VIETNAM MEDICAL JOURNAL H°1 - OCTOBER - 2017 Binh thu'dng d ky giu'a tinh bao I, cac NST tdn
tai du'di dang cae the ludng tri, neu cac NST trong the ludng hi tach nhau sdm gpi la the ddn tri, cd the la ddn trj NST thu'dng hoac ddn tri NST gidl tinh. Dot bien nay thu'dng do eac tac nhan gay roi loan thoi vd sac hoac dut thoi vd sac.
Ket qua nghien ciru cho thay tan so rdi loan sd lu'dng NST d te bao md tlnh hoan ciia chudt ea hai lieu 1 va lieu 2 deu khdng ed sy* khac biet so vdi Id chirng. Tan sd rdi loan eau true kieu ddn tri NST thu'dng d te bao md tlnh hoan eiia chudt d ea hai lieu 1 va lieu 2 deu khdng ed su' khac biet so vdi Id chu'ng. Ket qua nay ciing tu'dng tu" nhu' ket qua chirng ciia Dd Trung Dam [4], Phan Hoai Trung [5].
Tan sd rdi loan cau true kieu ddn trj NST gidi tinh d te bao md tinh hoan eiia chupt d lieu I khdng ed sy' khac biet so vdi id chu'ng, d lieu 2 cao hdn Id chu'ng. Tuy nhien, tong sd ddt bien cau triic lai khdng cd sd khac biet so vdi Id chiTng (bang 3.1). Ket qua nay cung tu'dng du'dng vdi chu'ng ciia Do Trung Dam (5,3% lieu 2, so vdl chu'ng 5,21 ± 2,08 %) [4]. HXH cd tae dung lam bleu md tinh tang sinh tren chudt thy'c [63[7]. Dae biet d lieu gap ddi lieu dieu trj, HXH lam te bao bleu md tinh tang sinh rat manh. Khi qua trinh tang sinh te bao xay ra qua manh, ed the khdng su'a chu^ kjp nhiiYig sai sdt. Vi vay, cd the da bieu hien sd sai sdt trong ghep cap eac NST gidi tinh. Day cung la cd sd cho viec tinh lieu sii' dyng tren lam sang, lieu 1 du viet hdn lieu 2.
V. KET LUAN • HXH d hai lieu 3g/kg TLCT va lieu 9g/kg TLQ 1
dung trong 30 ngay khong gay ra cae dot bien ve sd lu'dng cung nhu' dot bien eau triic d NSTte bao mo tlnh hoan chugt thu'c nghiem so vdi 16 ChiTng. Lieu 1 u'u viet hdn lieu 2
TAI L l | U T H A M KHAO
1. World Health Organization (1993), Researdi Guidelines for Evaluating the Safety and Efficac/ of Herbal Medicines, Manila, Philipm, pp 35 - 58.
2. Gad, Shayne C. (2002), "Subchronic and Chronic Toxicity Studies", Drug Safety Evaluation, Vi/iley - Interscience, a John Wiley and Sons, InC, Publication, 1, pp. Til-'il.
3. Bo Y Te (1996) "Phy luc 3: Hu'dng dan ve khao sSt ddc tinh thuoc co truyen", Hudng dan nghien cOu danh gia tfnh an toan va hieu lut biuSc r£
truyen Viet Nam, tr. 41-6.
4. Do Trung D^m (2006), PhdOng phap nghien cihi tac dung dddc ly cua thuoc td dUdc thao, NXB Khoa hoc va i<y diuat Ha Noi, tx. 335- 42, 347-52, 355-368, 377-392
5. Phan Hoai Trung (2004), "Nghien ciTu tinh an toan va tae dung eiia bai thuoc "Sinh tmh thang"
den so lu'dng, chat lu'cfng tinh triing", Luan an hen syyhgc, TrUdng Dai hoc Y Ha Noi.
