Chinese Medical E-ournals Database
Adv Search
中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2021, Vol. 17 ›› Issue (06): 671 -678. doi: 10.3877/cma.j.issn.1673-5250.2021.06.008

Original Article

The expression and significance of serum levels of folic acid, vitamin B12 and ferritin in pregnant women in different pregnancy periods

Chunyan Liu1,1, Juan Li2,2,†()   

  • Received:2021-01-29 Revised:2021-10-26 Published:2021-12-01
  • Corresponding author: Juan Li
  • Supported by:
    National Natural Science Foundation of China(81503298)
HTML ( ) PDF ( )
Objective

To investigate serum levels of folic acid, vitamin B12 and ferritin (this study is referred to as " 3 parameters of anemia" ) of pregnant women and their significances.

Methods

There were 130 pregnant women in early, middle and late pregnancy, respectively, who underwent prenatal examination and childbirth in Binzhou Second People′s Hospital from January 2017 to January 2019, and 130 non∑- pregnant women of childbearing age who underwent physical examination in the same hospital at the same time, were selected as research subjects. According to gestational age and pregnant or not, they were divided into early pregnancy group, middle pregnancy group, late pregnancy group and control group, respectively. These 3 parameters of anemia of all subjects were measured. These parameters of anemia among four groups were overall compared by one-way ANOVA and further compared by SNK-q method. Chi-square test was used to make overall and pairwise comparison of incidence of 3 parameters of anemia abnormal (deficiency among one of three substances of folic acid, vitamin B12 and ferritin), anemia and complications during pregnancy among pregnant women in early, middle and late pregnancy group. Independent-samples t test was used to compare neonatal growth and development indexes at birth between neonates of pregnant women with 3 parameters of anemia abnormal and normal in different pregnancy group, respectively; The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013, and all subjects signed the informed consent forms for clinical research.

Results

① There were no significant differences in 3 parameters of anemia of subjects between early pregnancy group and control group (P>0.05). The serum levels of folic acid, vitamin B12 and ferritin in middle pregnancy group and late pregnancy group were (8.8±2.4) nmol/L, (238.2±103.8) pmol/L and (41.5±10.3) μg/L, and (6.3±1.2) nmol/L, (134.2±23.5) pmol/L and (15.7±6.8) μg/L, respectively, which were lower than those of (12.9±3.4) nmol/L, (353.7±122.9) pmol/L and (77.7±15.1) μg/L in early pregnancy group and those of (13.6±3.8) nmol/L, (376.9±128.7) pmol/L and (80.3±16.3) μg/L in control group, respectively, and the differences were statistically significant (middle pregnancy group vs early pregnancy group: q=16.226, 12.702, 32.478, all P<0.001; middle pregnancy group vs control group: q=18.997, 15.254, 34.810, all P<0.001; late pregnancy group vs early pregnancy group: q=26.120, 24.140, 55.625, all P<0.001; late pregnancy group vs control group: q=28.891, 26.691, 57.957, all P<0.001). With the increase of gestational age, 3 parameters of anemia decreased gradually, and the differences were statistically significant (P<0.05). ② The incidence of 3 parameters of anemia abnormal, incidence of folic acid deficiency megaloblastic anemia and iron deficiency anemia, and total incidence of anemia of pregnant women in late pregnancy group were higher than those in early and middle pregnancy group, respectively; The incidence of those indexes above mentioned in middle pregnancy group were higher than those in early pregnancy group, and all the differences above were statistically significant (P<0.05). ③ The incidence of pregnancy induced hypertension, myocardial ischemia/damage, fetal abnormalities and total complications of pregnant women in late pregnancy group were higher than those in early and middle pregnancy group, respectively, and the differences were statistically significant (P<0.05). There were no significant differences in incidence of pregnancy complications mentioned above between early pregnancy group and middle pregnancy group (P>0.05). ④ Among pregnant women in early, middle and late pregnancy groups, each group showed that the body length of newborns delivered by pregnant women with 3 parameters of anemia abnormal were shorter than those of normal, and the differences were statistically significant (P<0.05). In late pregnancy group, the birth weight of newborns delivered by pregnant women with ferritin deficiency was lighter than that of normal, and the difference was statistically significant (P<0.05). Except for there were no significant differences in head circumference at birth of newborns between delivered by pregnant women with vitamin B12 deficiency and normal in early pregnancy group, and pregnant women with ferritin deficiency and normal in late pregnancy group (P>0.05). In other cases, the head circumference at birth of newborns delivered by pregnant women with 3 parameters of anemia abnormal were smaller than those of normal, and the differences were statistically significant (P<0.05).

