妊娠叶酸缺乏与早产风险：巢式病例对照研究。
Folate deficiency in pregnancy and the risk of preterm birth: A nested case-control study.
机构信息
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Women's and Children's Health, Uppsala University, Sweden.
出版信息
J Glob Health. 2024 Jul 12;14:04120. doi: 10.7189/jogh.14.04120.
BACKGROUND
Preterm birth (PTB) and its complications are important public health problems. Its aetiology is multifactorial and involves both modifiable and non-modifiable factors. Among the modifiable risk factors, micronutrient deficiencies, including maternal folate deficiency, are increasingly being studied in PTB. In this study, we estimated the prevalence of folate deficiency during pregnancy and examined its association with PTB among rural Bangladeshi women.
METHODS
We conducted a nested case-control study using data from a population-based cohort of 3000 pregnant women who were enrolled between 8 and 19 weeks of gestation following ultrasound confirmation of gestational age. Sociodemographic, epidemiologic, clinical, and pregnancy outcomes data were collected through home visits, while blood samples were collected at enrolment and 24-28 weeks of gestation during pregnancy. We included all women who delivered preterm (defined as live births <37 weeks of gestation) as cases (n = 235) and a random sample of women having a term birth as controls (n = 658). The main exposure was folate concentrations in maternal serum during 24-28 weeks of pregnancy. We categorised women into folate deficient (<3 ng/mL) and not deficient (≥3 ng/mL). We then performed multivariable logistic regression analysis to examine the association between maternal folate levels and PTB, adjusting for relevant covariates.
RESULTS
Thirty-eight per cent of the enrolled pregnant women were folate deficient. Maternal serum folate deficiency was significantly associated with PTB (adjusted OR (aOR) = 1.73; 95% confidence interval (CI) = 1.27-2.36). The risk of PTB was also higher among women who were of short stature (aOR = 1.83; 95% CI = 1.27-2.63), primiparous (aOR = 1.60; 95% CI = 1.15-2.22), and had exposure to passive smoking (aOR = 1.54; 95% CI = 1.02-2.31).
CONCLUSIONS
The prevalence of folate deficiency was high among pregnant women in rural Bangladesh, and folate deficiency was significantly associated with an increased risk of preterm birth.
背景
早产（PTB）及其并发症是重要的公共卫生问题。其病因是多因素的，涉及可改变和不可改变的因素。在可改变的危险因素中，包括母体叶酸缺乏在内的微量营养素缺乏症越来越多地在 PTB 中得到研究。在这项研究中，我们估计了妊娠期间叶酸缺乏的流行率，并研究了其与孟加拉国农村妇女 PTB 的关系。
方法
我们使用了一项基于人群的队列研究的数据进行了嵌套病例对照研究，该研究纳入了 3000 名孕妇，这些孕妇在超声确认妊娠年龄为 8 至 19 周后入组。通过家访收集社会人口学、流行病学、临床和妊娠结局数据，而在妊娠 24-28 周时采集血样。我们将所有早产（定义为活产<37 周）的妇女作为病例（n=235），并随机选择足月分娩的妇女作为对照（n=658）。主要暴露是妊娠 24-28 周时母体血清中的叶酸浓度。我们将妇女分为叶酸缺乏（<3ng/ml）和不缺乏（≥3ng/ml）。然后，我们进行了多变量逻辑回归分析，以检查母体叶酸水平与 PTB 之间的关系，调整了相关协变量。
结果
38%的入组孕妇叶酸缺乏。母体血清叶酸缺乏与 PTB 显著相关（调整后的比值比[aOR] = 1.73；95%置信区间[CI] = 1.27-2.36）。身材矮小的妇女（aOR=1.83；95%CI=1.27-2.63）、初产妇（aOR=1.60；95%CI=1.15-2.22）和被动吸烟（aOR=1.54；95%CI=1.02-2.31）的 PTB 风险也更高。
结论
孟加拉国农村孕妇叶酸缺乏的流行率很高，叶酸缺乏与早产风险增加显著相关。
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