DHA、营养素摄入量和产妇特征作为随机临床试验中 DHA 补充对妊娠结局的预测因素。
DHA, nutrient intake, and maternal characteristics as predictors of pregnancy outcomes in a randomised clinical trial of DHA supplementation.
机构信息
Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Pediatrics, University of Arizona, Tucson, AZ, USA.
出版信息
Clin Nutr. 2023 Nov;42(11):2229-2240. doi: 10.1016/j.clnu.2023.09.005. Epub 2023 Sep 20.
PURPOSE
To investigate the relationships among docosahexaenoic acid (DHA) intake, nutrient intake, and maternal characteristics on pregnancy outcomes in a phase III randomised clinical trial designed to determine the effect of a DHA dose of 1000 mg/day compared to 200 mg/day on early preterm birth (<34 weeks gestation).
METHODS
A secondary aim of the phase III randomised trial was to explore the relationships among pregnancy outcomes (maternal red blood cell phospholipid (RBC-PL) DHA at delivery, preterm birth, gestational age at delivery, labor type, birth anthropometric measures, low birth weight, gestational diabetes, pre-eclampsia, and admission to a neonatal intensive care unit) in participants (n = 1100). We used Bayesian multiple imputation and linear and logistic regression models to conduct an analysis of five general classes of predictor variables collected during the trial: a) DHA intake, b) nutrient intake from food and supplements, c) environmental exposure to tobacco and alcohol, d) maternal demographics, and e) maternal medical history.
RESULTS
DHA supplementation lowered the risk of preterm birth and NICU admission, and increased gestation and birth weight as observed in the primary analysis. Higher maternal RBC-PL-DHA at delivery was associated with DHA supplementation and formal education of a bachelor's degree or higher. DHA supplementation and maternal age were associated with a higher risk of gestational diabetes. Total vitamin A intake was associated with longer gestation, while fructose and intake of the long chain omega-6 fatty acid, arachidonic acid, were associated with shorter gestation. Risk of preterm birth was associated with a history of low birth weight, preterm birth, pre-eclampsia, and NICU admission.
CONCLUSION
Bayesian models provide a comprehensive approach to relationships among DHA intake, nutrient intake, maternal characteristics, and pregnancy outcomes. We observed previously unreported relationships between gestation duration and fructose, vitamin A, and arachidonic acid that could be the basis for future research.
TRIAL REGISTRATION NUMBER AND DATE
ClinicalTrials.gov (NCT02626299); December 10, 2015.
目的
在一项旨在确定每天 1000 毫克与 200 毫克剂量的二十二碳六烯酸（DHA）对早期早产（<34 周妊娠）影响的 III 期随机临床试验中，调查 DHA 摄入量、营养素摄入量和产妇特征与妊娠结局之间的关系。
方法
III 期随机试验的次要目的是探索妊娠结局（产妇红细胞磷脂（RBC-PL）中 DHA 的分娩时、早产、分娩时的胎龄、分娩类型、出生人体测量指标、低出生体重、妊娠糖尿病、子痫前期和新生儿重症监护病房入院）之间的关系在参与者中（n=1100）。我们使用贝叶斯多重插补和线性和逻辑回归模型，对试验期间收集的五类一般预测变量进行分析：a）DHA 摄入量，b）来自食物和补充剂的营养素摄入量，c）烟草和酒精的环境暴露，d）产妇人口统计学特征，和 e）产妇病史。
结果
正如主要分析中观察到的那样，DHA 补充降低了早产和新生儿重症监护病房入院的风险，并增加了胎龄和出生体重。产妇 RBC-PL-DHA 分娩时较高与 DHA 补充和学士学位或更高学位的正规教育有关。DHA 补充和产妇年龄与妊娠糖尿病的风险增加有关。总维生素 A 摄入量与胎龄较长有关，而果糖和长链ω-6 脂肪酸花生四烯酸的摄入量与胎龄较短有关。早产的风险与低出生体重、早产、子痫前期和新生儿重症监护病房入院的病史有关。
结论
贝叶斯模型提供了一种综合方法来研究 DHA 摄入量、营养素摄入量、产妇特征和妊娠结局之间的关系。我们观察到以前未报告的妊娠持续时间与果糖、维生素 A 和花生四烯酸之间的关系，这些关系可能是未来研究的基础。
试验注册号和日期
ClinicalTrials.gov（NCT02626299）；2015 年 12 月 10 日。
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