农村育龄妇女增补叶酸项目实施制约因素与对策

育龄妇女增补叶酸项目的有效实施是预防神经管缺陷（neural tube defects,NTDs）的重要保证。文章综述了育龄妇女增补叶酸项目实施的现状、项目实施的制约因素,以及解决农村育龄妇女增补叶酸制约因素的对策。结果可为育龄妇女增补叶酸项目的有效实施提供参考依据。     

育龄妇女血清叶酸及红细胞叶酸水平检测分析

目的了解育龄妇女血清叶酸及红细胞叶酸水平,为昆明地区育龄妇女增补叶酸预防神经管畸形(NTDs)等出生缺陷提供参考。方法选取2010年1月至2011年10月于本研究所门诊就诊的261例育龄妇女为研究对象。采集其年龄、孕次等相关临床资料(本研究遵循的程序符合云南省人口和计划生育科学技术研究所人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试者知情同意,并与之签署临床研究知情同意书)。采集受试者空腹静脉血4mL,采用电化学发光法分别测定血清叶酸及红细胞叶酸水平。以预防NTDs的叶酸推荐值为标准,进行叶酸水平分析。结果 261例育龄妇女的血清叶酸、红细胞叶酸的平均水平分别为(9.74±3.23)ng/L和(529.79±205.44)ng/L,以试剂盒正常参考值为标准判断标准。本组受试者血清叶酸和红细胞叶酸缺乏率分别为8.43%(22/261)和5.36%(14/261)。若以预防NTDs推荐值为标准进行判断,则本组妇女血清叶酸、红细胞叶酸水平偏低率分别为67.82%(177/261)和73.95%(193/261)。结论昆明地区育龄妇女叶酸缺乏率不高,但仍有超过1/2以上育龄妇女的血液叶酸水平低于预防NTDs的推荐值,故对育龄妇女须加强叶酸增补方面的知识普及。     

163例育龄妇女血液叶酸水平检测结果分析

目的:了解育龄妇女血液叶酸水平,为制定叶酸预防出生缺陷方案提供依据。方法:取163名育龄妇女空腹静脉血4 m l,用电化学发光方法测定血清叶酸和红细胞叶酸水平。结果:血清叶酸和红细胞叶酸的平均水平分别为(9.71±4.16)ng/L和(529.18±194.25)ng/L,缺乏率分别为11.04%和1.23%。分别有53.99%和58.28%的妇女血清叶酸、红细胞叶酸水平小于预防神经管畸形最佳浓度,农村育龄妇女高达74.51%。结论:云南省育龄妇女叶酸缺乏率不高,但有1/2妇女血液叶酸水平小于预防神经管畸形最佳浓度,孕前应结合改变膳食结构健康教育加强叶酸的补充,并重点关注农村育龄妇女。     

兵团育龄妇女叶酸知晓与服用情况分析

目的:了解新疆生产建设兵团近5年有生育史妇女的叶酸知晓及服用情况。方法:数据来源于第三次兵团卫生服务调查结果,采取四阶段分层、整群随机抽样方法,共调查2005年7月1日～2010年6月30日有生育史的妇女627人;对叶酸知晓和服用的影响因素进行单因素和非条件Logistic逐步回归分析。结果:兵团近5年有生育史的妇女叶酸知晓率为56.8%,服用率为41.0%;妊娠期间服用叶酸257人,占41.0%,平均年龄(30.9±4.6)岁;知道叶酸可以预防神经管畸形301人,占48.0%;在知晓叶酸的妇女中,妊娠前及期间服用叶酸257人,占72.2%。汉族、文化程度高、孕早期做过产检、从事非农业劳动的妇女叶酸知晓率高,汉族、文化程度高、孕早期做过产检、年龄25～34岁的妇女叶酸服用率高。结论:应加强宣传教育,普及叶酸知识,提高育龄妇女增补叶酸行为的主动性。     

补充叶酸对育龄妇女营养与健康状况的影响

叶酸缺乏可导致胚胎神经管畸形(NTDs)等出生缺陷。育龄妇女在怀孕时由于需要量增加以及生理机能出现很大变化等原因,容易发生叶酸缺乏。对育龄妇女孕前或孕早期补充叶酸,可有效降低NTDs的发生率,提高出生人口健康水平。许多专业组织和政府机构采取各种措施来增加育龄妇女的叶酸摄入,主要方式有富含叶酸食物的摄入、使用叶酸补充剂和叶酸强化食品等。     

