孕妇增补微量营养素状况及其与妊娠结局关联的队列研究

目的:了解安徽地区孕妇增补微量营养素的现况,探讨增补微量营养素与妊娠结局的关系。方法:以2008年10月～2010年10月在安徽省合肥、马鞍山、芜湖3个市的妇幼保健机构首次进行孕期保健体检的孕妇为对象,调查孕早期增补微量营养素的情况,通过孕妇保健手册了解妊娠结局情况。结果:至2011年5月分娩单胎活产儿的孕妇共10 269人。孕早期服用复合维生素、复合微量元素、钙剂、铁剂、叶酸坚持1个月以上的孕妇分别为660人(6.4%)、520人(5.1%)、384人(3.7%)、208人(2.0%)、5 358人(52.2%),孕前半年服用叶酸坚持1个月以上的孕妇2 021人(19.7%)。在控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产史及胎儿性别后,孕早期持续服用复合微量元素(RR=0.25,95CI%=0.09～0.69)和叶酸(RR=0.72,95CI%=0.55～0.96)都会减少发生小于胎龄儿的风险。多元线性回归模型显示,控制母亲年龄、文化程度、家庭人均月收入、孕前BMI、自然流产史、人工流产及胎儿性别后,孕早期补充复合维生素、复合微量元素、叶酸均能增加胎儿出生体重,孕早期服用叶酸可增加胎儿出生胸围,差异具有统计学意义(P<0.05),而孕前半年增补叶酸与妊娠结局指标无显著关联(P>0.05)。结论:孕妇孕早期补充微量营养素可促进胎儿宫内生长,减少小于胎龄儿的发生。

Cohort study of the status of trace elements supplement and its relationship with pregnancy outcome

Objective:To understand the current situation of trace elements supplement of pregnant women in Anhui,explore the relationship between trace elements supplement and pregnancy outcome.Methods:The pregnant women who received gestational physical examination for the first time in maternal and child health institutes in Hefei city,Maanshan city,and Wuhu city of Anhui province from October 2008 to October 2010 were selected as study objects,the status of trace elements supplement during the first trimester of pregnancy was investigated,then the pregnancy outcome was understood by maternal health manual.Results:A total of 10 269 pregnant women gave birth to single and live babies until May 2011.The proportions of pregnant women taking multivitamin,compound trace elements,calcium,iron,and folic acid for more than one month during the first trimester of pregnancy were 6.4%(660 pregnant women),5.1%(520 pregnant women),3.7%(384 pregnant women),2.0%(208 pregnant women),and 52.2%(5 358 pregnant women),respectively;2 021 pregnant women(19.7%) taken folic acid for more than one month at half a year before pregnancy.After controlling maternal age,educational level,family average monthly income,pregestational body mass index(BMI),the history of spontaneous abortion,and fetal gender,continuous oral administration of compound trace elements(RR=0.25,95CI%=0.09-0.69) and folic acid(RR=0.72,95CI%=0.55-0.96) during the first trimester of pregnancy can reduce the risk of small for gestational age(SGA) infants.Multivariate linear regression model showed that after controlling maternal age,educational level,family average monthly income,pregestational BMI,the history of spontaneous abortion,and fetal gender,continuous oral administration of compound vitamin,compound trace elements,and folic acid during the first trimester of pregnancy could increase fetal birth weight,oral administration of folic acid during the first trimester of pregnancy could increase fetal birth chest circumference,there was statistically significant difference(P<0.05),but there was no significant correlation between folic acid supplement for more than one month at half a year before pregnancy and the indexes of pregnancy outcome(P>0.05).Conclusion:Supplement of trace elements during the first trimester of pregnancy for the pregnant women can promote intrauterine growth of fetuses and reduce the occurrence of SGA infants.