Conclusions

The more gestational age is, the lower levels of serum folate, vitamin B12 and ferritin, and the higher risk of anemia and pregnancy complications are. During different pregnancy period, if pregnant women with one of 3 parameters of anemia abnormal may affect the growth and development of fetus.

Key words: Pregnancy trimesters, Folic acid, Vitamin B12, Ferritins, Anemia, Pregnancy complications, Pregnant women, Fetus
表1 4组受试者贫血3项指标比较(±s)
组别 例数 叶酸浓度(nmol/L) 维生素B12浓度(pmol/L) 铁蛋白含量(μg/L)
早孕期组 130 12.9±3.4 353.7±122.9 77.7±15.1
中孕期组 130 8.8±2.4 238.2±103.8 41.5±10.3
晚孕期组 130 6.3±1.2 134.2±23.5 15.7±6.8
对照组 130 13.6±3.8 376.9±128.7 80.3±16.3
总体比较(F值/P值)   187.221/<0.001 152.205/<0.001 771.743/<0.001
两两比较(q值/P值)        
  早孕期组vs中孕期组   16.226/<0.001 12.702/<0.001 32.478/<0.001
  早孕期组vs晚孕期组   26.120/<0.001 24.140/<0.001 55.625/<0.001
  早孕期组vs对照组   1.565/0.119 1.486/0.138 1.334/0.183
  中孕期组vs晚孕期组   9.894/<0.001 11.437/<0.001 23.147/<0.001
  中孕期组vs对照组   18.997/<0.001 15.254/<0.001 34.810/<0.001
  晚孕期组vs对照组   28.891/<0.001 26.691/<0.001 57.957/<0.001
表2 3组孕妇贫血3项指标异常及贫血发生率比较[例数(%)]
组别 例数 叶酸缺乏 维生素B12缺乏 铁蛋白缺乏 巨幼细胞性贫血 缺铁性贫血 混合性贫血 贫血总发生率
叶酸缺乏性 维生素B12缺乏性
早孕期组 130 16(12.3) 3(2.3) 21(16.2) 4(3.1) 1(0.8) 6(4.6) 1(0.8) 12(9.2)
中孕期组 130 29(22.3) 14(10.8) 55(42.3) 12(9.2) 1(0.8) 15(11.5) 2(1.5) 30(23.1)
晚孕期组 130 48(36.9) 32(24.6) 106(81.5) 24(18.5) 4(3.1) 37(28.5) 6(4.6) 71(54.6)
总体比较(χ2值/P值)   21.942/<0.001 30.016/<0.001 113.139/<0.001 16.937/<0.001 3.047/0.218 30.907/<0.001 4.777/0.092 68.354/<0.001
两两比较(χ2值/P值)                  
  早孕期组vs中孕期组   4.542/0.033 7.616/0.006 21.493/<0.001 4.262 /0.039 — 4.196/0.041 — 9.201/0.002
  早孕期组vs晚孕期组   21.225/<0.001 27.766/<0.001 111.213/<0.001 16.010/<0.001 — 26.777/<0.001 — 61.606/<0.001
  中孕期组vs晚孕期组   6.661/0.010 8.558/0.003 42.428/<0.001 4.643/0.031 — 11.635/0.001 — 27.216/<0.001
表3 3组孕妇妊娠并发症发生率比较[例数(%)]
组别 例数 妊娠期高血压疾病 心肌缺血/损害 胎儿异常 并发症总发生率
早孕期组 130 4(3.1) 1(0.8) 1(0.8) 6(4.6)
中孕期组 130 11(8.5) 1(0.8) 2(1.5) 14(10.8)
晚孕期组 130 23(17.7) 8(6.2) 9(6.9) 40(30.8)
总体比较(χ2值/P值)   16.153/<0.001 10.058/0.007 9.802/0.007 37.346/<0.001
两两比较(χ2值/P值)          
  早孕期组vs中孕期组   3.467/0.063 0.000/1.000 0.337/0.561 3.467/0.063
  早孕期组vs晚孕期组   14.920/<0.001 5.640/0.018 6.656/0.010 30.532/<0.001
  中孕期组vs晚孕期组   4.873/0.027 5.640/0.018 4.651/0.031 15.800/<0.001
表4 早孕期组孕妇中，贫血3项指标异常者与正常者分娩新生儿出生时生长发育指标比较(±s)
项目 例数 身长(cm) 体重(kg) 头围(cm)
叶酸        
  缺乏 16 49.1±1.2 3.06±0.33 33.9±1.7
  正常 114 51.0±1.3 3.13±0.29 35.4±1.6
t值   5.772 0.894 3.419
P值   <0.001 0.373 0.001
维生素B12        
  缺乏 3 49.1±1.2 3.02±0.21 33.7±1.7
  正常 127 50.8±1.1 3.12±0.27 35.2±1.6
t值   2.734 0.557 1.636
P值   0.007 0.579 0.104
铁蛋白        
  缺乏 21 49.4±1.2 3.07±0.23 33.8±1.6
  正常 109 51.0±1.1 3.13±0.29 35.5±1.6
t值   6.004 0.895 4.491
P值   <0.001 0.373 <0.001
表5 中孕期组孕妇中，贫血3项指标异常者与正常者分娩新生儿出生时生长发育指标比较(±s)
