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Article(id=1240972420039889057, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202312410, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1703088000000, receivedDateStr=2023-12-21, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800481089, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800481089, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800481089, creator=13701087609, updateTime=1773800481089, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1615, endPage=1619, ext={EN=ArticleExt(id=1240972420413182122, articleId=1240972420039889057, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Effect of folic acid supplementation on the risk of gestational diabetes mellitus in perinatal women, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between folic acid supplementation behavior and the risk of gestational diabetes mellitus (GDM) in peri-pregnant women, so as to provide evidence for health care of perinatal women.

Methods

Based on the monitoring data of pregnancy health care system in Tongzhou district of Beijing from January 2016 to December 2021, multivariate stepwise Logistic regression model and interaction model were used to investigate the effect of folic acid supplementation behavior on the risk of GDM in perinatal women.

Results

A total of 92 708 subjects were included in this study, including 9 926 patients with GDM, with a prevalence rate of 10.71%. The results of Logistic regression analysis showed that folic acid supplementation during perinatal period (OR=0.627, 95%CI: 0.421-0.933), regular folic acid supplementation (OR=0.927,95%CI: 0.887-0.968), simple folic acid supplementation (OR=0.815, 95%CI: 0.778-0.853), and folic acid supplementation before pregnancy (OR=0.921, 95%CI: 0.882-0.963) were associated with the reduced risk of GDM (P<0.05). The results of interaction analysis showed that there was significant interaction between folic acid supplementation type (OR=0.761, 95%CI:0.726-0.798) and folic acid supplementation time (OR=0.721, 95%CI: 0.658-0.791) and whether folic acid supplementation was regular or not (P<0.05).

Conclusion

Folic acid supplementation before pregnancy and folic acid alone can effectively reduce the incidence of GDM. Nutrition and health education before pregnancy should be strengthened and the importance of regular folic acid supplementation before pregnancy should be emphasized in order to reduce the risk of GDM and protect maternal and infant health.

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目的

探讨围孕期妇女叶酸补充行为与妊娠糖尿病（gestational diabetes mellitus, GDM）发生风险的关系，为围孕期妇女保健提供依据。

方法

以2016年1月—2021年12月北京市通州区孕期保健系统的孕期保健监测数据为基础，采用多因素逐步logistic回归模型和交互作用模型探讨围孕期妇女叶酸补充行为对GDM发生风险的影响。

结果

本研究共纳入92 708名研究对象，其中GDM患者9 926名，患病率为10.71%。Logistic回归分析结果显示，围孕期补充叶酸（OR=0.627，95%CI：0.421～0.933）、规律补充叶酸（OR=0.927，95%CI：0.887～0.968）、补充单纯叶酸（OR=0.815，95%CI：0.778～0.853）、孕前补充叶酸（OR=0.921，95%CI：0.882～0.963）与GDM的发生风险降低有关（P<0.05）。交互作用分析结果提示，叶酸补充类型与叶酸补充时间、叶酸补充是否规律的交互作用均有统计学意义（P<0.05），OR（95%CI）分别为0.761（0.726～0.798）和0.721（0.658～0.791）。

结论

孕前、规律补充、单纯叶酸可有效降低GDM的发生。应加强孕前营养健康教育，强调孕前规律补充叶酸的重要性，以降低GDM的发生风险，保障母婴健康。

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余焕玲，E-mail:
高敏，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=dlbw71vyj52OvW1SGk0A/Q==, magXml=q1+lZXsQPVyIYD30X3fIxw==, pdfUrl=null, pdf=ZOwoiwz/MrVBF3W9001Xew==, pdfFileSize=528620, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=W6z1KjSbkZceuhJC9h1fAA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=cIaAtVj+fEmauL65QaVk2w==, mapNumber=null, authorCompany=null, fund=null, authors=

蔺桂银（1990—），女，硕士在读，研究方向：疾病预防控制

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蔺桂银（1990—），女，硕士在读，研究方向：疾病预防控制

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蔺桂银（1990—），女，硕士在读，研究方向：疾病预防控制

