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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)
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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
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