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山东大学学报 (医学版) ›› 2020, Vol. 58 ›› Issue (5): 115-120.doi: 10.6040/j.issn.1671-7554.0.2019.1464

• • 上一篇    

孕前叶酸增补依从性及其影响因素

尹周一*,张凤梅*,王梦圆,刘西瑶,池岩娜,高莉洁,王志萍   

  1. 山东大学公共卫生学院, 山东 济南 250012
  • 发布日期:2022-09-27
  • 通讯作者: 王志萍. E-mail:zhipingw@sdu.edu.cn*共同第一作者.
  • 基金资助:
    山东大学大学生科技创新基金项目(2017311);山东大学公共卫生学院科研组织建设项目(2017zz20)

Folic acid supplementation compliance and influencing factors before pregnancy

YIN Zhouyi*, ZHANG Fengmei*, WANG Mengyuan, LIU Xiyao, CHI Yanna, GAO Lijie, WANG Zhiping   

  1. School of Public Health, Shandong University, Jinan 250012, Shandong, China
  • Published:2022-09-27

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摘要： 目的 了解围孕期增补叶酸政策实施多年后,育龄妇女叶酸增补依从性情况,探索叶酸增补影响因素,为重点人群制定增补叶酸措施提供依据。 方法 以山东省某县为研究现场,采用基于人群的1∶1匹配病例对照研究方法,对研究期间出生缺陷患儿及与其匹配正常儿的母亲进行问卷调查,分别作为病例组和对照组;采用配对t/χ2检验及多因素条件Logistic回归分析叶酸增补依从性,采用多因素Logistic回归分析方法探索孕前叶酸增补依从性影响因素。 结果 研究期间,研究现场共诊断263例出生缺陷患儿,最终入组180例病例组及180例对照组。(1)病例组与对照组围孕期的叶酸增补比例分别为81.67%和88.33%(P=0.111)、规律增补比例分别为10.56%和15.00%(P=0.229),孕前3个月的叶酸增补比例分别为33.33%和40.00%(P=0.213)、增补天数分别为(19.63±32.05)和(26.32±36.33)d(P=0.053);(2)出生缺陷发生风险随孕前3个月叶酸增补天数增多而下降(OR=0.933,95%CI:0.872~0.999,P=0.046);(3)孕前增补叶酸的主要影响因素为意外怀孕(OR=2.825,95%CI:1.303~6.127,P=0.009)以及本次妊娠为首次妊娠(OR=2.657,95%CI:1.171~6.029,P=0.019)。 结论 育龄妇女围孕期叶酸增补比例相对较高,但孕前叶酸增补依从性较差。可针对首次妊娠妇女加强叶酸作用的普及教育;广泛倡导充分备孕以避免意外怀孕,从而提高孕前叶酸增补依从性。

关键词: 叶酸, 孕前, 出生缺陷, 依从性, 影响因素

Abstract: Objective To examine the folic acid supplementation compliance of women of childbearing age after the policy of supplementing folic acid in the periconceptional period has been implemented for many years, to explore the factors affecting folic acid supplementation, and to provide scientific evidence for determining the specific measures for supplementing folic acid in key populations. Methods A county-based 1∶1 matched case-control study was conducted in a county in Shandong Province. Questionnaire survey was conducted between mothers of children with or without birth defects during the study period, who were defined as case group and control group, respectively. Paired t test, χ2 test and conditional multivariate Logistic regression analysis were used to examine folic acid supplementation compliance. Unconditional multivariate Logistic regression analysis was used to explore the factors affecting pre-pregnancy folic acid supplementation compliance. Results A total of 263 cases of birth defects were diagnosed at the study site, and 180 cases were enrolled in case group and 180 cases were enrolled in control group. (1)In the periconceptional period, the folic acid intake proportions of case group and control group were 81.67% and 88.33%(P=0.111), and the regular intake proportions were 10.56% and 15.00%(P=0.229). In the last three months before pregnancy, the folic acid intake proportions were 33.33% and 40.00%(P=0.213), and the days of intake were(19.63±32.05)and(26.32±36.33)d(P=0.053). (2)The risk of birth defects decreased with the increase of folic acid supplementation days in the last three months before pregnancy(OR=0.933, 95%CI: 0.872-0.999, P=0.046). (3)The main influencing factors for pre-pregnancy folic acid administration were unintended pregnancy(OR=2.825, 95%CI: 1.303-6.127, P=0.009)and the first pregnancy(OR=2.657, 95%CI: 1.171-6.029, P=0.019). Conclusion Women of childbearing age have a relatively high proportion of folic acid supplementation in the periconceptional period but poor compliance with folic acid before pregnancy. In order to improve the pre-pregnancy folic acid utilization, the universal education of folic acid action for first pregnant woman should be strengthened. The fully prepared pregnancy can be actively advocated to avoid unintended pregnancy and improve compliance with folic acid before pregnancy.