中国神经管缺陷高发地区育龄妇女叶酸增补的KAP现况调查

目的:了解我国中西部6省育龄妇女叶酸增补知识,行为和态度的基本情况,为进一步提高干预效果提供科学依据。方法:随机抽取全国神经管缺陷发生率较高的山西、新疆、内蒙、青海、甘肃和陕西6省的293个贫困县的33025名19～44岁育龄妇女作为调查对象,进行不记名自填式问卷调查。结果:43.47%的调查对象知晓叶酸的性质,33.79%知晓叶酸的防治知识,8.41%知晓每天正确服用叶酸的方法,愿意服用免费发放的叶酸的人数占82.60%。结论:我国中西部6省贫困县育龄妇女的叶酸增补知识和行为均有待于进一步提高,应开展有针对性的干预工作。     

海南农村育龄妇女叶酸增补情况分析

<正>研究表明,育龄妇女在妊娠前3个月至孕早期3个月内每天服用0.4mg叶酸可以有效预防50%～80%神经管畸形(NTDs)的发生[1,2]。围孕期服用叶酸预防NTDs的效果不仅取决于是否服用,更重要的是取决于服用的依从性状况。向育龄妇女开展的健康教育,对于提高其对NTDs及叶酸的认知水平,降低NTDs的发生率具有重要意义[3]。海南省于2010年1月起正式实施农村妇女免费增补叶酸预防NTDs。为了解海南省农村育龄妇女对叶酸干预的知晓情况、叶酸增补依从现状及其影响因素,于2011年5月对陵水、定安两地部分农村育龄妇女进     

基层医务人员为育龄妇女增补叶酸预防神经管缺陷KAP分析

神经管缺陷(neural tube defects,NTDs)系在胚胎发育早期,特别在神经管闭合期,因受到不良因子的损害,神经管不能闭合而致一系列先天畸形[1]。目前,已经公认孕妇体内缺乏叶酸与胎儿神经管缺陷的发生有密切的关系;从孕前3个月开始直到怀孕以后的头3个月,每天增补0.4mg叶酸可以降低50%～70%的神经管缺陷发生[2]。也可见叶酸预防先天性心脏病、口面裂、泌尿道梗阻、肢体短缩和脐     

马鞍山市孕期妇女服用叶酸状况及其影响因素分析

目的了解马鞍山市孕期妇女叶酸服用情况以及影响因素,为更好地开展孕前及早孕期保健提供依据。方法对市妇幼保健院进行产前检查的孕妇606人进行叶酸服用情况调查,采用Logistic回归分析影响孕期服用叶酸的相关因素。结果目标人群叶酸服用率为59.9%。听家人和朋友（28.7%）、医务人员（25.1%）说等途径是孕期妇女获得叶酸知识的主要来源。单因素分析发现,影响孕期妇女服用叶酸的主要影响因素为：年龄、教育程度、职业、对叶酸知识的了解程度。经过多因素Logistic回归分析发现,具有大专及以上教育程度、教师职业和对叶酸知识的了解程度与叶酸服用关系密切。结论为提高孕期妇女叶酸服用率,应该根据不同人群的特点加强宣传。     

孕妇服用叶酸行为影响因素研究

目的分析孕妇服用叶酸的影响因素,为提高叶酸干预效果提供基础数据。方法采用医院及入户调查方法,抽取甘肃省两个县内2094名孕后三个月至产后一年的妇女进行面对面匿名问卷调查。结果 2094名调查对象中,叶酸服用率为25.4%。叶酸认知水平、年龄、出生缺陷生育史及孕后去医院检查、文化程度、计划妊娠、流产史、孕前去医院检查等是影响孕妇叶酸服用行为的主要影响因素。结论孕妇生育史及对叶酸的认知水平是影响其叶酸服用的重要原因;对育龄人群广泛开展叶酸认知教育,倡导健康的计划生育观念应成为干预的重点措施;而如何找到提高孕前叶酸服用的有效途径还有待探讨。     

