JAMA Psychiatry:妊娠前和妊娠期使用叶酸和复合维生素可降低“后患”?

2018-04-10 安雅晶 环球医学网

研究表明,缺乏叶酸增加胎儿神经缺陷的风险,但研究还表明,叶酸补充过多会大幅增加新生儿患自闭症的风险。有研究显示,孕妇用复合维生素可预防胎儿出生缺陷,但也有研究显示,服用复合维生素过量可能导致胎儿畸形。研究结果纷纷扰扰,育龄女性到底要不要补?

研究表明,缺乏叶酸增加胎儿神经缺陷的风险,但研究还表明,叶酸补充过多会大幅增加新生儿患自闭症的风险。有研究显示,孕妇用复合维生素可预防胎儿出生缺陷,但也有研究显示,服用复合维生素过量可能导致胎儿畸形。研究结果纷纷扰扰,育龄女性到底要不要补?

以色列、美国、瑞典和加拿大科学家就此展开研究,考察了妊娠前和妊娠期孕妇使用叶酸和复合维生素补充剂与后代自闭症谱系障碍(ASD)风险之间的相关性。此研究2018年2月发表于《JAMA Psychiatry》。

对2003年1月1日~2007年12月31日出生的45300名以色列儿童进行病例对照队列研究,并从出生随访ASD风险至2015年1月26日。病例组为所有确诊为ASD的儿童,对照组为随机抽取所有活产出生儿童的33%组成样本。

孕妇维生素补充剂分为叶酸(维生素B9)、复合维生素补充剂(解剖学治疗学及化学分类系统A11编码维生素A、B、C和D)、妊娠前和妊娠期暴露的任何其他组合。

使用校正了混杂因素的Cox成比例风险回归模型计算相对风险(RRs)及其95% 置信区间(CIs),从而量化孕妇维生素补充与后代ASD风险之间的相关性。敏感性分析用于检测结果的稳健性。

研究中的45300名儿童[女孩22090人,男孩23210人;随访结束时的平均(SD)年龄,10.0岁]中,572人(1.3%)确诊为ASD。

与妊娠前未暴露相比,孕妇妊娠前叶酸和/或复合维生素补充剂暴露与后代较低的ASD可能性在统计学上显着相关。

与妊娠期未暴露相比,孕妇妊娠期叶酸和/或复合维生素补充剂暴露与后代较低的ASD可能性在统计学上显着相关。

妊娠前叶酸暴露、妊娠期叶酸暴露、妊娠前复合维生素暴露、妊娠期复合维生素暴露的RRs分别为0.56、0.32、0.36和0.35。各敏感性分析之间,结果一般保持统计学显着性。

与未暴露相比,妊娠前和妊娠期孕妇叶酸和复合维生素补充剂暴露与后代ASD风险减低相关。

该针对45300例后代的病例对照队列研究,观察到妊娠前和/或妊娠期母亲维生素补充剂使用与后代ASD风险降低之间有显着差异。

研究者解释,妊娠前和妊娠期使用特定维生素补充剂的女性所生孩子的ASD风险降低对公共卫生而言有重要意义;可能的机制包括表观遗传修饰。

看来,妊娠前和妊娠期使用叶酸和复合维生素是必要的,但要避免走极端。

原始出处:
Levine SZ, Kodesh A, Viktorin A, et al.Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring.JAMA Psychiatry. 2018 Feb 1;75(2):176-184. doi: 10.1001/jamapsychiatry.2017.4050.

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