台灣北部地區懷孕婦女鐵質及影響孕期貧血之相關因子調查

全球約有41.8%的孕婦貧血，鐵缺乏是導致貧血的主因，其次是維生素缺乏或不足。近期研究顯示：肥胖也會對母體的鐵營養狀況產生負面影響。本研究採用國民健康署委託計畫之國民營養調查懷孕婦女（NAHSIT-PW 2017-2019）北區數據做為樣本，採用問卷及血液檢查鐵質、葉酸、維生素B12、維生素D營養狀態。共計收案475人，第一孕期～三孕期分別為140人、166人、169人。鐵不足的孕婦佔90.1%，鐵缺乏的孕婦佔37.7%，缺鐵性貧血佔9.3%，貧血佔16%。隨著孕期增加，缺鐵性貧血、維生素B12缺乏、維生素D及葉酸不足的人數也隨之增加（all p-trend<0.01）。邏輯迴歸分析得知，孕前BMI（OR=0.28; 95% CI=0.009-0.87）、孕期（OR=12.58; 95% CI=3.95-40.00）、維生素B12缺乏（OR=3.96; 95% CI=1.15-13.68）及葉酸不足（OR=4.09; 95% CI=1.66-10.1）和孕期缺鐵性貧血有顯著關係。總體而言，孕前BMI>24（kg/m^2），對於懷孕初期缺鐵性貧血具保護性，但隨著孕期進展，身體儲存的鐵質及維生素逐漸耗盡，其保護性也逐漸消失。孕前BMI<24（kg/m^2）孕婦須注意補充葉酸及維生素D，而孕前BMI>24（kg/m^2）的孕婦須注意補充維生素B12，以避免孕期缺鐵性貧血的發生。

關鍵字

孕婦；缺鐵性貧血；國民營養調查；孕前身體質量指數；維生素B12缺乏；葉酸不足

並列摘要

Iron deficiency anemia (IDA) is the main nutritional disorder disease affecting 41.8% pregnant women worldwide. The primary cause of gestational IDA is inadequate intakes of dietary iron and vitamin (Vit). The aim of this study was to evaluate iron status of pregnant women participating in Nationwide Nutrition and Health Survey, Taiwan (Pregnant NAHSIT 2017-2019). A total of 475 pregnant women, aged between 15-48 years living in Northern Taiwan, were recruited between 2017-2019. Data such as sociodemography, blood biochemistry, and disease history before and during pregnancy were collected. The blood biochemistry included iron, folic acid, Vit B12, and Vit D. The total number of cases enrolled in trimester 1, 2 and 3 was 140, 166 and 169, respectively. The overall prevalence rates of nutritional deficiency were: 90.1% women with iron depletion , 37.7%with iron depletion, 9.3% with IDA and 16%with anemia。The number of pregnant women with nutritional deficiency was sign ificantly increased through the progression of gestational stages (all p-trend < 0.01). Adjusted multivariate logistic regression found that pre-pregnancy body mass index (pBMI) (OR=0.28; 95% CI=0.009-0.87), trimester (OR=12.58; 95% CI=3.95-40.00), Vit B12 deficiency (OR=3.96; 95% CI=1.15-13.68) and folate depletion (OR=4.09; 95% CI=1.66-10.1) were independent risk factor for gestational IDA. pBMI 24 (kg/m^2 ) protected against IDA in early pregnancy but become statistically insignificant in the late pregnancy. Our results suggest that iron deficiency remains a major public health concerns among pregnant women living in northern Taiwan, affecting one-fourth (19.5%) women in the late pregnancy. Women with concomitant deficiency of iron and erythropoiesis-related vitamins are at the greatest risk of gestational IDA.

並列關鍵字

pregnant women ； iron deficiency anemia ； pre-pregnancy body mass index ； vitamin B12 deficiency ； folate depletion

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