Key words: Folic acid, Pre-pregnancy, Birth defects, Compliance, Influencing factors

中图分类号: 

  • R17
[1] 安郁宽, 徐艳岩. 物理因素与出生缺陷[J]. 生物学通报, 2013, 48(12): 17-19.
[2] 罗美瑜. 我国出生缺陷的现状及干预[J]. 海峡预防医学杂志, 2006, 12(5): 1-2.
[3] Dai L, Zhu J, Liang J, et al. Birth defects surveillance in China [J]. World J Pediatr, 2011, 7(4): 302-310.
[4] Figueiredo RF, Figueiredo N, Feguri A, et al. The role of the folic acid to the prevention of orofacial cleft: an epidemiological study [J]. Oral Dis, 2015, 21(2): 240-247.
[5] 温美珍. 贫困地区育龄妇女增补叶酸预防出生缺陷效果评价[J]. 中国优生与遗传杂志, 2018, 26(11): 105-106. WEN Meizhen. Folic acid supplementation for women of childbearing age in poor areas [J]. Chinese Journal of Birth Health & Heredity, 2018, 26(11): 105-106.
[6] 沈佩芳, 胡惠敏. 叶酸预防胎儿神经管缺陷的效果观察[J]. 中国药业, 2011, 20(11): 67-68.
[7] 毛宝宏, 邱伟涛, 王燕侠, 等. 孕前及孕期叶酸摄入对出生缺陷发生风险的影响[J]. 中国优生与遗传杂志, 2017, 25(9): 91-94. MAO Baohong, QIU Weitao, WANG Yanxia, et al. Birth defects in relation to maternal folic acid supplementation and dietary folate intake [J]. Chinese Journal of Birth Health & Heredity, 2017, 25(9): 91-94.
[8] 谢璐璐, 朱清, 刘畅, 等. 甘肃省育龄妇女叶酸服用依从性及影响因素调查[J]. 中国预防医学杂志, 2019, 20(12): 1219-1222. XIE Lulu, ZHU Qing, LIU Chang, et al. Investigation and analysis on compliance to folic acid supplementation among childbearing aged-women in Gansu Province [J]. China Preventive Medicine, 2019, 20(12): 1219-1222.
[9] 中华人民共和国国家卫生健康委员会. 增补叶酸预防神经管缺陷项目管理方案[J].中国生育健康杂志, 2009, 20(4): 198-199.
[10] 杨爽, 刘宇龙, 党文珊, 等. 山西省城镇孕妇叶酸服用现况及其影响因素分析[J]. 中国计划生育学杂志, 2018, 26(11): 1019-1023. YANG Shuang, LIU Yulong, DANG Wenshan, et al. Statue of folic acid intake of the urban pregnant women of Shanxi Province and its influence factors [J]. Chin J Fam Plan, 2018, 26(11): 1019-1023.
[11] 张龙飞. 基于小区域方法的出生缺陷流行病学研究[D]. 济南: 山东大学, 2018.
[12] 围受孕期增补叶酸预防神经管缺陷指南工作组. 围受孕期增补叶酸预防神经管缺陷指南(2017)[J]. 中国生育健康杂志, 2017, 28(5): 401-410.
[13] 宋沁峰, 王佳楣, 高素红, 等. 孕妇叶酸正确服用率及其影响因素研究进展[J]. 中国生育健康杂志, 2019, 30(5): 487-489.
[14] 袁淑怡, 颜虹, 曾令霞, 等. 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[J]. 西安交通大学学报(医学版), 2017, 38(3): 343-347. YUAN Shuyi, YAN Hong, ZENG Lingxia, et al. Association between congenital heart disease and folic acid supplementation during periconceptional [J]. Journal of Xian Jiaotong University(Medical Sciences), 2017, 38(3): 343-347.
[15] 杨爽, 金永生, 张雪娟. 山西省农村孕妇叶酸知信行现况及其影响因素[J]. 中国生育健康杂志, 2018, 29(3): 266-270.
[16] 刘奇秋, 顾斌. 免费婚检已孕女性叶酸服用情况分析[J]. 河北医药, 2016, 38(19): 3021-3022, 3025.
