摘要
目的以单纯补充叶酸为对照，评价孕期补充多种微营养素或铁／叶酸对出生体重、分娩孕周和孕晚期血红蛋白的影响。设计采用整群随机双盲对照试验设计。地点中国陕西省的两个贫困县（长武县和彬县）。研究对象5828名孕妇及其分娩的4697名活产新生儿。干预措施以村为单位整群随机化，同一个村的孕妇孕期每天补充叶酸（对照组）、铁／叶酸或多微营养素。多微营养素含15种推荐量的维生素和矿物质。主要结局指标测量出生体重、身长、头围在产后72小时内测量。通过产后42天访视收集新生儿生存情况。结果与单纯补充叶酸比较，多微营养素可显著提高出生体重42g（95％CI7—78g）；孕期补充多微营养素和铁／叶酸均可显著增加分娩孕周（铁／叶酸：0．23周，95％CI0．10～0．36周；多微营养素：0．19周，95％CI0．06～0．32周）。铁／叶酸可显著减少34周以内的早产（RR0．50，95％CI0．27～0．94，P=0．031）。相对于纯叶酸组，多微营养素和铁／叶酸均可显著增加孕妇孕晚期的血红蛋白水平（铁／叶酸：5．0g／L，95％CI2．0～8．0g／L，P=0．001；多微营养素：6．9g／L，95％CI4．1～9．6g／L，P〈0．001）。孕期营养素补充对围产儿死亡没有明显影响，但铁／叶酸可减少54％（RR0．46，95％CI0．21～0．98）的7天内新生儿死亡。结论与对照组（叶酸）比较，在中国贫困农村孕期补充铁／叶酸可延长分娩孕周从而减少早期新生儿死亡；多微营养素可适当增加出生体重，尽管如此，对早期新生儿死亡并无明显影响。在孕期微营养素干预中，剂量充足的铁对于降低发展中国家的新生儿死亡是最关键的。
Objective To examine the impact of antenatal supplementation with multiple micronutrients or iron and folic acid compared with folic acid alone on birth weight, duration of gestation, and maternal haemoglobin concentration in the third trimester. Design Cluster randomised double blind controlled trial. Setting Two rural counties in north west China. Partidpants 5828 pregnant women and 4697 live births. Interventions Villages were randomised for all pregnant women to take either daily folic acid （control）, iron with folic acid, or multiple micronutrients with a recommended allowance of 15 vitamins and minerals. Main outcome measures Birth weight, length, and head circumference measured within 72 hours after delivery. Neonatal survival assessed at the six week follow-up visit. Results Birth weight was 42 g （95% confidence interval 7 to 78 g） higher in the multiple micronutfients group compared with the folic acid group. Duration of gestation was 0.23 weeks （0.10 to 0.36 weeks） longer in the iron-folic acid group and 0. 19 weeks （0.06 to 0. 32 weeks ） longer in the multiple micronutrients group. Iron-folic acid was associated with a significantly reduced risk of early preterm delivery （ 〈 34 weeks） （relative risk 0. 50, 0. 27 to 0. 94, P = 0.031 ）. There was a significant increase in haemoglobin concentration in both iron-folic acid （5.0 g/L, 2.0 to 8.0 g/L, P =0.001） and multiple micronutrients （6.9 g/L, 4.1 to 9.6 g/L, P 〈0.001） groups compared with folic acid alone. In post hoc analyses there were no significant differences for perinatal mortality, but iron-folic acid was associated with a significantly reduced early neonatal mortality by 54% （relative risk 0.46, 0.21 to 0.98）. Conclusion In rural populations in China antenatal supplementation with iron-folic acid was associated with longer gestation and a reduction in early neonatal mortality compared with folic acid. Multiple micronutrients were associated with modestly increased birth weight compared with folic acid, but, despite this weight gain, there was no significant reduction in early neonatal mortality. Pregnant women in developing countries need sufficient doses of iron in nutrient supplements to maximise reductions in neonatal mortality.
出处
《英国医学杂志中文版》
2009年第1期23-27,共5页
The BMJ Chinese Edition
基金
本研究由联合国儿童基金会（项目编号YH101-H12/03）和国家自然科学基金（项目编号30271131）共同资助.项目所需孕妇营养素的原料由帝诗曼公司提供,孕妇营养素片剂由北京世纪维它公司制作.志谢：参与本研究的所有妇女和她们的家庭
项目组下列成员：康轶君、方博和梁卫峰（现场督导）项目县卫生局和妇幼保健院
Ray Yip、Mary Cogswell和梅祖国就本研究的设计和现场实施方案提供的宝贵意见
李强、王全丽、肖生彬、邢远、周小彦、王蓓和谢红帮助我们进行数据管理
David Hipgrave、Sandy Huffman、Rachel Huxley和Robyn Norton等国外专家对本稿件提出了非常有价值的建议