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Diabetes& Metabolic Syndrome, 2017, 11: S141-S146., articleTitle=Implication of homocysteine in diabetes and impact of folate and vitamin B12 in diabetic population, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240986261809320819, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, xref=1., ext=[AuthorCompanyExt(id=1240986261826098040, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, companyId=1240986261809320819, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Nutrition and Food Hygiene, School of Public Health of Capital Medical University, Beijing 100069, China), AuthorCompanyExt(id=1240986261842875257, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, companyId=1240986261809320819, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.首都医科大学公共卫生学院营养与食品卫生学系，北京 100069)]), AuthorCompany(id=1240986262002258817, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, xref=2., ext=[AuthorCompanyExt(id=1240986262010647425, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, companyId=1240986262002258817, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.北京市通州区妇幼保健院妇女保健科)])], figs=[ArticleFig(id=1240986267144474769, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, language=EN, label=Figure 1, caption=Flowchart of the study population inclusion, figureFileSmall=bp3qEqHxW6Rrx630lVyrhA==, figureFileBig=unSUpqBpaYbiL28VabbYPw==, tableContent=null), ArticleFig(id=1240986267329024154, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, language=CN, label=图1, caption=研究对象纳入流程图, figureFileSmall=bp3qEqHxW6Rrx630lVyrhA==, figureFileBig=unSUpqBpaYbiL28VabbYPw==, tableContent=null), ArticleFig(id=1240986267463241894, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, language=EN, label=Table 1, caption=

Distribution of periconceptional folate supplementation behaviors in GDM and non-GDM women ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
一般资料GDM
(n=9 926)		非GDM
(n=82 782)		χ2值P值
叶酸补充行为
是否补充
否19430（15.46）164（84.54）4.6020.032
是92 5149 896（10.70）82 618（89.30）
是否规律
否52 6875 756（10.92）46 931（89.08）6.075 90.014
是40 0214 170（10.42）35 851（89.58）
叶酸类型a
单纯叶酸33 0613 115 （9.42）29 946（90.58）88.812<0.001
复合多维片59 6416 811（11.42）52 830（88.58）
补充叶酸时间b
孕前46 4964 847（10.42）41 649（89.58）7.9070.005
孕后46 2065 079（10.99）41 127（89.01）
), ArticleFig(id=1240986267731677358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, language=CN, label=表1, caption=

GDM组与非GDM组围孕期妇女围孕期叶酸补充行为的比较［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
一般资料GDM
(n=9 926)		非GDM
(n=82 782)		χ2值P值
叶酸补充行为
是否补充
否19430（15.46）164（84.54）4.6020.032
是92 5149 896（10.70）82 618（89.30）
是否规律
否52 6875 756（10.92）46 931（89.08）6.075 90.014
是40 0214 170（10.42）35 851（89.58）
叶酸类型a
单纯叶酸33 0613 115 （9.42）29 946（90.58）88.812<0.001
复合多维片59 6416 811（11.42）52 830（88.58）
补充叶酸时间b
孕前46 4964 847（10.42）41 649（89.58）7.9070.005
孕后46 2065 079（10.99）41 127（89.01）
), ArticleFig(id=1240986268050444471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, language=EN, label=Table 2, caption=

Correlation between folate supplementation behaviors and GDM

, figureFileSmall=null, figureFileBig=null, tableContent=
叶酸补充行为β OR值（95%CI）wald χ2P值
叶酸补充（否=0，是=1）
Model 10.2260.0990.636（0.430～0.939）5.1750.023
Model 20.2420.1010.616（0.415～0.914）5.8060.016
Model 30.2330.1010.627（0.421～0.933）5.3060.021
叶酸补充规律（否=0，是=1）
Model 10.0260.0110.950（0.910～0.991）5.6170.018
Model 20.0250.0110.951（0.911～0.993）5.2610.022
Model 30.0380.0110.927（0.887～0.968）11.6080.001
叶酸补充时间（孕后=0，孕前=1）
Model 10.0290.0110.943（0.905～0.984）7.4490.006
Model 20.0260.0110.949（0.910～0.990）5.8000.016
Model 30.0410.0110.921（0.882～0.963）13.52<0.001
叶酸补充类型（复合多维片=0）
（单纯叶酸片=1）
Model 10.1090.0120.804（0.768～0.841）90.483<0.001
Model 20.1070.0120.807（0.771～0.845）85.368<0.001
Model 30.1020.0120.815（0.778～0.853）77.009<0.001
叶酸补充时间*叶酸补充类型0.2730.0240.761（0.726～0.798）129.391<0.001
叶酸补充规律*叶酸补充类型0.3270.0470.721（0.658～0.791）48.406<0.001
), ArticleFig(id=1240986268616675521, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972420039889057, language=CN, label=表2, caption=

