葉酸可能預防早產


  January 31, 2008(達拉斯訊)-根據一項收納超過38,000位女性的研究結果顯示,懷孕前補充葉酸一年可能顯著地降低早產的機率。
  
  這項在生產胎兒醫學會第28屆年會上發表的研究指出,補充葉酸是一種簡單又便宜,可能降低早產風險的方法;其效果在降低早期早產上是最有效的,服用葉酸達一年的女性,發生早期早產的機率降低了70%。
  
  德州大學加爾維斯敦醫學分校的Radek Bukowski醫師向Medscape產科學與婦女健康表示,這是令人興奮且有希望的;然而,他與其他作者提醒,這項研究結果需要再重複確認以及進一步地檢閱。
  
  進行這項觀察性世代研究時,Bukowski醫師與其同事分析來自參加FASTER(the First And Second Trimester Evaluation of Risk)研究女性的數據,這項研究由國家健康研究院贊助;較早期的研究是收納僅懷一個胎兒的女性,且該研究被設計來早期偵測唐氏症的發生,當納入這項研究時,這些女性要報告懷孕之前服用葉酸的情況。
  
  大約有20%的受試者,或是6,777位女性,在懷孕前已經服用葉酸至少一年以上,其中36%女性服用葉酸短於一年、44%女性並未使用葉酸;這項研究納入年齡、身體質量指數、早產病史、或是其他已經會影響早產風險的因子;在所有族群中,共有160件早產事件。
  
  在發表會上,Bukowski醫師表示早期早產的風險,以發生在懷孕20到28週之間分娩定義,使用葉酸超過一年的女性,相較於並未使用葉酸的女性,風險下降了70%;28到32週分娩的風險下降了50%;在32週之後分娩的機率在兩組之間是差不多的,趨勢的P值為.01。
  
  Bukowski醫師指出,這項研究發現是引人注意的,因為服用葉酸是個簡單的方式、且安全性紀錄良好,這可能是非常容易實踐的;這項研究並未詢問攝取的量,他附帶表示,目前的假設是,這些女性服用現行建議的每天400 μg。
  
  這些研究結果與發現血中葉酸濃度及早產風險有關的觀察性試驗是相容的,然而,解釋葉酸為何可以降低早產機率的機轉仍然不明。
  Bukowski醫師假設葉酸可能加強免疫系統,這可能保護懷孕女性對抗感染;他表示,他不相信長期使用葉酸只是一種較好健康習慣的指標,且他的分析結果試著解釋這些影響。
  
  為了進一步探索這些與其他問題,Bukowski醫師正在研究試驗受試者的血液樣本,針對葉酸與其他微量營養素的血中濃度進行分析。
  
  俄亥俄州克里夫蘭西儲大學產科胎兒醫學地鐵健康中心主任的Brian Mercer醫師,同時也是這項會議的主席表示,要做出統一的建議,目前的數據仍嫌太少,我們需要看到當研究發表時的最終數據;然而,如果結果是一樣的,那葉酸可能是預防首次早產少數的機會之一。
  
  FASTER試驗由國家衛生研究院贊助。Bukowski醫師與Mercer醫師已經表示無相關資金上的往來。

Folic Acid May Prevent Preterm

By Laura Beil
Medscape Medical News

January 31, 2008 (Dallas) — Folic acid supplementation for 1 year before conception might significantly reduce the risk for preterm delivery, according to a new analysis involving more than 38,000 women.

The finding, described here during the Society for Maternal-Fetal Medicine 28th Annual Meeting, suggests an easy and inexpensive method that may reduce the risk for preterm delivery. The effects were most profound with regard to the earliest preterm births, which was reduced by 70% among women who had taken folic acid for a year.

"This is exciting and promising," Radek Bukowski, MD, PhD, from the University of Texas Medical Branch at Galveston, told Medscape Ob/Gyn & Women's Health. However, he and others cautioned that the results need to be replicated and further scrutinized.

Performing an observational cohort study, Dr. Bukowski and colleagues analyzed data from women who had participated in the First And Second Trimester Evaluation of Risk (FASTER) trial, sponsored by the National Institutes of Health. That earlier study had enrolled women with singleton pregnancies and was designed to improve early detection of Down syndrome. When entering the study, women reported on their use of folic acid before conception.

About 20% of the participants, or 6777 women, had taken folic acid supplements for least 1 year before becoming pregnant, 36% had taken folic acid for less than 1 year, and 44% had not taken folic acid supplements at all. The study took into account age, race, body mass index, history of preterm birth, and other variables known to affect risk for early delivery. Across all groups, 160 preterm births occurred.

During his presentation, Dr. Bukowski reported that the risk for earliest preterm deliveries — those happening between 20 and 28 weeks of pregnancy — was 70% lower among women with 1 year of folic acid use compared with those who had not taken the supplement. Rates of delivery between 28 and 32 weeks of pregnancy were 50% lower. Delivery rates after 32 weeks were similar in both groups. The trend had a P value of .01.

The findings are tantalizing because folic acid is a simple intervention with a good safety record, and "[i]t could be very easily implemented," Dr. Bukowski said. Although the study did not ask the amount taken, the assumption, he noted, is that the women took the currently recommended 400-μg daily dose.

These results fit with observational studies that have found an association between serum folic acid levels and risk for preterm delivery. The mechanism to explain folic acid's protection, however, remains unclear. Dr. Bukowski hypothesized that folic acid might boost the immune system, which may protect pregnant women against infection. He said he does not believe that longtime use of folic acid is simply a marker for better health habits, as his analysis tried to account for these influences.

To further explore these and other questions, Dr. Bukowski is next evaluating serum samples of the study participants, looking for correlations with the concentration of folic acid and other micronutrients.

Meanwhile, there are still too few data to make universal recommendations, said Brian Mercer, MD, director of maternal-fetal medicine at MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, and program chair for the meeting.

"We need to see the final results when the study is published," he said. However, if the results hold up, folic acid may be "one of the very few opportunities to prevent first preterm births."

The FASTER trial was funded by the National Institutes of Health. Dr. Bukowski and Dr. Mercer have disclosed no relevant financial relationships.

Society for Maternal-Fetal Medicine 28th Annual Meeting: Abstract 5. Presented January 31, 2008.

    
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