神经管畸形高、低发区农村孕早期妇女血液叶酸水平比较研究

目的 了解神经管畸形高发区与低发区农村孕早期妇女血液叶酸状况。方法 采用现况调查方法对2003年神经管畸形高发与低发两个地区共688名农村孕早期妇女的血浆叶酸与红细胞叶酸水平进行研究。结果 高发区农村孕早期妇女血浆叶酸浓度（10．53nmol／L）与红细胞叶酸浓度（389．2nmol／L）中位数明显低于低发区妇女（血浆叶酸30．39nmol/L，红细胞叶酸926．0nmol／L），差异有统计学意义；高发区妇女血浆叶酸缺乏率约为50％，红细胞叶酸缺乏率约为43％，远高于低发区妇女（血浆叶酸6％，红细胞叶酸4％），差异有统计学意义；高、低发区服用叶酸组妇女血浆叶酸水平约为不服用组的2倍，红细胞叶酸水平是不服用组的1．4倍，差异有统计学意义；高、低发区服用叶酸组孕早期妇女的血浆缺乏率均低于不服用组，相对危险度（RR）值分别为0．60（95％CI：0．36～1．01）与0．16（95％CI：0．06～0．44），差异均有统计学意义；高、低发区服用叶酸组与不服用组红细胞叶酸缺乏率之间的RR值分别为0．64（95％CI：0．36～1．13）与0．39（95％CI：0．13～1．13），差异无统计学意义；服用叶酸的孕早期妇女中，低发区血浆叶酸水平约为高发区的1．7～1．9倍，红细胞叶酸水平约为高发区的2倍，差异有统计学意义；服用叶酸的孕早期妇女中，高发区血浆叶酸与红细胞叶酸缺乏率约为低发区的10～14倍，差异有统计学意义。结论 神经管畸形高发区农村孕早期妇女血液叶酸水平很低，增补叶酸可有效提高妇女血液叶酸水平、降低妇女叶酸缺乏率，高发区育龄妇女怀孕前后每日服用0．4mg叶酸的剂量可能不足，建议增加服用剂量。     

我国神经管畸形高低发区孕早期妇女血液叶酸水平比较研究

神经管畸形出生患病率在我国存在明显的地域差异,北方高于南方、农村高于城市。一般认为,饮食因素是造成这种分布差异的主要原因。但迄今为止,尚无不同地域孕早期妇女血液叶酸水平比较的研究报道。在国家“十五”科技攻关课题支持下,北京大学生育健康研究所研究人员于2002年12月～2004年4月间,对神经管畸形高发的山西省和神经管畸形低发的江苏省部分地区孕早期妇女(孕(16周内)的血液叶酸水平进行了测定和比较,并对叶酸的服用情况进行了调查。研究对象包括神经管畸形高发区农村孕早期妇女358名,城市孕早期妇女204名;神经管畸形低发区农村孕早…     

叶酸缺乏与神经管畸形

我国每年约有20万～30万肉眼可见的先天畸形儿出生,其中,神经管缺陷约有10万人。对妇女孕前或孕早期进行免费补服叶酸,可有效降低神经管缺陷的发生率,提高出生人口健康水平。     

山东枣庄妇女怀孕前后服用叶酸增补剂预防神经管畸形

育龄妇女在孕前和孕早期服用0．4mg叶酸增补剂预防神经管畸形（NTDs），是由中国妇婴保健中心与美国疾病控制中心经过多年研究的一项科技成果，由国家卫生部、人口与计划生育委员会在全国推广使用。2000年4月在本区推广妇女孕前或孕早期服用了0．4mg叶酸增补剂（商品名斯利安），通过与同期未使用叶酸增补剂的孕妇对比，现将观察结果报道如下。     

叶酸与神经管畸形

神经管畸形（Neuraltubedefects，NTDS）包括无脑儿、脊柱裂及脑膨出等，是新生儿常见的一种先天畸形。无脑儿为严重脑发育不全，并有颅骨缺损，一般于出生前或出生后短时间内即死亡。脊柱裂是在胚胎发育期神经管未能闭合严重缺损所造成，患儿出生后虽可存活，但成为终身残废。据国际出生缺陷监测情报所统计资料，全世界每年约有30－40万神经管畸形病例发生。据我国198be－1987年对全国29省市自治区的出生缺陷监测结果，神经管畸形的发病率为2．74％，在各种出生缺陷中占居首位，每年全国约有8一州万神经管畸形患儿出生。我国神经管畸形发…     

