期 FAO 和 MMFA 补充信息。活产、死产和选择性终止妊娠的妊娠结局（包括肢体缺陷）均被记录在系统中。采用倾向评分法调整潜在混杂因素。
共纳入 63969 例单胎分娩妇女。肢体缺陷的总患病率为每 10000 例活产 47.5 例（n=63969）。与未服用补充剂的女性（非使用者）相比，FAO/MMFA 使用者的肢体缺陷患病率较低（每 10000 例出生 46.1 例 vs. 61.9 例，调整后的风险比[RR]0.80，95%置信区间[CI]0.56，1.12）。与非使用者（n=6462，10.2%）相比，服用 FAO（n=26567，42.0%）或 MMFA（n=30259，47.8%）的女性发生总马蹄足的风险较低（RR 0.40，95%CI 0.20，0.84），孤立性马蹄足的风险也较低（RR 0.41，95%CI 0.17，0.97）。除马蹄足外，FAO 补充剂似乎与降低其他肢体缺陷的风险无关，而 MMFA 补充剂组发生其他肢体缺陷的风险降低了 30%-50%。当以 FAO 补充剂作为对照时，MMFA 补充剂与较低的肢体缺陷或孤立性肢体缺陷风险相关。
围孕期补充 FAO 或 MMFA 与后代的马蹄足呈负相关，与 FAO 相比，MMFA 与孤立性肢体缺陷的风险降低有关。