泸州地区育龄妇女叶酸增补依从性及其影响因素

目的调查泸州地区育龄妇女叶酸增补依从性及其影响因素,为制定增补叶酸干预措施提供科学依据。方法于2020年6月至12月期间,采用方便抽样法选取四川省泸州市江阳区、纳溪区及泸县等7个县区共计38个乡镇或社区卫服务中心招募携带1岁及以内儿童接种疫苗的儿童母亲作为调查对象进行《育龄妇女叶酸知晓及叶酸服用情况》问卷调查,采用描述性分析方法对结果进行分析,并采用单、多因素分析方法对叶酸增补依从性影响因素进行分析。结果709名育龄妇女年龄20~47岁,平均年龄(32.09±6.51)岁。有307名(43.30%)进行孕前优生健康检查。84.76%调查对象曾服用过叶酸,32.02%正确知晓叶酸增补目的,而孕前3个月至孕早期3个月规范服用叶酸者仅占19.46%。多因素Logistic回归分析结果显示,大专及以上文化程度(OR=2.158)、家庭月收入>3000元(OR=2.502)、机关事业单位职工(OR=3.543)、企业工作人员(OR=2.776)、生育2次(OR=1.793)和≥3次(OR=2.504)、孕前有进行优生健康检查(OR=4.586)、叶酸知识知晓(OR=8.499)的泸州地区育龄妇女对叶酸规范服用率更高。结论泸州地区育龄妇女的叶酸知晓和孕前叶酸规范服用率均较低,应针对重点人群增强叶酸预防神经管缺陷的认知,加强叶酸增补健康知识的宣传教育,从而提高孕前叶酸增补依从性。     

河南育龄妇女孕前血清叶酸水平及影响因素研究

目的 调查河南省育龄妇女孕前血清叶酸水平并分析其相关影响因素,为开展育龄妇女叶酸服用的保健服务提供依据.方法 采取整群抽样的方法选取河南959名育龄妇女进行问卷调查,采用贝克曼微粒子化学发光法进行血清叶酸值测定,用卡方检验、方差分析比较不同亚组人群的叶酸水平,采用非条件logistic回归方法进行血清叶酸水平影响因素的单因素分析,并对有统计学意义的变量进行多因素分析.结果 受调查育龄妇女血清叶酸平均水平为(10.36±6.14 ng/mL),年龄较大、文化程度较高、职业为教师公务员、怀孕次数较多的育龄妇女叶酸水平较高(χ2=12.51,P<0.05;χ2=14.63,P<0.05;χ2=27.05,P<0.05;χ2=71.96,P<0.05).单因素分析结果显示:年龄、文化程度、职业、BMI、怀孕次数、经济压力和维生素补充时间与育龄妇女叶酸水平有关.多因素分析结果表明:与正常人群相比,肥胖及有中重度经济压力人群叶酸低于正常水平的风险更高(OR=2.51, 95%CI:1.28~4.92;OR=2.30, 95%CI:1.10~4.80);与大专及以上文化程度相比,初中及以下、高中文化程度人群叶酸低于正常水平的风险更高(OR=1.83, 95%CI: 1.14~2.92;OR=1.64, 95%CI: 1.03~2.61);维生素持续补充时间超过1个月能显著降低育龄妇女发生叶酸缺乏的风险(OR=0.18,95%CI: 0.04~0.77).结论 需对年轻女性、农民职业妇女、肥胖人群和经济压力大的人群有针对性的提出叶酸增补方案并开展营养健康教育.     

Risk factors for nightblindness among women of childbearing age in Cambodia

OBJECTIVE: To characterize risk factors for nightblindness among nonpregnant women of childbearing age, a group recently recognized to be at high risk of vitamin A deficiency in some developing countries. DESIGN: Case-control study. SETTING: The study included >15 000 households in National Micronutrient Survey of Cambodia conducted in 2000. SUBJECTS: The prevalence of nightblindness among 13 358 nonpregnant women was 2.0%. A total of 328 nonpregnant women with nightblindness were matched by province with 1009 nonpregnant women without nightblindness. METHODS: Univariate and multivariate logistic regression models were used to estimate odds ratios (ORs) as estimates of the relative risk of factors associated with nightblindness. RESULTS: In a final model, materials in the wall of the house (OR 1.4, 95% confidence interval (CI) 0.9-2.0), land ownership < or =0.5 hectares (OR 1.4, 95% CI 1.0-1.9), nightblindness in last pregnancy (OR 44.5, 95% CI 29.2-67.8), parity >3 (OR 1.5, 95% CI 1.0-2.1), diarrhea within the last 2 weeks (OR 1.9, 95% CI 1.3-2.8), maternal body mass index <18.5 (OR 1.8, 95% CI 1.2-2.7), and lack of consumption of vitamin A-rich animal foods in the last 24 h (1-60 retinol equivalents (RE) OR 1.1, 95% CI 0.7-1.6; > or =60 RE, OR 0.7, 95% CI 0.4-1.0) were associated with nightblindness among nonpregnant women. CONCLUSIONS: Women of childbearing age in Cambodia with low socioeconomic status, low consumption of vitamin A-rich animal foods, a history of nightblindness during the previous pregnancy, parity >3, malnutrition, and diarrhea have a higher risk of nightblindness. SPONSORSHIP: United States Agency for International Development (442-G-00-95-00515-00).     