[17] 党秋红, 曾宪旭, 李剑峰, 等. 意外怀孕与神经管畸形[J]. 中国妇幼保健, 2013, 28(3): 508-509.
[18] 陈浩, 王园, 郭浩岩. 三省市育龄妇女免费服用叶酸政策接受度的影响因素分析[J]. 现代预防医学, 2015, 42(13): 2369-2371. CHEN Hao, WANG Yuan, GUO Haoyan. Influencing factors of the acceptance level for the policy of taking free folic acid among women of childbearing age in three provinces [J]. Modern Preventive Medicine, 2015, 42(13): 2369-2371.
[19] 靳荣荣, 曲翌敏, 李娟娟, 等. 北京市郊区育龄妇女叶酸服用现状调查[J]. 中华流行病学杂志, 2017, 38(10): 1347-1351.
[20] 王战, 张乐, 闫会娜, 等. 北京市高知地区孕妇增补叶酸的知信行现况调查[J]. 中国妇幼健康研究, 2017, 28(10): 1272-1275. WANG Zhan, ZHANG Le, YAN Huina, et al. A cross-sectional study on the knowledge, attitude and practice of folic acid supplement status in pregnant woman in intellectual dense area of Beijing [J]. Chinese Journal of Woman and Child Health Research, 2017, 28(10): 1272-1275.
[21] 米立芬. 孕妇营养知信行现状及其影响因素分析[D]. 唐山:华北理工大学, 2018.
[22] 曹蒙蒙. 某市583例育龄妇女孕期自我健康管理的调查研究[D]. 保定:河北大学, 2019.
[23] 曹艳华. 育龄妇女叶酸缺乏的原因及叶酸的产科应用[J]. 中国优生与遗传杂志, 2000, 8(1): 9-10.
[24] 郑明明, 胡娅莉. 神经管缺陷及其病因学研究[J]. 国外医学妇幼保健分册, 2003, 14(5): 282-284. ZHENG Mingming, HU Yali. Neural tube defects and their etiology [J]. Foreign Medical Sciences(Section of Maternal and Child Health), 2003, 14(5): 282-284.
[25] 董倩, 王金桃, 见明智, 等. 神经管缺陷高发区母亲相关行为因素研究[J]. 中华疾病控制杂志, 2012, 16(6): 476-478. DONG Qian, WANG Jintao, JIAN Mingzhi, et al. Research on mothers behaviour factors in areas with high incidence of NTDs [J]. Chinese Journal of Disease Control & Prevention, 2012, 16(6): 476-478.
[26] 曾梦君, 熊黎黎, 吴颖岚, 等. 2009—2015 年湖南省育龄妇女增补叶酸预防出生缺陷效果评价[J]. 中国妇幼保健, 2017, 32(9): 1835-1837.
[27] 钟欢欣. 衢州地区孕期叶酸代谢障碍相关基因及叶酸干预与出生缺陷的相关性研究[D]. 杭州:浙江中医药大学, 2018.
[28] 李文静, 杨文方, 曾令霞, 等. 延安育龄妇女出生缺陷 KAP 调查及其影响因素分析[J]. 中国妇幼健康研究, 2017, 28(7): 797-801. LI Wenjing, YANG Wenfang, ZENG Lingxia, et al. KAP investigation on birth defects of childbearing women and its influencing factors in Yan an City [J]. Chinese Journal of Woman and Child Health Research, 2017, 28(7): 797-801.
[29] 文芳芳. 叶酸增补依从率的现状与干预措施[J]. 航空航天医学杂志, 2014, 25(3): 390-391.
[30] 谢璐璐. 甘肃省育龄妇女叶酸补服知行现况及影响因素调查[D]. 兰州:兰州大学, 2019.
[31] 张乐, 任爱国, 李智文, 等. 新《婚姻登记条例》实施前后孕早期妇女叶酸知识和增补率的变化[J]. 中国妇幼保健, 2005, 20(21): 2750-2753. ZHANG Le, REN Aiguo, LI Zhiwen, et al. Knowledge and use of folic acid supplements among women in their first trimester of pregnancy regist [J]. Maternal and Child Health Care of China, 2005, 20(21): 2750-2753.
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