孕期母亲叶酸补充与幼儿期哮喘
2015/11/20
摘要
背景：哮喘是最为常见的儿童慢性疾病之一。虽然孕期补充叶酸有助于预防神经管缺陷，然而动物模型仍提示孕期补充叶酸可能是呼吸道疾病的危险因素，即使有些流行病学研究有不一样的结论。我们对怀孕期间处方叶酸的时间以及儿童哮喘之间的关系进行了研究。
方法：这项回顾性队列研究纳入了104,428例出生于1996年-2005年且其母亲被田纳西州医疗补助计划登记在案的儿童。我们研究了怀孕期间叶酸的处方与4.5-6岁期间儿童哮喘的联系。我们基于以早期妊娠为中心的处方分布将孕妇分为不同的暴露组：无叶酸暴露组，仅在早孕时期暴露组，早孕后暴露组以及早孕及其之后暴露组。我们使用哮喘特定的医疗就诊和药物使用来定义哮喘。逻辑回归模型被用来在研究相关性时校正潜在的混杂因素。
结果：总体有15%的儿童患有哮喘。与无叶酸处方暴露的孕妇所生的孩子相比，仅在早孕期暴露的孕妇所生的孩子或者早孕期及之后均有暴露的孕妇所生的孩子患哮喘的相对比率是增加的(校正的比值比= 1.2, 95% 置信区间= 1.1, 1.3, 和1.2, 95%置信区间= 1.2, 1.3)；早孕期之后暴露的孕妇所生的孩子没有观察到相关性。
结论：怀孕期间处方叶酸的时间与儿童哮喘的发生相关。我们的发现有利于理解产前营养补充在儿童呼吸道健康中所扮演的角色。
（杨冬 审校）
Epidemiology. 2015 Sep 10. [Epub ahead of print]
Maternal Folic Acid Supplementation During Pregnancy and Early Childhood Asthma.
Veeranki SP1, Gebretsadik T, Mitchel EF, Tylavsky FA, Hartert TV, Cooper WO, Dupont WD, Dorris SL, Hartman TJ, Carroll KN.
Abstract
BACKGROUND:Asthma is one of the most common chronic childhood diseases. While folic acid supplementation around conception helps prevent neural tube defects, an animal model suggests that it may be a risk factor for respiratory diseases, although epidemiologic studies have had conflicting results. We investigated the timing of folic acid-containing prescription filling during pregnancy and child asthma.
METHODS:In a retrospective cohort study of 104,428 children, born 1996-2005, and their mothers enrolled in Tennessee Medicaid, we investigated the association of filling folic acid-containing prescriptions during pregnancy and childhood asthma at ages 4.5-6 years. We categorized women into exposure groups based on prescription filling centered around the first trimester: no folic acid prescription exposure, exposure in first trimester only, exposure after first trimester, and exposure in first trimester and beyond. We defined asthma using asthma-specific healthcare visits and medication fills. Using logistic regression models, we investigated the relationship adjusting for potential confounders.
RESULTS:Overall 15% of children had asthma. Compared with children born to women with no folic acid prescription exposure, children born to women with exposures in the first trimester only or first trimester and later had increased relative odds of asthma (adjusted odds ratios = 1.2, 95% confidence interval = 1.1, 1.3, and 1.2, 95% confidence interval = 1.2, 1.3); no association was seen in children born to women exposed after the first trimester.
CONCLUSION:Timing of folic acid-containing prescription filling during pregnancy was associated with childhood asthma. Our findings contribute to understanding of the role of prenatal nutritional supplements on child respiratory health.
Epidemiology. 2015 Sep 10. [Epub ahead of print]