6. Soan Minh ThiJy, tru'dng Viet Binh, Quan Hoanp Lam, Vu Manh Hung (2013), "Tac dung cua bai thuoc HXH tren hinh thai tmh hoan chuot cong trang". Tap chi Y hoe Viet Nam; 2013. tap 403, tr 587-593.
7. Bean Minh ThMy, Tru'dng Viet Binh, Quan Hoang Lam, Vu Manh Hung (2011), "Tac dung cua vien nang HXH len hinh thai cau true tmh hoan bi ton thUdng do nhiet". Tap chi Y hoc thue hanh; So 769-H770, tr 273-279
SO S A N H T A C DONG BO SUNG DA VI CHAT V a i SAT - ACID FOLIC (y PHU Nir MANG THAI DOI V a i CHIEU CAO, CAN NANG TRE S a SINH
Pham Qudc Hung', Le Danh Tuyen^ Nguyin Cdng Khan^
Nguyen DS Huy^ TrSn Thuy Nga^, D^ng Dinh Thoang^
(CNSS). Nghien eiru du'Oc hoan thanh tai Ha Nam vao thang 2/2015 vdi 202 PNMT bo sung DVC va 202 PNMT bo sung SAF tiT khi thai 6-16 tuan tdi sau sinh 3 thang. Ket qua nghien ciTu cho thay bo sung DVC cho PNMT da cai thien CCSS, CNSS tot hdn bd sung SAF vdl miTc CO y nghTa thong ke. CCSS trung binh 6 nhom DVC (49,8 ± 2,8 cm) cao hdn nhdm SAF (49,0 ± 2,21cm). CNSS trung binh d nhom DVC (3233 ± 3S9g) cao hdn nhdm SAF (3161 ± 335g). Ty le nhe can so vdi tudi thai d nhdm DVC la 2,6%, d nhdm SAF la 7,3%. Ty le nhe can sd smh d nhdm DVC la 1,6%, 6 nhdm sat SAF la 3,7%. Nhung sU khac biet nay co y nghia thong ke (p<0,05).
Tdkhoa: da vi chat, phu nC mang thai, chieu cao sd smh, can nang sd sinh.
T O M TAT
Nghi§n CLTU cd ddi chiTng, ngau nhien cum, mu ddi nham so sanh hieu qua bd sung da vi chat (DVC) vdi sat - acid folic (SAF) d phu nij" mang thai (PNMT) ddi vdi chieu cao sd sinh (CCSS), can nang sd sinh
•^ Tdch&c Consortium for Health Action
^Vlen Dinh dudng Quoc gia
^Bo Yte
''Sd Khoa hgc va Cdng nghe Ha Nam Chiu bach nhiem chinh: Pham Qudc Hiing Email: [email protected] Ngay nhan bai: 22.7.2017 Ngay phan bien khoa hoc: 19.9.2017 Ngay duyet bai: 26.9.2017
TAP CHt Y HOC VIET NAM TAP 459 - THAHG 10 - SO 1 - 2017 SUMIVIARY
EFFECTS OF PRENATAL MULTIPLE MICRONUTRIENT VERSUS IRON-FOLIC
ACID SUPPLEMENTATION ON BIRTH WEIGHT AND BIRTH HEIGHT A double-blind, duster randomized, and controlled study was conducted to compare the effects of prenatal multiple micronutnent (MMN) with iron - folic acid (IFA) supplementation on newborn birth weight and height. The study was done in Ha Nam in 2015 with 202 pregnant women (PW) using MMN and 202 PW using IFA from 6-16 gestational weeks to 3 months postpartum. The study results showed that prenatal MMN supplementabon's effects on birth weight and height were better than IFA supplementation's with significant differences. The mean birth height of the MMN group (49.8 ± 2.8 em) was higher than that of the IFA group (49.0 ± 2,21cm). The mean birth weight of the MMN group (3233 ± 359g) was higher than that of the IFA group (3161 ± 335g). The prevalence of small for gestational age was 2.5% in the MMN group and 7.3% in the IFA group. The prevalence of low birth weight of the MMN group (1.6%) was lower than that of IFA group (3,7%).