项目 例数 身长(cm) 体重(kg) 头围(cm)
叶酸        
  缺乏 29 49.2±1.3 3.09±0.37 33.9±1.6
  正常 101 50.7±1.2 3.11±0.24 35.4±1.3
t值   5.651 0.347 5.168
P值   <0.001 0.729 <0.001
维生素B12        
  缺乏 14 49.2±1.1 2.99±0.25 33.9±1.8
  正常 116 50.5±1.1 3.12±0.33 35.2±1.6
t值   4.049 1.424 2.777
P值   <0.001 0.157 0.006
铁蛋白        
  缺乏 55 49.5±1.1 3.05±0.29 34.2±1.6
  正常 75 51.0±1.2 3.14±0.31 35.7±1.5
t值   7.131 1.680 5.701
P值   <0.001 0.095 <0.001
表6 晚孕期组孕妇中，贫血3项指标异常者与正常者分娩新生儿出生时生长发育指标比较(±s)
项目 例数 身长(cm) 体重(kg) 头围(cm)
叶酸        
  缺乏 48 49.0±1.2 3.10±0.30 33.8±1.2
  正常 82 50.9±1.3 3.15±0.38 35.3±1.8
t值   8.178 0.780 5.102
P值   <0.001 0.437 <0.001
维生素B12        
  缺乏 32 49.1±1.2 3.01±0.28 33.8±1.4
  正常 98 50.5±1.1 3.15±0.32 35.1±1.7
t值   5.967 1.264 3.983
P值   <0.001 0.208 <0.001
铁蛋白        
  缺乏 106 50.0±1.1 3.11±0.21 34.7±1.3
  正常 24 50.9±1.1 3.25±0.34 35.0±1.2
t值   3.715 2.595 1.323
P值   <0.001 0.011 0.188
[1]
张晓瑜，杨艳，樊萍. 孕产妇血清Hcy、叶酸、VB12和血脂水平对重度子痫前期早期诊断的价值[J]. 临床与病理杂志，2020, 40(9): 2307-2311. DOI: 10.3978/j.issn.2095-6959.2020.09.014.
[2]
Costa EM, Azevedo JAP, Martins RFM, et al. Anemia and dental caries in pregnant women: a prospective cohort study[J]. Biol Trace Elem Res, 2017, 177(2): 241-250. DOI: 10.1007/s12011-016-0898-6.
[3]
郑文霞，仝艳丽. 不同孕期妇女血清叶酸、维生素B12和血清铁蛋白检测结果分析[J]. 中国妇幼保健，2018, 33(7): 1518-1520. DOI: 10.7620/zgfybj.j.issn.1001-4411.2018.07.26.
[4]
王小钰. 不同孕期孕妇HCY、叶酸、维生素B12水平与妊娠期高血压疾病的关系[J]. 中国妇幼保健，2019, 34(11): 2489-2491. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.11.23.
[5]
邢小飞. 血清叶酸和维生素在孕妇不同妊娠期表达及临床意义分析[J]. 四川解剖学杂志，2019, 27(1): 74-75. DOI: 10.3969/j.issn.1005-1457.2019.01.033.
[6]
曹泽毅. 中华妇产科学(临床版)[M]. 北京：人民卫生出版社，2010: 301-305.
[7]
中华医学会围产医学分会. 妊娠期铁缺乏和缺铁性贫血诊治指南[J]. 中华围产医学杂志，2014, 17(7): 451-454. DOI: 10.3760/cma.j.issn.1007-9408.2014.07.006.
[8]
Kassa GM, Muche AA, Berhe AK, et al. Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and Meta-analysis[J]. BMC Hematol, 2017, 17: 17. DOI: 10.1186/s12878-017-0090-z.
[9]
胡贻椿，陈竞，李敏，等. 2010—2012年中国城市孕妇贫血及维生素A、维生素D营养状况[J]. 中华预防医学杂志，2017, 51(2): 125-131. DOI: 10.3760/cma.j.issn.0253-9624.2017.02.006.
[10]
隗麟懿，王星，何思春. 孕早期血清内AFP、β-HCG、叶酸和维生素B12变化与胚胎停育的相关性研究[J]. 解剖学研究，2018, 40(1): 13-16.
[11]
黄欢，马辉莺，叶青燕. 初产妇胎儿宫内发育迟缓相关因素分析[J]. 河北医药，2021, 43(1): 112-114, 118. DOI: 10.3969/j.issn.1002-7386.2021.01.026.
[12]
Breymann C, Milman N, Mezzacasa A, et al. Ferric carboxymaltose vs. oral iron in the treatment of pregnant women with iron deficiency anemia: an international, open-label, randomized controlled trial (FER-ASAP)[J]. J Perinat Med, 2017, 45(4): 443-453. DOI: 10.1515/jpm-2016-0050.
[13]
沈元，翟光华，尹娟，等. 血清铁蛋白、叶酸、维生素B12检测对妊娠期妇女不同孕期的临床意义[J]. 检验医学与临床，2017, 14(11): 1635-1637. DOI: 10.3969/j.issn.1672-9455.2017.11.043.
[14]
Finkelstein JL, Kurpad AV, Thomas T, et al. Vitamin B12 status in pregnant women and their infants in South India[J]. Eur J Clin Nutr, 2017, 71(9): 1046-1053. DOI: 10.1038/ejcn.2017.29.
