陕西省妇女围孕期微量营养素增补现况调查及其影响因素分析
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摘要
目的调查陕西省妇女围孕期微量营养素增补现况,并分析其影响因素,为相关部门制定母婴健康方针提供帮助。方法 2010—2013年,采用分层多阶段随机抽样方法,抽取陕西省20个县和10个城区符合纳入标准的妇女30 027例为调查对象。采用面对面问卷调查法进行调查,收集妇女的人口学特征(包括民族、户籍地、地域分布、年龄、配偶年龄、文化程度、配偶文化程度、家庭月收入、家族智障史、家族出生缺陷史、妊娠期是否患病、妊娠期是否进行产检、产次、既往流产史、既往出生缺陷史)、围孕期微量营养素增补情况(包括服用微量营养素的类别、服用持续时间),其中微量营养素包括叶酸、钙剂、铁剂、复合微量营养素。采用多因素Logistic回归分析妇女围孕期微量营养素增补的影响因素。结果共发放问卷30 027份,回收有效问卷29 953份,有效回收率为99.75%。围孕期未服用任何微量营养素者4 693例(15.67%),至少服用1种微量营养素者25 260例(84.33%),其中服用微量营养素≤30 d者7 400例(24.71%)。微量营养素增补中,围孕期从未服用叶酸、钙剂、铁剂、复合微量营养素者分别为9 989例(33.35%)、12 886例(43.02%)、28 206例(94.17%)、28 856例(96.34%),服用叶酸、钙剂、铁剂、复合微量营养素≤30 d者分别为4 178例(13.95%)、5 161例(17.23%)、689例(2.30%)、455例(1.52%),服用叶酸、钙剂、铁剂、复合微量营养素>30 d者分别为15 040例(50.21%)、11 150例(37.22%)、732例(2.44%)、633例(2.11%)。多因素Logistic回归分析结果显示,关中地区〔OR=2.59,95%CI(2.37,2.82)〕、陕南地区〔OR=2.80,95%CI(2.51,3.13)〕、23~35岁〔OR=1.27,95%CI(1.14,1.41)〕、配偶年龄为23~35岁〔OR=1.14,95%CI(1.01,1.29)〕、文化程度为初中〔OR=1.55,95%CI(1.37,1.76)〕、文化程度为高中及以上〔OR=2.28,95%CI(1.95,2.66)〕、配偶文化程度为初中〔OR=1.31,95%CI(1.14,1.50)〕、配偶文化程度为高中及以上〔OR=1.63,95%CI(1.38,1.92)〕、妊娠期患病〔OR=1.67,95%CI(1.55,1.81)〕、妊娠期进行产检〔OR=4.34,95%CI(3.32,5.67)〕、初产妇〔OR=1.42,95%CI(1.29,1.55)〕、既往有流产史〔OR=1.26,95%CI(1.12,1.42)〕是妇女围孕期是否服用微量营养素的影响因素(P<0.05)。结论陕西省妇女围孕期微量营养素增补率为84.33%,其中叶酸增补情况较好,但钙剂、铁剂、复合微量营养素增补情况并不理想;此外,应当对居住于陕北地区、文化水平低及经产妇加强围孕期的微量营养素增补宣传,以提高其围孕期微量营养素摄入率。
Objective To investigate the periconceptional micronutrient supplementation of pregnant women in Shaanxi provide,analyze its risk factors and help the relevant departments to formulate the maternal and child health policy. Methods According to the inclusion criteria,30 027 women from 20 counties and 10 urban districts in Shaanxi province were selected by stratified multistage random sampling method from 2010 to 2013. A face- to- face questionnaire survey was conducted. The demographic characteristics of the women(including ethnicity,domicile,geographical distribution,age,age of the spouse,educational degree,education,educational degree of the spouse,family income per month,family history of mental retardation,family history of birth defects,whether being sick during pregnancy,whether taking antenatal care,parity,previous abortion history,previous history of birth defects),status of periconceptional micronutrients(including folic acid,calcium,iron,and multi- micronutrients) supplementation(including the types of nutrients used,duration of taking) were collected. Multivariate Logistic regression was used to analyze the influencing factors of micronutrient supplementation during periconceptional period. Results A total of 30 027 questionnaires were distributed,29 953 valid questionnaires were recovered,the effective response rate was 99. 75%. There were 4 693 women(15. 67%) who did not take any micronutrients during periconceptional period,25 260(84. 33%) took at least one kind of micronutrients,and among these 7 400(24. 71%) took micronutrients less than or equal to 30 days. In the periconceptional micronutrients supplementation,the number of women who never took folic acid,calcium,iron and compound micronutrients was respectively 9 989(33. 35%),12 886(43. 02%),28 206(94. 17%),and 28 856(96. 34%),the number of women who had took folic acid,calcium,iron and compound micronutrients for no more than 30 days was respectively 4 178(13. 95%),5 161(17. 23%),689(2. 30%),and 455(1. 52%), while that of women who had took the above four supplements for more than 30 days was respectively 15 040(50. 