陕西省育龄妇女围孕期服用叶酸与产儿先天性心脏病的关系
Association between congenital heart disease and folic acid supplementation during periconceptional period among women of childbearing age in Shaanxi

摘要：目的 探讨围孕期妇女服用叶酸与产儿先天性心脏病的关系，为采取有针对性的干预措施提供科学依据。方法 应用分层随机整群抽样方法，抽取陕西省30个区县。对2010年1月至2013年11月间曾经怀孕、符合纳入标准、已知生育结局并知情同意的育龄妇女及其生育子女进行入户调查。采用Logistic回归模型控制相关影响因素分析妇女叶酸服用与产儿先天性心脏病发生的风险关系。结果 本研究共纳入28354名育龄妇女，其活产儿先天性心脏病患病率为7.3‰，育龄妇女围孕期叶酸服用率为64.4%，但其中按照规范服用叶酸的妇女仅占17.2%。围孕期妇女规范服用叶酸可能是产儿先天性心脏病的保护因素，单因素分析结果显示OR为0.502(95% CI：0.279～0.902)；在控制了家庭背景因素，母亲因素以及孕期接触危险因素后多因素分析发现，叶酸规范服用仍然是先天性心脏病的保护性因素(调整OR=0.512，P=0.046)。然而，尚未发现不规范服用叶酸对产儿先天性心脏病发生的保护作用。结论 按照规范时间和剂量服用叶酸(孕前3个月至孕早期3个月，每天服用0.4mg，且累计服用时间超过90d)，可能预防先天性心脏病的发生。
ABSTRACT: Objective To explore the association between folic acid supplementation during periconcerptional period and congenital heart disease in newborns to provide scientific evidence for making intervening measures. Methods Using stratified random cluster sampling, a total of 30 counties were sampled from Shaanxi Province. A questionnaire survey was conducted among childbearing-aged women pregnant between January 2010 and November 2013. All of the included women had definite pregnancy outcomes and had signed the consent form. Logistic regression was performed to investigate the association between folic acid supplementation during pregnancy and congenital heart disease in newborns. Results In total, 28354 questionnaires were available for analysis. The overall prevalence of congenital heart disease among live-birth neonates in the present study was 7.3‰. The percentage of childbearing-age women who had taken folic acid supplementation during pregnancy was 64.4%, while only 17.2% of them took folic acid according to the specification. Taking folic acid regularly during pregnancy was associated with a lower risk of congenital heart disease among the newborns (OR=0.502, 95% CI: 0.279-0.902). The multiple-factor analysis results also showed that taking folic acid regularly during periconcerptional period could reduce the risk of congenital heart disease (adjusted OR=0.512, P=0.046) when we controlled the family background factors, mother factors and exposure risk factors during pregnancy. However, no association was found between irregularly taking folic acid during periconcerptional period and the risk of congenital heart disease. Conclusion Taking folic acid according to the specification during periconcerptional period (taking folic acid during 3 months before pregnancy to 3 months after pregnancy with a daily dose of 0.4mg for more than 90 days) may prevent congenital heart disease of newborns