叶酸摄入对先天性异常的影响。一项系统评价与荟萃分析。

The effect of folic acid intake on congenital anomalies. A systematic review and meta-analysis.

作者信息

Moges Natnael, Sisay Chanie Ermias, Anteneh Rahel Mulatie, Zemene Melkamu Aderajew, Gebeyehu Asaye Alamneh, Belete Melaku Ashagrie, Kebede Natnael, Anley Denekew Tenaw, Dessie Anteneh Mengist, Alemayehu Ermiyas, Dagnaw Fentaw Teshome, Asmare Zufan Alamrie, Tsega Sintayehu Simie

机构信息

Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.

Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia.

出版信息

Front Pediatr. 2024 Jul 19;12:1386846. doi: 10.3389/fped.2024.1386846. eCollection 2024.

DOI:10.3389/fped.2024.1386846

PMID:39100647

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11294162/

Abstract

BACKGROUND

Congenital anomalies pose a significant challenge to global health and result in considerable morbidity and mortality in early childhood. With the decline of other causes of death among children under five, the burden of congenital anomalies is rising, emphasizing the need for improved prenatal care, screening, and nutrition for pregnant women. This systematic review and meta-analysis aim to estimate the pooled effect of folic acid intake on congenital anomalies.

METHODS

To identify relevant research published up until December 30/2023, we conducted electronic searches of PubMed/Medline, PubMed Central, Hinary, Google, African Journals Online, Web of Science, Science Direct, and Google Scholar databases using predefined eligibility criteria. We used Excel to extract data and evaluated the studies using the JBI appraisal checklist. We computed the pooled effect size with 95% confidence intervals for maternal folic acid intake on congenital anomalies using STATA version 17 and the DerSimonian and Laird random effects meta-analysis model. We assessed statistical heterogeneity using Cochran's -test, statistic, and visual examination of the funnel plot.

RESULTS

The review included 16 case-control, cohort, and cross-sectional studies. According to the results of this systematic review and meta-analysis, maternal folic acid intake significantly lowers the incidence of congenital anomalies (odds ratio (OR), 0.23; confidence interval (CI), 0.16, 0.32). Among the included studies, both the Cochrane -test statistic (2 = 118.82, < 0.001) and test statistic ( = 87.38%, < 0.001) revealed statistically significant heterogeneity. Egger's weighted regression ( < 0.001) and funnel plot show evidence of publication bias in this meta-analysis.

CONCLUSION

The results of the recent meta-analysis and systematic review have demonstrated a significant association between maternal folic acid intake and the risk of congenital anomalies. Specifically, children whose mothers received periconceptional folic acid supplementation had a 77% reduced risk of congenital anomalies. To further investigate the correlation between maternal folic acid supplementation and the occurrence of various congenital anomalies, particularly in developing countries, it is recommended that a comprehensive prospective study be conducted.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42024511508).

摘要

背景

先天性异常对全球健康构成重大挑战，并导致幼儿期出现相当高的发病率和死亡率。随着五岁以下儿童其他死因的减少，先天性异常的负担正在上升，这凸显了改善孕妇产前护理、筛查和营养的必要性。本系统评价和荟萃分析旨在估计叶酸摄入对先天性异常的综合影响。

方法

为了确定截至2023年12月30日发表的相关研究，我们使用预定义的纳入标准，对PubMed/Medline、PubMed Central、Hinary、Google、非洲期刊在线、科学网、Science Direct和谷歌学术数据库进行了电子检索。我们使用Excel提取数据，并使用JBI评估清单对研究进行评估。我们使用STATA 17版本以及DerSimonian和Laird随机效应荟萃分析模型，计算了孕妇叶酸摄入对先天性异常的合并效应量及其95%置信区间。我们使用Cochran's Q检验、I²统计量和漏斗图的可视化检查来评估统计异质性。

结果

该综述纳入了16项病例对照研究、队列研究和横断面研究。根据这项系统评价和荟萃分析的结果，孕妇叶酸摄入显著降低了先天性异常的发生率（优势比（OR）为0.23；置信区间（CI）为0.16，0.32）。在纳入的研究中，Cochrane Q检验统计量（Q² = 118.82，P < 0.001）和I²检验统计量（I² = 87.38%，P < 0.001）均显示出具有统计学意义的异质性。Egger加权回归（P < 0.001）和漏斗图表明该荟萃分析存在发表偏倚的证据。