[15]
王青，刘燕，扈玉婷. 宝鸡市孕产妇贫血患病状况分析[J]. 中国妇幼保健，2017, 32(20): 5090-5092. DOI: 10.7620/zgfybj.j.issn.1001-4411.2017.20.67.
[16]
Judistiani RTD, Gumilang L, Nirmala SA, et al. Association of colecalciferol, ferritin, and anemia among pregnant women: result from cohort study on vitamin D status and its impact during pregnancy and childhood in Indonesia[J]. Anemia, 2018: 2047981. DOI: 10.1155/2018/2047981.
[17]
何国琳，孙鑫，谭婧，等. 中国部分城市妊娠期铁缺乏和缺铁性贫血患病率的调查[J]. 中华妇产科杂志，2018, 53(11): 761-767. DOI: 10.3760/cma.j.issn.0529-567x.2018.11.006.
[18]
王青波，康熙雄. 孕妇血清同型半胱氨酸、叶酸与维生素B12的水平及临床意义[J]. 中国地方病防治杂志，2018, 33(6): 701-702.
[19]
Ma R, Wang L, Jin L, et al. Plasma folate levels and associated factors in women planning to become pregnant in a population with high prevalence of neural tube defects[J]. Birth Defects Res, 2017, 109(13): 1039-1047. DOI: 10.1002/bdr2.1040.
[20]
赵曼丽. 孕早期血清叶酸、同型半胱氨酸水平检测的临床意义及预防妊娠并发症、胎儿出生缺陷的临床疗效分析[J]. 中国妇幼保健，2019, 34(6): 1249-1251. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.06.13.
[21]
Maffoni S, De Giuseppe R, Stanford FC, et al. Folate status in women of childbearing age with obesity: a review[J]. Nutr Res Rev, 2017, 30(2): 265-271. DOI: 10.1017/S0954422417000142.
[22]
汪靖园，王海燕，袁鹏丽，等. 孕妇血清HCY、FA、VitB12水平变化及其临床意义研究[J]. 国际检验医学杂志，2019, 40(12): 1512-1514. DOI: 10.3969/j.issn.1673-4130.2019.12.025.
[23]
张亚京，王鑫，陈华，等. 母血与脐血中同型半胱氨酸、胎盘生长因子、叶酸及Vit B12与胎儿生长受限的关系[J]. 中华实用儿科临床杂志，2013, 28(14): 1086-1089. DOI: 10.3760/cma.j.issn.2095-428X.2013.14.014.
[1] Fei Dai, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yuanshi Tian, Ming Di. Value of multiple fetal echocardiographic quantitative parameters in assessing heart structure and function in fetuses with coarctation of the aorta[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(10): 950-958.
[2] Zusheng Du, Bowen Zhao, Zhen Zhang, Mei Pan, Xiaohui Peng, Ran Chen, Yankai Mao. Impact of gestational age and apex orientation on left atrial strain assessed by two-dimensional speckle tracking imaging in normal fetuses during the second and third trimesters[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(09): 843-851.
[3] Shangdi Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Ran Chen, Yankai Mao, Yang Chen, Hua Yuan, Yan Chen. Value of quantitative fetal atrial size parameters in assessing cardiac malformations in fetuses with atrial disproportion in middle and late trimesters[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(08): 785-793.
[4] Qiulian Wang, Ying Zhang, Chunmin Li, Shuming Xu, Yuqi Zhang. Prenatal ultrasound diagnosis of fetal aortic arch obstruction with complex intracardiac structural malformations: causes of missed diangosis and misdiagnosis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 718-725.