Estimating the impact of mandatory folic acid fortification on the folic acid intake of Australian women of childbearing age

Objective : The primary aim of this study was to estimate the impact of mandatory folic acid (FA) fortification of bread‐making flour on the FA intake of Australian women of childbearing age (16–44 years). The secondary objective was to investigate the relationship between estimated FA intake and socio‐economic status (SES) and age. Method : Dietary modelling was used to estimate FA intake under four mandatory fortification scenarios – no supplement use, supplement use unrelated to FA intake, supplement use only among the highest consumers of bread, and increased supplement use. Data were obtained from the 1995 National Nutrition Survey for food intake patterns, the 2007 Victorian Population Health Survey for FA supplement use, and a marketplace survey. Results : It is estimated that the National Health and Medical Research Council (NHMRC) recommendation for an additional 400 mg/day FA will be achieved by a minimum of 3.9, 25.4, 21.7 and 30% of the target population under scenarios 1–4, respectively. The FA upper level of intake is exceeded by a maximum of 0.1, 1.7, 6.1 and 4.1% of the target population for scenarios 1–4, respectively. Conclusions : Mandatory FA fortification is not sufficient for the NHMRC recommendations for minimum and maximum intakes to be met by all of the target population under a number of plausible behaviour scenarios. Implications : Targeted nutrition education campaigns are needed for SES and age sub‐groups and research of this nature should be extended to other population groups. Monitoring and evaluation of this policy will be important to ensure appropriate FA intake.     

岳阳市育龄女性增补叶酸预防神经管缺陷的效果分析

目的分析岳阳市育龄女性增补叶酸预防神经管缺陷的效果,为以后的临床工作提供参考依据。方法选取2017年4月1日-2018年3月31日在岳阳市助产机构住院流产及分娩的64 276例育龄女性作为研究对象,根据治疗方式分为观察组(54 086例,规律服用叶酸)和对照组(10 190例,未规律服用叶酸)。比较两组神经管畸形发生率。结果观察组和对照组出生缺陷、围生儿出生缺陷、神经管畸形发生率比较差异均有统计学意义(均P<0. 05)。结论岳阳市增补叶酸预防神经管畸形发生的效果显著,但仍有提升空间,在未来工作中可通过优化健康宣教、干预出生缺陷发生的相关因素而降低神经管畸形发生率。     

Folic acid awareness and supplementation among Texas women of childbearing age

OBJECTIVE: Neural tube defects (NTDs) affect about seven of every 10,000 deliveries in Texas. To reduce the risk for NTDs, women are encouraged to supplement with 400 mcg folic acid daily during their reproductive years. This study examines folic acid awareness, knowledge, and supplementation practices among women of childbearing age (WCBA), including residents of Texas-Mexico border as well as women of Hispanic origin/ethnicity, populations that have NTD rates up to three times higher than the national average. METHODS: We conducted a statewide multistage sample telephone survey among Texas women of childbearing age in 2001. In total 1,196 women age 18 to 44 were interviewed. RESULTS: About 78% of WCBA knew about folic acid, 28% knew that folic acid prevents birth defects, and 25% knew to take folic acid before pregnancy. The prevalence of daily folic acid supplementation among all women of childbearing age was 33%. Education was the strongest predictor of folic acid awareness followed by race/ethnicity and age. Significant predictors of daily folic acid supplementation were education and ethnicity. CONCLUSIONS: Our findings suggest the need for more emphases on strategies to improve the level of folic acid supplementation among low educated women, and race ethnic minority populations.     

