母亲在怀孕期间摄入叶酸与 MOBAND-CP 队列中脑瘫的风险。

Maternal intake of folate during pregnancy and risk of cerebral palsy in the MOBAND-CP cohort.

机构信息

Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.

出版信息

Am J Clin Nutr. 2022 Feb 9;115(2):397-406. doi: 10.1093/ajcn/nqab351.

DOI:10.1093/ajcn/nqab351

PMID:34687208

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8827124/

Abstract

BACKGROUND

Folate prevents neural tube defects and may play a role in some neurodevelopmental disorders.

OBJECTIVES

We investigated whether higher intakes of periconceptional or midpregnancy folate, as recommended, were associated with a reduced risk of offspring cerebral palsy (CP).

METHODS

We included participants from the Nordic collaboration cohort consisting of mother-child dyads in the Danish National Birth Cohort and the Norwegian Mother, Father, and Child Cohort Study [combined as MOthers and BAbies in Norway and Denmark (MOBAND-CP)]. A total of 190,989 live-born children surviving the first year of life were included. Missing covariate data were multiply imputed. Our exposures were defined as any or no folic acid supplementation in gestational weeks (GWs) -4 to 8 (periconceptional), 9 to 12, and -4 to 12, and supplemental, dietary, and total folate during midpregnancy (GWs 22-25). CP overall and the unilateral and bilateral spastic subtypes, as well as CP with low or moderate/high gross motor function impairments, were our outcomes of interest.

RESULTS

Periconceptional folic acid supplementation was not associated with CP [adjusted odds ratio (aOR), 1.02; 95% CI: 0.82-1.28]. However, supplementation in GWs 9 to 12 was associated with a reduced risk of CP (aOR, 0.74; 95% CI: 0.57-0.96), and inverse associations were indicated for both the unilateral (aOR, 0.68; 95% CI: 0.46-1.02) and bilateral (aOR, 0.70; 95% CI: 0.49-1.02) spastic subtypes, although the associations were not statistically significant. Supplemental or dietary folate in midpregnancy alone were not associated with CP. Strong inverse associations were observed with low gross motor function impairment (aOR, 0.49; 95% CI: 0.29-0.83), while for unilateral CP the aOR was 0.63 (95% CI: 0.34-1.22) for intakes of ≥500 compared to ≤199 dietary folate equivalents/day during midpregnancy.

CONCLUSIONS

Our findings suggest that folate intakes in GWs 9 to 12 and midpregnancy were associated with lower risks of CP, while no association was observed for periconceptional supplementation.

摘要

背景

叶酸可预防神经管缺陷，并可能在某些神经发育障碍中发挥作用。

目的

我们研究了围孕期和孕中期摄入推荐量的叶酸是否与降低子女脑瘫（CP）的风险有关。

方法

我们纳入了来自北欧合作队列的参与者，该队列由丹麦国家出生队列和挪威母亲、父亲和儿童队列研究中的母婴对子组成[合并为挪威和丹麦的母亲和婴儿（MOBAND-CP）]。共纳入 190989 名存活至 1 岁的活产儿。缺失的协变量数据采用多重插补法进行处理。我们的暴露因素定义为在妊娠周（GWs）-4 至 8（围孕期）、9 至 12 和-4 至 12 时补充叶酸，以及在孕中期（GWs 22-25）补充、饮食和总叶酸。CP 整体以及单侧和双侧痉挛型亚组，以及 CP 伴有低或中/高粗大运动功能障碍，是我们感兴趣的结局。

结果

围孕期补充叶酸与 CP 无关[调整后的优势比（aOR），1.02；95%置信区间：0.82-1.28]。然而，GWs 9 至 12 时的补充与 CP 风险降低相关（aOR，0.74；95%置信区间：0.57-0.96），并且单侧（aOR，0.68；95%置信区间：0.46-1.02）和双侧（aOR，0.70；95%置信区间：0.49-1.02）痉挛型亚组也有类似的趋势，尽管这些关联没有统计学意义。孕中期单独补充或饮食叶酸与 CP 无关。与低粗大运动功能障碍显著相关（aOR，0.49；95%置信区间：0.29-0.83），而对于单侧 CP，与孕中期摄入 500 至 199 膳食叶酸当量/天相比，摄入 ≥500 膳食叶酸当量/天的 aOR 为 0.63（95%置信区间：0.34-1.22）。