21%), 11 150(37. 22%),732(2. 44%),633(2. 11%). The results of logistic regression showed that Guanzhong region 〔OR = 2. 59,95% CI(2. 37,2. 82) 〕,Shannan region 〔OR = 2. 80,95% CI(2. 51,3. 13) 〕, age between 23 and 35 〔OR = 1. 27,95% CI(1. 14,1. 41) 〕,spouse' s age between 23 and 35 〔OR = 1. 14,95% CI(1. 01,1. 29) 〕, educational degree of junior high school〔OR = 1. 55,95% CI(1. 37,1. 76) 〕,educational degree of senior high school or above〔OR = 2. 28,95%CI(1. 95,2. 66) 〕, spouse' s educational degree of junior high school 〔OR = 1. 31,95% CI(1. 14,1. 50) 〕, spouse' s educational degree of senior high school or above 〔OR = 1. 63,95% CI(1. 38,1. 92) 〕,sick during pregnancy 〔OR = 1. 67,95% CI(1. 55,1. 81) 〕,antenatal care 〔OR = 4. 34,95% CI(3. 32,5. 67) 〕,primiparas 〔OR = 1. 42,95% CI(1. 29,1. 55) 〕,previous history of abortion 〔OR = 1. 26,95% CI(1. 12,1. 42) 〕 were the influencing factors of micronutrient supplementation status during periconceptional period(P < 0. 05). Conclusion The rate of periconceptional micronutrient supplementation in Shaanxi province is 84. 33%. The supplementation of folic acid is better,but the supplementation of calcium,iron,multi- micronutrients is not ideal. In addition,more work should be done to strengthen preconceptional supplementation propoganda of women from northern part of Shaanxi province,low educational level women and multiparaes,and thus improve the intake rate of micronutrients during preconceptional period.
Objective To investigate the periconceptional micronutrient supplementation of pregnant women in Shaanxi provide,analyze its risk factors and help the relevant departments to formulate the maternal and child health policy. Methods According to the inclusion criteria,30 027 women from 20 counties and 10 urban districts in Shaanxi province were selected by stratified multistage random sampling method from 2010 to 2013. A face- to- face questionnaire survey was conducted. The demographic characteristics of the women(including ethnicity,domicile,geographical distribution,age,age of the spouse,educational degree,education,educational degree of the spouse,family income per month,family history of mental retardation,family history of birth defects,whether being sick during pregnancy,whether taking antenatal care,parity,previous abortion history,previous history of birth defects),status of periconceptional micronutrients(including folic acid,calcium,iron,and multi- micronutrients) supplementation(including the types of nutrients used,duration of taking) were collected. Multivariate Logistic regression was used to analyze the influencing factors of micronutrient supplementation during periconceptional period. Results A total of 30 027 questionnaires were distributed,29 953 valid questionnaires were recovered,the effective response rate was 99. 75%. There were 4 693 women(15. 67%) who did not take any micronutrients during periconceptional period,25 260(84. 33%) took at least one kind of micronutrients,and among these 7 400(24. 71%) took micronutrients less than or equal to 30 days. In the periconceptional micronutrients supplementation,the number of women who never took folic acid,calcium,iron and compound micronutrients was respectively 9 989(33. 35%),12 886(43. 02%),28 206(94. 17%),and 28 856(96. 34%),the number of women who had took folic acid,calcium,iron and compound micronutrients for no more than 30 days was respectively 4 178(13. 95%),5 161(17. 23%),689(2. 