叶酸缺乏与婴儿神经管畸形

公元1932年,美国科学家戴伯从酵母和牛肝中,提取了一种营养素,将其用于治疗实验动物猴子的贫血,转而又用于治疗恶性贫血的病人,获得了满意的疗效,命令为“猴子维生素”。因猴子的英文为MONKEY,所以又叫“维生素M”,医     

浅谈孕早期叶酸合理应用的临床意义

叶酸是一种水溶性B族维生素,参与人体新陈代谢的全过程,是合体人体重要物质DNA的必需维生素。叶酸在人体细胞分裂中起着根本性的作用,孕早期叶酸缺乏是引起神经管畸形的主要原因。它除了引起胎儿神经管发育缺陷,影响胎儿发育外,还可使跟、口唇、胃肠道、心血管、肾、骨骼等器管畸形率增高;同时还可导致孕妇贫血,叶酸缺乏还可导致同型半胱氨酸向蛋氨酸转化障碍,发生同型半胱氨酸血症,引起血管内皮细胞损伤而诱发妊高征。     

神经管畸形不同发病区婚检妇女叶酸缺乏率的研究

在我国神经管畸形(NTDs)高发的北方和低发的南方城乡地区，分别进行了婚检妇女的叶酸营养状况监测，结果发现妇女血清叶酸总缺乏率为23．6％：，红细胞叶酸总缺乏率为298．1‰。红细胞叶酸缺乏率高于血清叶酸缺乏率。南方妇女叶酸缺乏率低于北方妇女。城市妇女叶酸缺乏率低于农村。夏、秋、冬、春季妇女的叶酸缺乏率不同。叶酸营养状况与神经管畸形发病率存在着负相关。     

妇女增补叶酸预防神经管畸形成果推广的成本-效果分析

为了论证妇女增补叶酸预防神经管畸形推广工作策略的可行性,本文从预防医学科学价值、经济学特征和社会适应性等方面进行了研究分析.以10万妇女服用小剂量叶酸增补剂(斯利安)成本652万元计算,每预防1个DALY的费用,北方神经管畸形高发区为567元,要好于食盐加碘防治碘缺乏病的875元.以100万元防治经费成本计算,可防治神经管畸形65.6例,先天性甲状腺功能低下症4.3例,苯丙酮尿症1.6例,妇女增补叶酸预防神经管畸形的效果显著.     

新婚妇女增补小剂量叶酸预防神经管畸形

神经管畸形（neural tube defects，NTDs）是造成胎婴儿死亡及儿童残疾的主要原因之一，是世界范围内一个重要公共卫生问题，育龄妇女增补叶酸可以预防NTDs发生。我院于2000-2002年期间对34571名新婚妇女进行了增补叶酸预防NTDs人群干预研究，研究结果如下。     

Periconceptional multivitamin folic acid use,dietary folate,total folate and risk of neural tube defects in South Carolina

PURPOSE: To investigate whether dietary folate or multivitamin folic acid taken 3 months before conception and during the first 3 months of pregnancy reduces the risk of isolated occurrent neural tube defect (NTD)-affected pregnancies. METHODS: This population-based case control study conducted between 1992 and 1997 included 179 women with NTD-affected pregnancies and 288 randomly selected controls. Women completed a food frequency questionnaire and were interviewed about lifestyle behaviors, pregnancy histories and use of multivitamins. RESULTS: Use of 0.4 mg or more of multivitamin folic acid at least 3 times per week during the periconceptional period showed no statistically significant reduction in NTD risk [adjusted odds ratio (AOR) = 0.55, 95% confidence interval (CI) = 025, 1.22]. After adjusting for covariates, protective effects for NTDs were observed at the highest quartiles of dietary folate and total folate (daily dietary folate plus daily multivitamin folic acid); the respective odds ratios were 0.40 (95% CI = 0.19, 0.84) and 0.35 (95% CI = 0.17, 0.72). CONCLUSIONS: This study illustrates some of the difficulties in determining effects of folic acid and dietary folate in a population where the consumption of foods rich in folate and the use of multivitamins are increasing and the rate of NTDs is declining. Studies are needed to monitor future changes in folate levels and their effect on health.     

