背景:以前的综述探讨了母亲使用叶酸和多种维生素补充剂与儿童神经管缺陷(NTD)风险之间的关系,没有明确的结论。
方法:使用PRISMA指南,PubMed,Embase,Scopus,WebofSciences,Cochrane系统评价数据库,搜索了Scopus和GoogleScholar,他们报告了补充叶酸和/或多种维生素对预防后代NTD的作用。纳入研究的质量采用多重系统评价(AMSTAR)进行评估。应用加权逆方差随机效应模型来找到合并估计。亚组分析,异质性,还评估了发表偏倚和敏感性分析.
结果:纳入了10例SRM和296,816名研究参与者。随机效应模型分析表明,在全球范围内,叶酸或多种维生素补充剂预防NTD的综合效果为0.43(0.29,0.58).在亚组分析中,叶酸组的合并效应为0.23,而服用多种维生素组的这一估计值为0.63和0.61。在针对预防事件组的SRM中,发现预防NTD的汇总效果为0.50,虽然这一估计值为0.20),但在旨在预防复发的SRM中,在这些SRM中,0.61旨在评估叶酸或多种维生素对预防发生和复发的影响。在观察性研究的SRM中,发现补充叶酸或多种维生素对预防NTD的综合作用为0.45,而在随机对照试验的SRM中,这一估计值为0.43。
结论:产前补充叶酸和/或复合维生素与NTD降低57%相关。服用叶酸补充剂的参与者与NTD降低的百分比略高(77%)相关。观察到NTD的复发和发生预防减少了80%和50%。在RCT的SRM和观察性研究中发现NTD减少了57%和55%。考虑到在孕前期间将这些补充剂纳入NTD预防策略是建议的。需要更大规模的前瞻性队列和随机对照试验。
BACKGROUND: Previous reviews explored the association between maternal use of folic acid and multivitamin supplements and risk of neural tube defect (NTD) in children, with no definitive conclusion. These reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review is to combine the inconsistent data on the effect of prenatal folic acid and/or multivitamin supplementation for the prevention of NTD in offspring.
METHODS: Using the PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar reported that the effects of folic acid and/or multivitamin supplementation for the prevention of NTD in offspring were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.
RESULTS: Ten SRM with 296,816 study participants were included. The random-effects model analysis from 10 included systematic review and meta-analysis revealed that the pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD globally is found to be 0.43 (95% CI: 0.29, 0.58) (I2 = 93.50%; p ≤0.001). In the subgroup analysis, the pooled effect was found to be 0.23 (0.09, 0.37) in folic acid group, while this estimate is 0.63 (0.53, 0.72) and 0.61 (0.46, 0.75) in groups who took multivitamin. The pooled effect of prevention of NTD was found to be 0.50 (0.34, 0.66) in SRMs aimed at occurrence prevention (primary prevention) group, while this estimate is 0.20 (-0.01, 0.41) among SRMs, which aimed at reoccurrence (secondary) prevention, and 0.61 (0.46, 0.75) among those SRMs aimed to assess the effect folic acid or multivitamin for the prevention of both occurrence and reoccurrence. The pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD was found to be 0.45 (0.03, 0.87) in SRMs of observational studies, while this estimate is 0.43 (0.32, 0.54) among SRMs of randomized controlled trials.
CONCLUSIONS: This umbrella review of systematic review and meta-analysis found that prenatal folic acid and/or multivitamin supplementation was associated with a 57% reduction in NTD. Participants who took folic acid supplementation were associated with a slightly higher (77%) percentage of reduction in NTD compared with those who took multivitamin (37%). Reductions of 80% and 50% were observed for reoccurrence and occurrence prevention of NTD. Reductions of 57% and 55% of NTD have been found in SRM of RCTs and observational studies. This umbrella review revealed that both folic acid and multivitamin were associated with significantly lower levels of NTD in children. Considering the incorporation of those supplements in NTD prevention strategies during the preconception period is recommended. More large-scale prospective cohort and RCTs are needed to understand the protective effect of multivitamins and/or folic acid on NTD risk addressing the molecular mechanisms and to determine the optimal dose, duration, and timing of maternal multivitamin and folic acid intake for best child NTD risk reduction.