Use of vitamins containing folic acid among women of childbearing age--United States, 2004

Neural tube defects (NTDs) are serious birth defects of the spine (spina bifida) and brain (anencephaly), affecting approximately 3,000 pregnancies each year in the United States. Periconceptional consumption of the B vitamin folic acid reduces the occurrence of NTDs by 50%-70%. To prevent these defects, the U.S. Public Health Service (1992) and Institute of Medicine (1998) issued separate recommendations that all women capable of becoming pregnant consume 400 micro g of folic acid daily, and the Food and Drug Administration mandated fortification of cereal grain products with folic acid to increase women's daily intake. Fortification of the U.S. food supply with folic acid has resulted in a 26% reduction in NTDs. However, even with fortification, not all women receive adequate levels of folic acid from their diets. Therefore, increasing the use of vitamins containing folic acid remains an important component of NTD prevention. To monitor the use of vitamins containing folic acid among women of childbearing age, the Gallup Organization has conducted a series of surveys for the March of Dimes Birth Defects Foundation since 1995. This report presents results from the 2004 survey, which indicated that although no substantial increase in the proportion of women who use vitamins containing folic acid daily occurred during 1995-2003, a substantial increase was observed in 2004, with 40% of women aged 18-45 years reporting daily consumption of a vitamin containing folic acid. This report also presents information about women's dieting behaviors. Regardless of dieting status, public health programs should stress the importance of women in their childbearing years consuming 400 micro g of folic acid daily through supplements, fortified foods, and a diet containing folate-rich foods.     

Use of supplements containing folic acid among women of childbearing age--United States, 2007

Neural tube defects (NTDs) are serious birth defects of the brain (anencephaly) and spine (spina bifida) that affect approximately 3,000 pregnancies each year in the United States. In 1992, the U.S. Public Health Service recommended that all women of childbearing age in the United States capable of becoming pregnant consume 400 microg of folic acid daily to reduce their risk for having a pregnancy affected by NTDs. To assess awareness, knowledge, and behavior related to folic acid among women of childbearing age (aged 18-45 years), CDC analyzed the results of a national survey conducted annually by the Gallup Organization during the period 2003-2007. This report summarizes the results of that analysis, which indicated that, among all women of childbearing age, those aged 18-24 years had the least awareness regarding folic acid consumption (61%), the least knowledge regarding when folic acid should be taken (6%), and the lowest reported daily use of supplements containing folic acid (30%). Because women in this age group account for nearly one third of all births in the United States, promotion of folic acid consumption should be targeted to this population.     

云南省农村育龄妇女增补叶酸影响因素调查

目的:探讨云南省农村育龄妇女围孕期及妊娠期增补叶酸的现状及影响因素。方法:采用整群随机抽样法抽取泸西县符合条件的共2538位农村孕产妇进行问卷调查。应用单因素分析和多因素非条件logistic逐步回归法寻找围孕期及妊娠期增补叶酸的影响因素。结果:51.7%的调查对象在围孕期或妊娠期补充过叶酸。多因素分析显示影响农村育龄妇女增补叶酸的因素有妻子的受教育年限(OR=0.53)、家庭去年的总收入(OR=2.222)、孕前健康检查状况(OR=3.397)、家中有无优生宣传资料(OR=1.957)、优生知识是否及格(OR=2.380)、是否知道叶酸的作用(OR=88.015)。结论:健康教育应当成为云南广大农村增补叶酸服务的先导,孕前保健服务应当是叶酸推广和其他生殖保健技术服务的结合。在叶酸的推广中,计划生育宣传员发挥着重要作用。     

重庆市育龄妇女孕前优生健康检查认知程度与知识获取途径研究

目的探讨重庆市育龄妇女对孕前优生健康检查的认知程度和服务获取途径,分析影响其主动获取孕前保健服务的原因,为有针对性的完善和制定有效的孕前保健推广策略提供科学依据。方法采取分层整群随机抽样的方法,对重庆市5大功能区10个区县育龄妇女进行问卷调查,调查其对孕前保健知识、免费孕前优生健康检查项目了解情况及知晓的途径等。采用χ~2检验和Kruskal-Wallis Test秩和检验进行数据分析。结果收回有效问卷2 100份。研究对象对孕前保健和建立健康生活方式知晓率69. 00%;对国家免费孕前优生健康检查知晓率81. 62%;对优生相关的传染病、病毒、遗传病的知晓程度依次降低,结果差异有统计学意义(χ~2=317. 746 5,P0. 000 1);不同职业间获取孕前优生知识的途径差异有统计学意义(χ~2=44. 329 7,P=0. 044 5)。结论找准目标人群对孕前优生健康检查的有效开展起重要作用。不同人群免费孕前优生检查知晓率有差异,应针对不同人群选用特定途径进行宣传。