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目的探讨妊娠期预防性补铁时机的选择及其对妊娠结局的影响。方法选取2015年10月-2016年10在河北医科大学第四医院产检的孕15~16周血红蛋白(Hb)及血清铁蛋白(SF)正常的孕妇148例为研究对象,随机分为观察组(80例)和对照组(68例)。观察组于孕16周开始口服铁剂,对照组暂时不补铁。两组孕妇均在孕16~19周末、20~23周末、24~27周末、28~31周末、32~35周末、36周~临产6个阶段检测Hb和SF水平。比较两组孕妇不同孕周铁缺乏(ID)和缺铁性贫血(IDA)的发病率,Hb和SF水平,并分析Hb和SF对妊娠结局的影响。结果两组孕妇各孕周Hb和SF水平比较,差异均有统计学意义(均P<0.05)。孕16~19周末两组孕妇ID和IDA的发病率比较,差异均无统计学意义(均P>0.05),余各孕周观察组孕妇ID和IDA发病率均低于对照组,差异均有统计学意义(均P<0.05)。两组孕妇妊娠期并发症、早产、低出生体重儿及产后出血发生率比较,差异均无统计学意义(均P>0.05)。结论妊娠16周开始预防性补铁可显著降低ID和IDA的发病率。预防性补铁对妊娠期并发症及分娩结局无明显影响。妊娠28周后ID发病率明显上升,应在妊娠28周增加补铁量以预防ID和IDA的发生。
Objective To explore the timing of preventive iron supplementation in pregnancy and its effect on pregnancy outcome. Methods From October 2015 to October 2016, 148 pregnant women with normal serum hemoglobin (Hb) and serum ferritin (SF) 15 to 16 weeks of gestation from the Fourth Hospital of Hebei Medical University were selected as study subjects and randomly divided into observation group 80 cases) and control group (68 cases). The observation group began oral administration of iron at 16 weeks’ gestation, and the control group did not have iron supplementation at the moment. Pregnant women in both groups were tested for Hb and SF at 6 to 19 weeks of gestation, 20 to 23 weeks, 24 to 27 weeks, 28 to 31 weeks, 32 to 35 weeks, and 36 weeks to 6 weeks of labor. The incidences of Iron Deficiency (ID) and Iron Deficiency Anemia (IDA), Hb and SF in different gestational weeks were compared between the two groups, and the effect of Hb and SF on pregnancy outcome was analyzed. Results The levels of Hb and SF in the two groups of pregnant women in each gestational week were significantly different (all P <0.05). There were no significant differences in the incidence of IDA and IDA between the two groups at 16-19 weeks of gestation (all P> 0.05), while the incidences of ID and IDA in pregnant women in the other gestational weeks were lower than those in the control group Statistical significance (all P <0.05). There was no significant difference in the incidence of pregnancy complications, premature birth, low birth weight children and postpartum hemorrhage between the two groups (all P> 0.05). Conclusions Preventive iron supplementation at 16 weeks gestation can significantly reduce the incidence of ID and IDA. Preventive iron supplementation had no significant effect on pregnancy complications and delivery outcomes. After 28 weeks of pregnancy, the incidence of ID increased significantly, and the amount of iron supplement should be increased at 28 weeks gestation to prevent the occurrence of ID and IDA.