[5] Lili Gu, Fan Jiang. Survey and analysis of quality of screening prenatal ultrasound images in Anhui Province[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 671-674.
[6] Qing Zeng, Huaxuan Wen, Ying Yuan, Yimei Liao, Yue Qin, Dandan Luo, Meiling Liang, Shengli Li. Sylvian fissure plateau angle: a new parameter to evaluate fetal sylvian fissure by transabdominal two-dimensional ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(05): 454-459.
[7] Jingyu Qian, Mingming Zheng. Interpretation of the Italian guidelines on non-invasive and invasive prenatal diagnosis：executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology（SIGO）[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 486-492.
[8] Xialin Li, Fang He. Risk assessment and early warning system for postpartum hemorrhage[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 498-503.
[9] Ziyang Liu, Jianjian Cui, Yin Zhao. Current research status on obstetric disseminated intravascular coagulation and its scoring system[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 511-518.
[10] Fanying Zeng, Jie Ruan, Xinghui Liu, Guolin He. Current status of perinatal medicine advances under the new reproductive situation and coping strategies in prenatal care[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 519-524.
[11] Xiaofei Li, Hongli Liu, Qiuling Shi, Jing Tian, Li Li, Hongbo Qi, Xin Luo. A prospective randomized controlled study of low intensity focused ultrasound uterine involution treatment for prevention and treatment of postpartum hemorrhage in natural childbirth women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 534-539.
[12] Rong Huang, Ziyu Liang, Wenjin Qi. Expression and significance of NLRP3 inflammasome in serum of pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 540-548.
[13] Long Zhang, Shanke Sun, Wei Xu, Wenzhu Li, Junda Li, Yongquan Chi, Guangsheng He, Feng Cheng, Xuehao Wang, Jianhua Rao. Clinical efficacy of laparoscopic splenectomy in the treatment of hematological diseases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 870-875.
[14] Yongqi Lei, Xinyang Liu, Liyu Yang, Xuehong Tie, Xingxin Yu, Zhida Geng, Yu Liu, Zhengliang Chen, Peng Hui, Yingjian Liang. Perivascular epithelioid cell tumor of the liver complicated with anemia: a case report and literature review[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(05): 710-718.
[15] Beibei Wang, Zhenyi Cui, Jing Wang, Hanyan Wang, Hongzhi Lv, Xiuting Li. Development and Validation of postoperative anemia prediction model in elderly patients with intertro-chanteric fracture[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2024, 10(06): 355-362.
Viewed
Full text


Abstract

Copyright © Chinese Medical Association, Chinese Medical Multimedia Press  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号