孕妇血清叶酸、同型半胱氨酸水平与胎儿神经管畸形危险性研究

目的 了解孕妇血清叶酸和同型半胱氨酸(homocysteine,Hcy)水平与胎儿神经管畸形(neural tube defects,NTDs)的关系. 方法 采用病例对照研究设计,以NTDs高发的山西省5个县作为研究现场,研究对象为此现场9所医院内进行产前检查或分娩并同意参与此研究的孕妇.病例组指经B超诊断为孕NTDs胎儿并通过终止妊娠确诊的孕妇及活/死产NTDs胎儿的孕妇.对照组指在同一医院随机选择的当地正常孕妇.检测所有研究对象血清叶酸和Hcy水平,比较病例组和对照组血清叶酸和Hcy水平差异.分别以对照组血清叶酸和Hcy水平的第10和90百分位数作为界值,比较不同水平组NTDs的发病风险. 结果 收集到符合要求的病例113例,对照148例.病例组和对照组血清叶酸水平分别为10.5(4.4～24.5)nmol/L、12.9(6.3～32.7)mol/L,2组比较,差异有统计学意义(P=0.001),2组血清Hcy浓度比较,差异无统计学意义(P>0.05);病例分型后发现,妊娠无脑儿及脊柱裂的孕妇血清叶酸水平低于对照组,差异有统计学意义(P<0.05),妊娠脑膨出的孕妇血清叶酸平均值低于对照组,但差异无统计学意义(P>0.05),妊娠无脑儿的孕妇血清Hcy水平高于对照组,差异有统计学意义(P<0.05);低叶酸水平孕妇妊娠NTDs 的危险性显著增加(OR=2.4;95% CI 1.1-5.6). 结论 在NTDs高发区,孕妇低水平叶酸是妊娠NTDs的独立危险因素;血清叶酸与Hcy相比是对NTDs胎儿的发生更有预测意义的指标.     

Fortification with low amounts of folic acid makes a significant difference in folate status in young women: implications for the prevention of neural tube defects.

BACKGROUND: Mandatory fortification of grain products with folic acid was introduced recently in the United States, a policy expected to result in a mean additional intake of 100 microgram/d. One way of predicting the effectiveness of this measure is to determine the effect of removing a similar amount of folic acid as fortified food from the diets of young women who had been electively exposed to chronic fortification. OBJECTIVE: The objective was to examine the effect on folate status of foods fortified with low amounts of folic acid. DESIGN: We investigated the changes in dietary intakes and in red blood cell and serum concentrations of folate in response to removing folic acid-fortified foods for 12 wk from the diets of women who reportedly consumed such foods at least once weekly (consumers). RESULTS: Consumers (n = 21) had higher total folate intakes (P = 0.002) and red blood cell folate concentrations (P = 0.023) than nonconsumers (women who consumed folic acid-fortified foods less than once weekly; n = 30). Of greater interest, a 12-wk intervention involving the exclusion of these foods resulted in a decrease in folate intake of 78 +/- 56 microgram/d (P < 0.001), which was reflected in a significant reduction in red blood cell folate concentrations (P < 0.05). CONCLUSIONS: Cessation of eating folic acid-fortified foods resulted in removing 78 microgram folic acid/d from the diet. Over 12 wk this resulted in a lowering of red blood cell folate concentrations by 111 nmol/L (49 microgram/L). This magnitude of change in folate status in women can be anticipated as a result of the new US fortification legislation and is predicted to have a significant, although not optimal, effect in preventing neural tube defects.     

Relation between serum folate status and blood mercury concentrations in pregnant women

ObjectiveTo evaluate the relation between maternal serum folate status and blood mercury in pregnant Korean women.MethodsThe nutritional status of folate and the blood mercury concentration were measured in pregnant Korean women who participated in a multicenter prospective study from 2006 through 2011. We analyzed existing blood mercury data based on serum folate status at two gestational time points (mid and late pregnancy, n = 1105 and 841, respectively).ResultsSerum folate concentrations in pregnant women were negatively associated with blood mercury concentrations at mid and late pregnancy (P trend = 0.012 and 0.002, respectively). A general linear model developed after adjusting for covariates indicated a significant negative association between the two at mid and late pregnancy.ConclusionWe found a negative association between serum folate and blood mercury concentrations in pregnant Korean women.