叶酸补充行为与GDM之间的关联性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
叶酸补充行为β OR值（95%CI）wald χ2P值
叶酸补充（否=0，是=1）
Model 10.2260.0990.636（0.430～0.939）5.1750.023
Model 20.2420.1010.616（0.415～0.914）5.8060.016
Model 30.2330.1010.627（0.421～0.933）5.3060.021
叶酸补充规律（否=0，是=1）
Model 10.0260.0110.950（0.910～0.991）5.6170.018
Model 20.0250.0110.951（0.911～0.993）5.2610.022
Model 30.0380.0110.927（0.887～0.968）11.6080.001
叶酸补充时间（孕后=0，孕前=1）
Model 10.0290.0110.943（0.905～0.984）7.4490.006
Model 20.0260.0110.949（0.910～0.990）5.8000.016
Model 30.0410.0110.921（0.882～0.963）13.52<0.001
叶酸补充类型（复合多维片=0）
（单纯叶酸片=1）
Model 10.1090.0120.804（0.768～0.841）90.483<0.001
Model 20.1070.0120.807（0.771～0.845）85.368<0.001
Model 30.1020.0120.815（0.778～0.853）77.009<0.001
叶酸补充时间*叶酸补充类型0.2730.0240.761（0.726～0.798）129.391<0.001
叶酸补充规律*叶酸补充类型0.3270.0470.721（0.658～0.791）48.406<0.001
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围孕期妇女叶酸补充行为对妊娠期糖尿病发生风险的影响
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蔺桂银 1 , 陈佳喧 2 , 高敏 1 , 余焕玲 1
现代预防医学 | 儿少卫生与妇幼保健 2024,51(9): 1615-1619
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(9): 1615-1619
围孕期妇女叶酸补充行为对妊娠期糖尿病发生风险的影响
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蔺桂银1, 陈佳喧2, 高敏1 , 余焕玲1
作者信息
  • 1.首都医科大学公共卫生学院营养与食品卫生学系，北京 100069
  • 2.北京市通州区妇幼保健院妇女保健科

    • 蔺桂银（1990—），女，硕士在读，研究方向：疾病预防控制

通讯作者:

余焕玲，E-mail:
高敏，E-mail:
Effect of folic acid supplementation on the risk of gestational diabetes mellitus in perinatal women
Gui-yin LIN1, Jia-xuan CHEN2, Min GAO1 , Huan-ling YU1
Affiliations
  • Department of Nutrition and Food Hygiene, School of Public Health of Capital Medical University, Beijing 100069, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202312410
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摘要
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目的

探讨围孕期妇女叶酸补充行为与妊娠糖尿病（gestational diabetes mellitus, GDM）发生风险的关系，为围孕期妇女保健提供依据。

方法

以2016年1月—2021年12月北京市通州区孕期保健系统的孕期保健监测数据为基础，采用多因素逐步logistic回归模型和交互作用模型探讨围孕期妇女叶酸补充行为对GDM发生风险的影响。

结果

本研究共纳入92 708名研究对象，其中GDM患者9 926名，患病率为10.71%。Logistic回归分析结果显示，围孕期补充叶酸（OR=0.627，95%CI：0.421～0.933）、规律补充叶酸（OR=0.927，95%CI：0.887～0.968）、补充单纯叶酸（OR=0.815，95%CI：0.778～0.853）、孕前补充叶酸（OR=0.921，95%CI：0.882～0.963）与GDM的发生风险降低有关（P<0.05）。交互作用分析结果提示，叶酸补充类型与叶酸补充时间、叶酸补充是否规律的交互作用均有统计学意义（P<0.05），OR（95%CI）分别为0.761（0.726～0.798）和0.721（0.658～0.791）。

结论

孕前、规律补充、单纯叶酸可有效降低GDM的发生。应加强孕前营养健康教育，强调孕前规律补充叶酸的重要性，以降低GDM的发生风险，保障母婴健康。

妊娠期糖尿病  /  围孕期  /  叶酸补充行为  /  回顾性队列研究
Objective

To investigate the relationship between folic acid supplementation behavior and the risk of gestational diabetes mellitus (GDM) in peri-pregnant women, so as to provide evidence for health care of perinatal women.

