Laurence K M, James N, Miller M, Campbell H
Br Med J. 1980 Dec 13;281(6255):1592-4. doi: 10.1136/bmj.281.6255.1592.
One hundred and seventy-four women who had previously had a child with a neural-tube defect were assessed retrospectively on the quality of their diets during the first trimester of that pregnancy, between pregnancies, and during the first trimester of other pregnancies. They were then studied prospectively during the first trimester of 186 following pregnancies and the outcome of these was recorded. One hundred and three women (with 109 pregnancies) were given dietary counselling before the pregnancy, the remaining 71 (with 77 pregnancies) not being counselled. Seventy-eight (72%) of the counselled women improved their diet compared with only nine (12%) of the uncounselled women. The difference was significant (p < 0.001). There were three recurrences of neural-tube defects in the counselled women (3%) and five recurrences in the uncounselled (7%). Although this difference was not significant, the relative risk in the counselled group was reduced to less than half of that in the uncounselled group. All eight recurrences occurred in the 45 pregnancies in women taking poor diets (18%), whereas there were no recurrences in the 141 other pregnancies. This difference is significant (p < 0.001). It is concluded that women receiving adequate diets have a lower incidence and recurrence of fetal neural-tube defects than women receiving poor diets and that dietary counselling may be effective in reducing the incidence of fetal neural-tube defects.
对174名曾生育过神经管缺陷患儿的女性进行了回顾性评估，了解她们在该次妊娠的孕早期、两次妊娠之间以及其他妊娠的孕早期的饮食质量。然后对她们在接下来186次妊娠的孕早期进行前瞻性研究，并记录结果。103名女性（109次妊娠）在怀孕前接受了饮食咨询，其余71名女性（77次妊娠）未接受咨询。接受咨询的女性中有78名（72%）改善了饮食，而未接受咨询的女性中只有9名（12%）改善了饮食。差异具有统计学意义（p<0.001）。接受咨询的女性中有3例神经管缺陷复发（3%），未接受咨询的女性中有5例复发（7%）。虽然这种差异不具有统计学意义，但接受咨询组的相对风险降低到未接受咨询组的一半以下。所有8例复发都发生在45次饮食不良的女性妊娠中（18%），而在其他141次妊娠中没有复发。这种差异具有统计学意义（p<0.001）。研究得出结论，饮食充足的女性胎儿神经管缺陷的发生率和复发率低于饮食不良的女性，饮食咨询可能对降低胎儿神经管缺陷的发生率有效。
