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.
Tongzhou Maternal and Child Health Hospital, Beijing, China.
J Pediatr. 2022 Jan;240:72-78. doi: 10.1016/j.jpeds.2021.09.004. Epub 2021 Sep 8.
To determine the effects of maternal periconceptional supplementation with folic acid or multiple micronutrients containing folic acid on the prevention of fetal congenital heart defects (CHDs).
Data were drawn from a Prenatal Health Care System and a Birth Defects Surveillance System in a district of Beijing, China. A total of 63 969 singleton births, live or stillborn, 308 CHDs among them, during 2013 to 2018 were included. Associations between different patterns of supplementation and risk for total CHDs or main types of CHDs were evaluated with risk ratios (RRs).
For folic acid or multiple micronutrients containing folic acid users compared with nonusers, the adjusted RRs (ARRs) for total CHDs, critical CHD, and ventricular septal defect (VSD) were 0.60 (95% CI, 0.44-0.83), 0.41 (95% CI, 0.26-0.67), and 0.47 (95% CI, 0.30-0.74), respectively. When we compared multiple micronutrients containing folic acid users with folic acid users, the ARRs were 0.84 (95% CI, 0.66-1.09), 0.64 (95% CI, 0.41-1.00), and 0.94 (95% CI, 0.63-1.41) for total CHDs, critical CHD, and VSD, respectively. We also found that, compared with supplementation initiated after conception, supplementation initiated before conception was associated with a lower risk for CHDs: the ARRs were 0.68 (95% CI, 0.48-0.95) for total CHDs and 0.26 (95% CI, 0.10-0.71) for critical CHD, but 1.08 (95% CI, 0.63-1.83) for VSD.
Maternal periconceptional supplementation with folic acid or multiple micronutrients containing folic acid seems to decrease the risk for CHDs, especially critical CHD, in offspring. Supplementation confers a greater protective effect when it is initiated before conception. We did not find any difference between folic acid and multiple micronutrients containing folic acid in terms of preventing CHDs.
确定母亲在围孕期补充叶酸或含叶酸的多种微量营养素对预防胎儿先天性心脏病（CHD）的影响。
数据来自中国北京市某区的产前保健系统和出生缺陷监测系统。共纳入 2013 年至 2018 年期间 63969 例单胎活产或死产婴儿，其中 308 例患有 CHD。使用风险比（RR）评估不同补充模式与总 CHD 或主要 CHD 类型风险之间的关系。
与非使用者相比，叶酸或含叶酸的多种微量营养素使用者的总 CHD、关键 CHD 和室间隔缺损（VSD）的校正 RR（ARR）分别为 0.60（95%CI，0.44-0.83）、0.41（95%CI，0.26-0.67）和 0.47（95%CI，0.30-0.74）。当我们比较含叶酸的多种微量营养素使用者和叶酸使用者时，总 CHD、关键 CHD 和 VSD 的 ARR 分别为 0.84（95%CI，0.66-1.09）、0.64（95%CI，0.41-1.00）和 0.94（95%CI，0.63-1.41）。我们还发现，与受孕后开始补充相比，受孕前开始补充与 CHD 风险降低相关：总 CHD 的 ARR 为 0.68（95%CI，0.48-0.95），关键 CHD 的 ARR 为 0.26（95%CI，0.10-0.71），但 VSD 的 ARR 为 1.08（95%CI，0.63-1.83）。
母亲在围孕期补充叶酸或含叶酸的多种微量营养素似乎降低了后代患 CHD 的风险，尤其是关键 CHD。补充叶酸在受孕前开始时具有更大的保护作用。我们没有发现叶酸和含叶酸的多种微量营养素在预防 CHD 方面有任何差异。