Methods

Based on the monitoring data of pregnancy health care system in Tongzhou district of Beijing from January 2016 to December 2021, multivariate stepwise Logistic regression model and interaction model were used to investigate the effect of folic acid supplementation behavior on the risk of GDM in perinatal women.

Results

A total of 92 708 subjects were included in this study, including 9 926 patients with GDM, with a prevalence rate of 10.71%. The results of Logistic regression analysis showed that folic acid supplementation during perinatal period (OR=0.627, 95%CI: 0.421-0.933), regular folic acid supplementation (OR=0.927,95%CI: 0.887-0.968), simple folic acid supplementation (OR=0.815, 95%CI: 0.778-0.853), and folic acid supplementation before pregnancy (OR=0.921, 95%CI: 0.882-0.963) were associated with the reduced risk of GDM (P<0.05). The results of interaction analysis showed that there was significant interaction between folic acid supplementation type (OR=0.761, 95%CI:0.726-0.798) and folic acid supplementation time (OR=0.721, 95%CI: 0.658-0.791) and whether folic acid supplementation was regular or not (P<0.05).

Conclusion

Folic acid supplementation before pregnancy and folic acid alone can effectively reduce the incidence of GDM. Nutrition and health education before pregnancy should be strengthened and the importance of regular folic acid supplementation before pregnancy should be emphasized in order to reduce the risk of GDM and protect maternal and infant health.

