PDF(Pubmed)
Abstract：
Folic acid (FA) supplementation is associated with a lower risk of the neural tube and heart defects and is recommended for women of childbearing age. Although there are detailed recommendations, differences in the initiation time and duration of FA supplementation remain poorly studied.
A multicentre prospective study of 17,713 women was conducted. The incidence of congenital malformations in women taking a recommended dosage (e.g. 0.4 or 0.8 mg/day) of FA was compared with that in women without supplementation. The predicted probability of malformations by the initiation time and duration of FA use was estimated to determine optimal options.
Periconceptional FA supplementation was associated with a lower and insignificant risk of congenital malformations (1.59% vs. 2.37%; odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.44-1.08), heart defects (3.8 vs. 8.0 per 1000 infants; OR, 0.47; 0.21-1.02), and neural tube defects (7.0 vs. 11.5 per 10,000 infants; OR, 0.64; 0.08-5.15). FA use after pregnancy provided greater protection against total malformations. Statistically significant associations were found in women who initiated FA supplementation in the first month of gestation (OR, 0.55; 95% CI: 0.33-0.91) and in those who supplemented for 1 to 2 months (OR, 0.59; 95% CI: 0.36-0.98). Similar results were found for heart defects. The optimal initiation time was 1.5 (optimal range: 1.1 to 1.9) months before pregnancy and a duration of 4.0 (3.7 to 4.4) months was reasonable to achieve the lowest risk of congenital malformations. Heart defect prevention required an earlier initiation (2.2 vs. 1.1 months before pregnancy) and a longer duration (4.7 vs. 3.7 months) than the prevention of other malformations.
The timely initiation of FA supplementation for gestation was associated with a decreased risk of congenital malformations, which was mainly attributed to its protection against heart defects. The initiation of FA supplementation 1.5 months before conception with a duration of 4 months is the preferred option for congenital malformation prevention.
Chictr.org.cn identifier: ChiCTR-SOC-17010976.
A multicentre prospective study of 17,713 women was conducted. The incidence of congenital malformations in women taking a recommended dosage (e.g. 0.4 or 0.8 mg/day) of FA was compared with that in women without supplementation. The predicted probability of malformations by the initiation time and duration of FA use was estimated to determine optimal options.
Periconceptional FA supplementation was associated with a lower and insignificant risk of congenital malformations (1.59% vs. 2.37%; odds ratio [OR] 0.69; 95% confidence interval [CI]: 0.44-1.08), heart defects (3.8 vs. 8.0 per 1000 infants; OR, 0.47; 0.21-1.02), and neural tube defects (7.0 vs. 11.5 per 10,000 infants; OR, 0.64; 0.08-5.15). FA use after pregnancy provided greater protection against total malformations. Statistically significant associations were found in women who initiated FA supplementation in the first month of gestation (OR, 0.55; 95% CI: 0.33-0.91) and in those who supplemented for 1 to 2 months (OR, 0.59; 95% CI: 0.36-0.98). Similar results were found for heart defects. The optimal initiation time was 1.5 (optimal range: 1.1 to 1.9) months before pregnancy and a duration of 4.0 (3.7 to 4.4) months was reasonable to achieve the lowest risk of congenital malformations. Heart defect prevention required an earlier initiation (2.2 vs. 1.1 months before pregnancy) and a longer duration (4.7 vs. 3.7 months) than the prevention of other malformations.
The timely initiation of FA supplementation for gestation was associated with a decreased risk of congenital malformations, which was mainly attributed to its protection against heart defects. The initiation of FA supplementation 1.5 months before conception with a duration of 4 months is the preferred option for congenital malformation prevention.
Chictr.org.cn identifier: ChiCTR-SOC-17010976.
摘要：
背景：补充叶酸（FA）与神经管和心脏缺陷的风险较低有关，推荐用于育龄妇女。虽然有详细的建议，补充FA的起始时间和持续时间的差异仍然缺乏研究.
方法：对17,713名女性进行了一项多中心前瞻性研究。将服用推荐剂量（例如0.4或0.8mg/天）的FA的女性的先天性畸形发生率与不补充的女性的先天性畸形发生率进行比较。通过FA使用的开始时间和持续时间来估计畸形的预测概率，以确定最佳选择。
结果：周围知觉FA补充与先天性畸形的风险较低且微不足道（1.59％vs.2.37%；优势比[OR]0.69；95%置信区间[CI]：0.44-1.08)，心脏缺陷（3.8vs.每1000名婴儿8.0名；或，0.47；0.21-1.02)，和神经管缺陷(7.0vs.每10000名婴儿11.5；或，0.64；0.08-5.15）。怀孕后使用FA可以更好地防止总畸形。在妊娠第一个月开始补充FA的女性中发现了统计学上的显着关联（OR，0.55;95%CI：0.33-0.91)和补充1至2个月的人(OR，0.59；95%CI：0.36-0.98）。对于心脏缺陷也发现了类似的结果。最佳启动时间为怀孕前1.5个月（最佳范围：1.1至1.9），持续时间为4.0（3.7至4.4）个月是合理的，以实现先天性畸形的最低风险。心脏缺陷预防需要更早开始（2.2vs.怀孕前1.1个月）和更长的持续时间（4.7vs.3.7个月）比预防其他畸形。
结论：及时开始妊娠补充FA与先天性畸形的风险降低有关。这主要归功于它对心脏缺陷的保护。在受孕前1.5个月开始补充FA，持续时间为4个月，是预防先天性畸形的首选选择。
背景：Chictr.org.cn标识符:ChiCTR-SOC-17010976。
方法：对17,713名女性进行了一项多中心前瞻性研究。将服用推荐剂量（例如0.4或0.8mg/天）的FA的女性的先天性畸形发生率与不补充的女性的先天性畸形发生率进行比较。通过FA使用的开始时间和持续时间来估计畸形的预测概率，以确定最佳选择。
结果：周围知觉FA补充与先天性畸形的风险较低且微不足道（1.59％vs.2.37%；优势比[OR]0.69；95%置信区间[CI]：0.44-1.08)，心脏缺陷（3.8vs.每1000名婴儿8.0名；或，0.47；0.21-1.02)，和神经管缺陷(7.0vs.每10000名婴儿11.5；或，0.64；0.08-5.15）。怀孕后使用FA可以更好地防止总畸形。在妊娠第一个月开始补充FA的女性中发现了统计学上的显着关联（OR，0.55;95%CI：0.33-0.91)和补充1至2个月的人(OR，0.59；95%CI：0.36-0.98）。对于心脏缺陷也发现了类似的结果。最佳启动时间为怀孕前1.5个月（最佳范围：1.1至1.9），持续时间为4.0（3.7至4.4）个月是合理的，以实现先天性畸形的最低风险。心脏缺陷预防需要更早开始（2.2vs.怀孕前1.1个月）和更长的持续时间（4.7vs.3.7个月）比预防其他畸形。
结论：及时开始妊娠补充FA与先天性畸形的风险降低有关。这主要归功于它对心脏缺陷的保护。在受孕前1.5个月开始补充FA，持续时间为4个月，是预防先天性畸形的首选选择。
背景：Chictr.org.cn标识符:ChiCTR-SOC-17010976。
