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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (5): 374-377.DOI: 10.3969/j.issn.1673-5501.2022.05.009

• 论著 • 上一篇    下一篇

备孕夫妇烟草暴露和饮酒对血清叶酸水平的影响

胡健伟1,朱蔚1,喻茜1,郭颖1,韩霞1,陈逍天2,李梦茹2,周茜1,严卫丽2,3,陆妹娟1,黄国英2,3 
  

  1. 1 江苏省昆山市妇幼保健所  昆山，215300；2 复旦大学附属儿科医院  上海，201102；3 中国医学科学院小儿遗传相关心血管疾病早期防控创新单元（2018RU002）  上海，201102
  • 收稿日期:2022-04-23 修回日期:2022-10-17 出版日期:2022-10-25 发布日期:2022-10-25
  • 通讯作者: 黄国英；陆妹娟

The effect of tobacco exposure and alcohol drinking on serum folate levels in child-bearing couples

HU Jianwei1，ZHU Wei1, YU Qian1，GUO Ying1，HAN Xia1, CHEN Xiaotian2, LI Mengru2, ZHOU Qian1, YAN Weili2,3, LU Meijuan1, HUANG Guoying2,3   

  1. 1 Maternal and Child Health Center in Kunshan City, Kunshan 215300, China; 2 Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China; 3 Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai 201102, China
  • Received:2022-04-23 Revised:2022-10-17 Online:2022-10-25 Published:2022-10-25
  • Contact: HUANG Guoying；LU Meijuan

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摘要： 背景：现阶段备孕人群（夫妻双方）孕前叶酸补充剂的使用率和不良生活方式对叶酸水平影响不清楚。 目的：了解江苏省昆山市备孕人群的叶酸水平，分析烟草暴露和饮酒对血清叶酸水平的影响。 设计：横断面调查。 方法：以江苏省昆山市妇幼保健所（我所）婚前检查和孕前检查门诊为调查现场，以参加孕前检查、处于备孕状态的夫妻双方为研究对象（女方年龄<45岁）。行现场问卷调查并采血，分析备孕人群烟草暴露（近3个月有过吸烟或被动暴露于烟草烟雾环境中）和饮酒（过去30 d至少喝过1杯含有酒精的饮料）对血清叶酸水平的影响。由于尚无备孕人群特异的夫妻双方血清叶酸水平参考值，为确保样本统计效能最大，根据本研究人群血清叶酸检测值的P50百分位数，＜P50和≥P50分别定义为叶酸偏低组和叶酸正常组。协变量包括年龄、性别、BMI、学历和孕前是否使用叶酸补充剂。 主要结局指标：血清叶酸水平。 结果：2019年4月至2021年6月符合本文纳入排除标准的备孕期夫妻3 990对，共计7 980人进入本文分析。男性和女性年龄分别为（28.5±3.8）和（27.4±3.5）岁，烟草暴露比例分别为31.3%和0.9%，饮酒暴露比例分别为27.9%和6.0%，孕前服用叶酸补充剂分别占0.7%和2.7%，血清叶酸水平（中位数，ng·mL-1）分别为12.7 (9.5,17.0)和18.8 (14.0,26.1)。调整了年龄、性别、BMI、学历及孕前叶酸补充等协变量后，烟草暴露在总体人群（OR=1.48，95%CI：1.28~1.72）和男性（OR=1.46，95%CI：1.26~1.71）中与叶酸水平偏低显著相关；饮酒暴露在总体人群（OR=1.24，95%CI：1.09~1.42）、男性（OR=1.21，95%CI：1.05~1.42）和女性（OR=1.34，95%CI：1.02~1.76）中与叶酸水平偏低均显著相关。 结论：烟草暴露、饮酒与血清叶酸水平偏低存在关联且存在性别差异。

关键词: 血清叶酸, 烟草暴露, 饮酒, 备孕期夫妻

Abstract: Background：It is unclear about the effect of the rate of folic acid supplementation and unhealthy life habits in childbearing couples on the level of serum. Objective：To describe the serum folate levels in childbearing couples in Kunshan City and investigate the associations of tobacco exposure and alcohol drinking with serum folate levels. Design：Crosssectional study. Methods：The couples with the age of wife below 45 were enrolled from the premarital or prepregnancy examination clinic in Maternal and Child Health Center in Kunshan City. The questionnaires and blood samples were collected to analyze the relationship of the tobacco exposure defined as smoking or being passively exposed to tobacco smoke in the past 3 months and alcohol drinking defined as drinking alcoholic drink for at least one time in the past 30 days with serum folate levels. As there is no standard reference levels of serum folate for the childbearing couples, we used the P50 of serum folate level in this study to define the low folate group(<P50) and normal group (≥P50) to ensure a maximum statistic power. The covariates included age, sex, BMI, education, and the use of folic acid supplementation. Main outcome measures：Serum folate levels. Results：A total of 3 990 couples were enrolled from April 2019 to June 2021. The mean age were 28.5±3.8 and 27.4±3.5 years for the males and females. The prevalence of tobacco exposure, drinking and folic acid supplementation before pregnancy for males and females were 31.3% and 0.9%, 27.9% and 6.0%, 0.7% and 2.7%, respectively. Median serum folate levels in fathers and mothers were 12.7 ng·mL-1 (14.0, 26.1) and 18.8 ng·mL-1 (9.5, 17.0) correspondingly. After adjustment for covariates, the tobacco smoke exposure was associated with higher odds of low serum folate in whole population (OR=1.48, 95% CI:1.281.72), and this association was further observed in males (OR=1.46, 95%CI: 1.261.71), but not in females. Alcohol drinking was significantly associated with low serum folate levels in the whole population (OR=1.24，95%CI：1.091.42),males (OR=1.21，95%CI：1.051.42),and females (OR=1.34，95%CI：1.021.76). Conclusion：Tobacco exposure and alcohol drinking before pregnancy were associated with low serum folate, which may exist gender difference.

Key words: Serum folate, Tobacco exposure, Alcohol drinking, Child-bearing couples