Gestational diabetes mellitus  /  Perinatal period  /  Folic acid supplementation behavior  /  Retrospective cohort study
蔺桂银, 陈佳喧, 高敏, 余焕玲. 围孕期妇女叶酸补充行为对妊娠期糖尿病发生风险的影响. 现代预防医学, 2024 , 51 (9) : 1615 -1619 . DOI: 10.20043/j.cnki.MPM.202312410
Gui-yin LIN, Jia-xuan CHEN, Min GAO, Huan-ling YU. Effect of folic acid supplementation on the risk of gestational diabetes mellitus in perinatal women[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1615 -1619 . DOI: 10.20043/j.cnki.MPM.202312410
正文
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妊娠期糖尿病（gestational diabetes mellitus,GDM）指妊娠期间首次发现或发生的糖耐量异常。中国GDM患病率为14.8%[1]，GDM不仅影响孕产妇的健康状况，还会增加新生儿低血糖、高胆红素血症、肩难产和死产的风险[2-3]。
叶酸是胎儿生长发育不可或缺的营养素。妊娠期间，由于胎儿机体发育的需要以及母亲血量扩大，母体血清叶酸水平由妊娠第14周（45.7±21.3）nmol/L降至36周（19.5±16.5）nmol/L。妊娠期妇女的叶酸需要量是未怀孕妇女的510倍[4]。因此，妊娠期增补叶酸对提高孕期妇女血清叶酸水平十分重要[5]，也是预防神经管畸形的重要公共卫生措施。叶酸摄入不足引起的高同型半胱氨酸水平可能引起胰岛素抵抗、血脂异常，以及肝脏的损伤等，增加GDM的发生风险[6]。而补充叶酸可以通过降低甲基化能力及氧化应激来改善这些代谢紊乱，可能降低GDM的发生风险[7]。
北京市于2019年开始实施国家重大公共卫生项目以来，尽管目标人群叶酸补充率逐年上升，补充率达90%左右，但是按照要求从孕前开始并规律服用者比例较低[8]。截至目前围孕期妇女叶酸补充类型、是否规律以及增补时间等叶酸补充行为与GDM相关性的研究尚少，且在现有的研究中补充叶酸与GDM发生风险之间的关系尚有争论。为此，本研究以2016—2021年在北京市通州区进行孕期保健并分娩妇女的孕期保健和医疗记录信息为基础，探索围孕期妇女的叶酸补充行为与GDM之间的关系，为母婴保健和GDM的预防提供科学依据。
1　对象与方法
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1.1　研究对象
以2016—2021年北京市通州区孕期保健系统注册登记进行孕期保健监测并分娩的产妇作为研究对象，见图1。
纳入标准：（1）单胎妊娠；（2）年龄在18～50岁之间；（3）建档信息和孕期随访信息完整。
排除标准：（1）叶酸补充数据缺失者；（2）妊娠前患有糖尿病；（3）GDM数据缺失者；（4）排除体重指数（body mass index, BMI）缺乏或BMI<10 kg/m2或BMI>40 kg/m2。
1.2　研究方法
1.2.1　基本信息调查
孕期保健系统注册登记进行孕期保健监测数据包括：
（1）社会人口学特征：年龄、教育水平、分娩史、流产史、吸烟史、饮酒史、工作类型、糖尿病家族史。
（2）妊娠期相关信息：妊娠期高血压、辅助生殖、妊娠期贫血、妊娠期血小板减少症、甲状腺功能异常、身高（cm）、孕前体重（kg）。孕前BMI=孕前体重（kg）/身高的二次方（m）2。
（3）叶酸补充行为：①孕期是否补充叶酸；②是否规律补充叶酸；③叶酸补充时间（孕前/孕后）；④叶酸补充类型（复合多维片/单纯叶酸片）。其中，单纯叶酸片的叶酸含量为400 μg/片，复合多维片的叶酸含量有800 μg/片和400 μg/片两种。
1.2.2　诊断标准
参照《妊娠合并糖尿病诊治指南（2014）》，妊娠24～28周的孕妇进行75g口服葡萄糖耐量试验，诊断界值：空腹、1 h、2 h血糖值分别为5.1、10.0和8.5 mmol/L，任何一项血糖值达到异常阈值即可确诊[9]。
孕前、孕后是指在本次妊娠末次月经前和月经后。
规律（高频）服用是指10 d内服用8 d及以上，不规律（低频）服用是指10 d内服用营养补充剂的天数小于8 d。
1.3　质量控制
所有信息录入者均为经过培训的社区医务人员，社区产科质量办公室对追访结果每月进行信息质控，以确保信息录入的真实性、准确性。
1.4　统计方法
采用SPSS 22.0软件进行数据分析。孕妇年龄和孕前BMI为正态分布，以（均数±标准差）表示；分类变量以例数(%)表示。采用Pearson检验比较不同特征孕妇的GDM发生率。采用多因素非条件logistic回归模型探讨围孕期叶酸补充行为与GDM发生风险之间的关联。交互作用模型以是否患GDM（否=0，是=1）为因变量，分别以2个因素及乘积项（“a+b+a*b”）为自变量构建。Logistic回归模型和交互作用模型纳入自变量均为单因素回归分析中有统计学意义的变量，检验水准α=0.05。
2　结果
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2.1　不同叶酸补充行为的围孕期妇女GDM发生率的比较