30%),and 455(1. 52%), while that of women who had took the above four supplements for more than 30 days was respectively 15 040(50. 21%), 11 150(37. 22%),732(2. 44%),633(2. 11%). The results of logistic regression showed that Guanzhong region 〔OR = 2. 59,95% CI(2. 37,2. 82) 〕,Shannan region 〔OR = 2. 80,95% CI(2. 51,3. 13) 〕, age between 23 and 35 〔OR = 1. 27,95% CI(1. 14,1. 41) 〕,spouse' s age between 23 and 35 〔OR = 1. 14,95% CI(1. 01,1. 29) 〕, educational degree of junior high school〔OR = 1. 55,95% CI(1. 37,1. 76) 〕,educational degree of senior high school or above〔OR = 2. 28,95%CI(1. 95,2. 66) 〕, spouse' s educational degree of junior high school 〔OR = 1. 31,95% CI(1. 14,1. 50) 〕, spouse' s educational degree of senior high school or above 〔OR = 1. 63,95% CI(1. 38,1. 92) 〕,sick during pregnancy 〔OR = 1. 67,95% CI(1. 55,1. 81) 〕,antenatal care 〔OR = 4. 34,95% CI(3. 32,5. 67) 〕,primiparas 〔OR = 1. 42,95% CI(1. 29,1. 55) 〕,previous history of abortion 〔OR = 1. 26,95% CI(1. 12,1. 42) 〕 were the influencing factors of micronutrient supplementation status during periconceptional period(P < 0. 05). Conclusion The rate of periconceptional micronutrient supplementation in Shaanxi province is 84. 33%. The supplementation of folic acid is better,but the supplementation of calcium,iron,multi- micronutrients is not ideal. In addition,more work should be done to strengthen preconceptional supplementation propoganda of women from northern part of Shaanxi province,low educational level women and multiparaes,and thus improve the intake rate of micronutrients during preconceptional period.
引文
[1]王莲萍,丁昌芝,汤成菊,等.马鞍山市孕期妇女服用叶酸状况及其影响因素分析[J].安徽预防医学杂志,2010,16(1):35-36.WANG L P,DING C Z,TANG C J,et al.Analysis on folic acid intake of pregnant women and its effected factories in Ma'anshan city[J].Anhui Journal of Preventive Medicine,2010,16(1):35-36.
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[12]赵军,陈道桢,张建裕.2213例孕妇血液钙、铁、锌元素调查分析[J].中国实验诊断学,2011,15(4):734.ZHAO J,CHEN D Z,ZHANG J Y.Investigation and analysis on the blood calcium,iron and zinc in 2213 cases of pregnant women[J].Chinese Journal of Laboratory Diagnosis,2011,15(4):734.DOI:10.3969/j.issn.1007-4287.2011.04.064.
[13]ATALLAH A N,HOFMEYR G J,DULEY L.Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems[J].Cochrane Database Syst Rev,2002(1):CD001059.DOI:10.1002/14651858.CD001059.
[14]WAHED F,LATIF S A,NESSA A,et al.Gestational anemia[J].Mymensingh Med J,2010,19(19):462-468.
[15]HAIDER B A,BHUTTA Z A.Multiple-micronutrient supplementation for women during pregnancy[J].Cochrane Database Syst Rev,2006(4):36-38.
[16]SHAH P S,OHLSSON A,Knowledge Synthesis Group on Determinants of Low Birth Weight and Preterm Births.Effects of prenatal multimicronutrient supplementation on pregnancy outcomes:a meta-analysis[J].CMAJ,2009,180(12):E99-108.
[17]AMITAI Y,FISHER N,HARINGMAN M,et al.Increased awareness,knowledge and utilization of preconceptional folic acid in Israel following a national campaign[J].Prev Med,2004,39(4):731-737.
[18]LI Z,REN A,ZHANG L,et al.Periconceptional use of folic acid in Shanxi Province of northern China[J].Public Health Nutrition,2007,10(5):471-476.
[19]郑山,胡晓斌,王敏珍,等.孕妇服用叶酸行为影响因素研究[J].卫生研究,2010,39(6):743-746.ZHENG S,HU X B,WANG M Z,et al.Study on influencing factors of folic acid in pregnant women[J].Journal of Hygiene Resarch,2010,39(6):743-746.
[2]LIM C E,YII M F,CHENG N C,et al.The role of micronutrients in pregnancy[J].Aust Fam Physician,2009,38(12):980-984.
