叶酸补充剂的起始时间和持续时间与预防先天畸形。
Initiation and duration of folic acid supplementation in preventing congenital malformations.
机构信息
Medical Center of Diagnosis and Treatment for Cervical Disease, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215006, China.
出版信息
BMC Med. 2023 Aug 7;21(1):292. doi: 10.1186/s12916-023-03000-8.
BACKGROUND
Folic acid (FA) supplementation is associated with a lower risk of the neural tube and heart defects and is recommended for women of childbearing age. Although there are detailed recommendations, differences in the initiation time and duration of FA supplementation remain poorly studied.
METHODS
A multicentre prospective study of 17,713 women was conducted. The incidence of congenital malformations in women taking a recommended dosage (e.g. 0.4 or 0.8 mg/day) of FA was compared with that in women without supplementation. The predicted probability of malformations by the initiation time and duration of FA use was estimated to determine optimal options.
RESULTS
Periconceptional FA supplementation was associated with a lower and insignificant risk of congenital malformations (1.59% vs. 2.37%; odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.44-1.08), heart defects (3.8 vs. 8.0 per 1000 infants; OR, 0.47; 0.21-1.02), and neural tube defects (7.0 vs. 11.5 per 10,000 infants; OR, 0.64; 0.08-5.15). FA use after pregnancy provided greater protection against total malformations. Statistically significant associations were found in women who initiated FA supplementation in the first month of gestation (OR, 0.55; 95% CI: 0.33-0.91) and in those who supplemented for 1 to 2 months (OR, 0.59; 95% CI: 0.36-0.98). Similar results were found for heart defects. The optimal initiation time was 1.5 (optimal range: 1.1 to 1.9) months before pregnancy and a duration of 4.0 (3.7 to 4.4) months was reasonable to achieve the lowest risk of congenital malformations. Heart defect prevention required an earlier initiation (2.2 vs. 1.1 months before pregnancy) and a longer duration (4.7 vs. 3.7 months) than the prevention of other malformations.
CONCLUSIONS
The timely initiation of FA supplementation for gestation was associated with a decreased risk of congenital malformations, which was mainly attributed to its protection against heart defects. The initiation of FA supplementation 1.5 months before conception with a duration of 4 months is the preferred option for congenital malformation prevention.
TRIAL REGISTRATION
Chictr.org.cn identifier: ChiCTR-SOC-17010976.
背景
叶酸（FA）补充剂与神经管和心脏缺陷的风险降低有关，建议育龄妇女服用。尽管有详细的建议，但 FA 补充剂的起始时间和持续时间的差异仍研究甚少。
方法
对 17713 名妇女进行了一项多中心前瞻性研究。比较了服用推荐剂量（例如 0.4 或 0.8mg/天）FA 的妇女与未补充 FA 的妇女的先天性畸形发生率。通过 FA 使用的起始时间和持续时间来估计畸形的预测概率，以确定最佳选择。
结果
围孕期 FA 补充与先天性畸形的风险降低但无统计学意义相关（1.59% vs. 2.37%；比值比 [OR] 0.69；95%置信区间 [CI]：0.44-1.08）、心脏缺陷（每千名婴儿 3.8 例 vs. 8.0 例；OR 0.47；95%CI：0.21-1.02）和神经管缺陷（每千名婴儿 7.0 例 vs. 11.5 例；OR 0.64；95%CI：0.08-5.15）。妊娠后使用 FA 提供了更大的保护，以防总畸形。在妊娠第一个月开始补充 FA（OR，0.55；95%CI：0.33-0.91）和补充 1-2 个月（OR，0.59；95%CI：0.36-0.98）的妇女中，观察到统计学显著关联。对于心脏缺陷也有类似的结果。最佳起始时间是妊娠前 1.5 个月（最佳范围：1.1-1.9），持续 4.0 个月（3.7-4.4）是实现先天性畸形风险最低的合理时间。预防心脏缺陷需要更早的起始时间（妊娠前 2.2 个月 vs. 1.1 个月）和更长的持续时间（4.7 个月 vs. 3.7 个月），而不是其他畸形。
结论
妊娠期及时开始 FA 补充与先天性畸形风险降低有关，主要归因于其对心脏缺陷的保护作用。在受孕前 1.5 个月开始补充 FA，持续 4 个月，是预防先天性畸形的首选方案。
试验注册
Chictr.org.cn 标识符：ChiCTR-SOC-17010976。
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