纳入研究的2016—2021年于通州区住院分娩的孕产妇92 708名，平均年龄为（30.00±4.14）岁。其中GDM患者9 926名，GDM患病率为10.71%。围孕期从未补充过叶酸的妇女194人（0.21%），未规律补充叶酸的妇女52 687人（56.83%），补充单纯叶酸片33 061人（35.66%），补充多种维生素片59 641人（64.34%）；孕前开始补充叶酸46 496人（50.15%）；孕后开始补充叶酸46 206人（49.85%）。围孕期妇女不同叶酸补充行为与GDM发生情况比较发现，是否补充叶酸、是否规律补充叶酸、不同叶酸类型、不同补充叶酸时间与GDM发生风险差异有统计学意义（P<0.05）。见表1。
2.2　叶酸补充行为与GDM之间的关联性分析
在调整了年龄、BMI、教育水平、分娩史、流产史、吸烟史、饮酒史以及家族糖尿病史因素后，围孕期妇女补充叶酸能够降低GDM的发生风险（OR=0.627，95%CI：0.421～0.933）。剔除未补充叶酸的人群后，围孕期妇女叶酸补充是否规律、叶酸补充时间和叶酸补充类型与GDM发生风险差异有统计学意义（P<0.05），OR（95%CI）分别为0.927（0.887～0.968）、0.921（0.882～0.963）、0.815（0.778～0.853）。交互作用分析结果显示，叶酸补充类型与叶酸补充时间、叶酸补充是否规律的交互作用均有统计学意义，OR（95%CI）分别为0.761（0.726～0.798）、0.721（0.658～0.791）。见表2。
3　讨论
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本研究发现，2016—2021年于通州区住院分娩的孕产妇GDM患病率为10.71%，低于2013年北京平均水平（19.7%）[10]，可能与通州区分娩孕产妇文化程度较高有关。本研究结果显示学历为高中及以上的人群占92.30%。文化程度高的孕妇可能了解更多的健康知识，围孕期会注重食物的均衡摄入，对医生建议依从性更高[11]。
本研究结果显示，相较于围孕期未补充叶酸的妇女，补充叶酸的人群GDM的发生风险降低37.3%，这与Huang L[12]和倪丽君等[13]的研究结果一致。叶酸在糖脂代谢中发挥着重要的作用，叶酸缺乏会引起胰岛β细胞产生氧化应激反应导致内质网应激，进而使胰岛β细胞凋亡，诱发血糖升高[14]。本研究发现相较于怀孕后进行叶酸补充的妇女，孕前开始叶酸补充的妇女GDM的发生风险降低7.9%。前瞻性队列研究结果显示，怀孕前每天补充叶酸的女性与孕前未补充叶酸的女性相比，GDM的发生风险降低了30%[15]。北京于2009年开始实施增补叶酸预防神经管畸形项目，规定备孕妇女在孕前3个月至孕早期3个月每天服用1片（0.4 mg）叶酸[16]。自实施此方案以来，目标人群叶酸服用率逐年上升，但是叶酸服用依从率不容乐观[8]。本研究显示，规律地补充叶酸，GDM发生风险越低。药物动力学研究表明，围孕期妇女应至少持续12周补充叶酸0.4 mg/d才能维持正常的血浆叶酸浓度[17]。因此，在加强育龄妇女的叶酸增补工作时，应采取多种形式的宣传教育，加强育龄妇女对叶酸知识的认知，提高规律增补叶酸的依从性，对维持正常的血浆叶酸浓度，降低GDM的发生风险具有重要意义。本研究结果提示，单纯补充叶酸，能够降低GDM的发生风险，这与于宁宁[18]的研究结论一致。其原因可能是，复合多维片有800 μg/片和400 μg/片两种剂型，而单纯叶酸片仅有400 μg/片一种。有研究结果显示，过量的叶酸补充可能会加剧体内维生素B12的耗竭[19]，维生素B12缺乏可能会影响同型半胱氨酸浓度和脂肪生成，进而导致胰岛素抵抗和GDM的发生[20]。本研究发现叶酸补充类型与叶酸补充时间和叶酸补充是否规律地交互作用。提示孕前规律增补单纯叶酸对预防GDM的发生可能具有协同作用。
本项研究采用的是北京市通州区连续6年的监测数据，样本量较大且为回顾性队列研究，不存在回忆偏倚。且本研究在描述围孕期妇女补充叶酸现状的基础上，从叶酸补充开始时间、叶酸补充类型、叶酸补充是否规律三方面分析直接获得叶酸增补与GDM发生风险的关联，相关研究较少。然本研究未采集围孕期妇女通过膳食摄入叶酸和其他营养素的信息以及GDM史或大于胎龄儿分娩史，糖耐量异常史，难以排除这些因素对GDM的影响。另外本研究未采集到研究对象的血浆叶酸浓度的相关信息，只能通过叶酸补充行为来估计服用叶酸的剂量。
综上所述，孕前规律增补单纯叶酸片可降低GDM的发生风险。在临床实践以及围孕期营养健康宣教中，应加强对围孕期妇女适量补充叶酸的宣教，提高孕前补充和规律补充叶酸的依从率，以降低GDM的发生风险，保障母婴健康。
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202312410
  • 接收时间：2023-12-21
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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  • 收稿日期：2023-12-21
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    1.首都医科大学公共卫生学院营养与食品卫生学系，北京 100069
    2.北京市通州区妇幼保健院妇女保健科

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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