[3]OSRIN D,VAIDYA A,SHRESTHA Y,et al.Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal:double-blind,randomised controlled trial[J].Lancet,2005,365(9463):955-962.DOI:10.1016/S0140-6736(05)71084-9.
[4]RADIMER K,BINDEWALD B,HUGHES J,et al.Dietary supplement use by U.S.adults:data from the National Health and Nutrition Examination Survey,1999-2000[J].Am J Epidemiol,2004,160(4):339-349.
[5]ISHIHARA J,SOBUE T,YAMAMOTO S,et al.Demographics,lifestyles,health characteristics,and dietary intake among dietary supplement users in Japan[J].Int J Epidemiol,2003,32(4):546-553.
[6]KIM S H,HAN J H,Keen C L.Vitamin and mineral supplement use by healthy teenagers in Korea:motivating factors and dietary consequences[J].Nutrition,2001,17(5):373-380.
[7]HARRISON R A,HOLT D,PATTISON D J,et al.Are those in need taking dietary supplements?A survey of 21 923 adults[J].Br J Nutr,2004,91(4):617-623.
[8]BEITZ R,MENSINK G B,RAMS S,et al.Use of vitamin and mineral supplements in Germany[J].Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2004,47(11):1057-1065.
[9]宓铭.上海市孕妇营养素补充剂摄入情况分析[J].卫生研究,2008,37(4):460-462.MI M.Analysis of dietary supplement intake of pregnant women in Shanghai[J]Journal of Hygiene Resarch,2008,37(4):460-462.DOI:10.3969/j.issn.1000-8020.2008.04.022.
[10]曾果,黄承钰,邢爱耘,等.孕妇营养补充剂应用及其影响因素的调查[J].卫生研究,2004,33(1):85.ZENG G,HUANG C Y,XING A Y,et al.Application of nutritional supplements in pregnant women and its influencing factors[J].Journal of Hygiene Resarch,2004,33(1):85.DOI:10.3969/j.issn.1000-8020.2004.01.027.
[11]王杰,赵丽云,朴建华,等.2009年中国8省(市)孕妇营养与健康状况结果分析[J].卫生研究,2011,40(2):201-203.WANG J,ZHAO L Y,PIAO J H,et al.Analysis on the nutrition and health status of pregnant women in 8 provinces(cities)of China in 2009[J].Journal of Hygiene Resarch,2011,40(2):201-203.
[12]赵军,陈道桢,张建裕.2213例孕妇血液钙、铁、锌元素调查分析[J].中国实验诊断学,2011,15(4):734.ZHAO J,CHEN D Z,ZHANG J Y.Investigation and analysis on the blood calcium,iron and zinc in 2213 cases of pregnant women[J].Chinese Journal of Laboratory Diagnosis,2011,15(4):734.DOI:10.3969/j.issn.1007-4287.2011.04.064.
[13]ATALLAH A N,HOFMEYR G J,DULEY L.Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems[J].Cochrane Database Syst Rev,2002(1):CD001059.DOI:10.1002/14651858.CD001059.
[14]WAHED F,LATIF S A,NESSA A,et al.Gestational anemia[J].Mymensingh Med J,2010,19(19):462-468.
[15]HAIDER B A,BHUTTA Z A.Multiple-micronutrient supplementation for women during pregnancy[J].Cochrane Database Syst Rev,2006(4):36-38.
[16]SHAH P S,OHLSSON A,Knowledge Synthesis Group on Determinants of Low Birth Weight and Preterm Births.Effects of prenatal multimicronutrient supplementation on pregnancy outcomes:a meta-analysis[J].CMAJ,2009,180(12):E99-108.
[17]AMITAI Y,FISHER N,HARINGMAN M,et al.Increased awareness,knowledge and utilization of preconceptional folic acid in Israel following a national campaign[J].Prev Med,2004,39(4):731-737.
[18]LI Z,REN A,ZHANG L,et al.Periconceptional use of folic acid in Shanxi Province of northern China[J].Public Health Nutrition,2007,10(5):471-476.
[19]郑山,胡晓斌,王敏珍,等.孕妇服用叶酸行为影响因素研究[J].卫生研究,2010,39(6):743-746.ZHENG S,HU X B,WANG M Z,et al.Study on influencing factors of folic acid in pregnant women[J].Journal of Hygiene Resarch,2010,39(6):743-746.