The differences were statistically significant (p <0.05).
Key words: multiple micronutrient, pregnant women, birth weight, birth height
I. DAT VAN OE
Thieu vi chat dinh duQng (VCDD) 6 trieu phy niy mang thai (PNMT) dang la van de siTc khde toan cau. Hang nam thieu VCDD anh hu'dng tdi 20 trieu phy nu' mang thai (Pi^MT) anh hu'dng den chieu cao, can nang tre sd sinh, tae ddng den sy' phat trien lau dai ciia tre sinh ra bdi nhu'ng PNMT nay [1]. Ket qua nghien ciTu gan day d Viet Nam tren PNMT eho thay ty le thieu mau la 36,5% (trong do 71,8% la do thieu sat), 90% thieu kem, 22,4% thieu vitamin D, 72,8%
thieu iot [2]. Bien phap hu'u hieu nhat la bo sung vi chat du'dng uong, trong dd bo sung sat - acid folic da du'dc ap dyng tai nhieu nu'de trong dd ed Viet Nam. Gan day y tu'dng sd dung vien da vi chat cho PNMT thay the cho vien sat - acid folic nham bo sung ca sat va cac vi chat thieu hut khac dang du'dc nhieu su" iing hd. Tuy vay, hieu qua cua bd sung nay edn dang la van de tranh luan [3]. Nghien cu'u nay nham so sanh tae ddng cua bd sung da vi chat vdi bd sung sat ~ acid folic d PNMT ddi vdi chieu cao va can nang cua tre sd sinh.
II. 0 6 l TU'ONG VA PHU'ONG PHAP NGHIEN CO'U Ddi tu'dng nghien edu: phy nu' mang thai 5- 16 tuan d 14 xa thupc huyen Ly Nhan, tinh Ha Nam dap utig tieu chuan chap nhan va loai triT
nghien eiiu. Tieu chuan Ida chon: ed thai 6-16 tuan, sinh sdng dn dinh tai dia ban nghien edu, tinh nguyen tham gia nghien eiTu, ed ky ban chap thuan tham gia nghien ciTu. Tieu chuan loai trir: da thai, mac cac benh man tfnh nhu' tieu du'dng, tim mach, viem gan, thieu mau nang (Hb<7.0g/dl), dj iTng vdi mdt trong eae thanh phan eiia vien da vi chat, dang tham gia mdt nghien ciTu khac.
Thiet ke nghien edu: Nghien ciTu thu' nghiem can thiep cdng ddng ed ddi ehimg, ngau nhien cum, mil ddi.
7770'/5'/a/j.-tir thang 2/2013 den 2/2015.
Cd miu, chon mau: Cd 404 PNMT da du'dc tuyen chpn vao nghien culi vdi 202 PNMT bd sung da vi chat va 202 PNMT bo sung sat - acid folic. Nghien ciTu se theo doi nhu'ng tre sinh ra bdi eae PNMT tham gia nghien cu'u d hai nhdm nay. Da ed 381 tre 190 thude nhdm da vi chat va 191 nhdm thude nhdm sat - acid folic da tham gia vao dieu tra,
Vi chat bosung: vien da vi chat va vien sat - acid folic du'dc ddng gdi gidng het nhau ve kich thu'de hinh dang vdi ma so rieng. Vien sat-aeid folic vdi ham lu'dng sat nguyen t d 60 mg va folic acid 2,5mg. Vien da vi chat bao gom 15 vi chat:
sat (60mg), folic acid (2,5mg), Kem (20mg), lot (300meg), Dong (4mg), Selen (130mcg), Vitamin A (1600RE), B l (2,8mg), B2 (2,8mg), B3 (36mg), B6 (3,8mg), B12 (5,2mcg), C (140mg), D (400IU), E (20mg), Lieu lu'dng bo sung la 2 vlen/tuan, tiT 6-16 tuan thai den 3 thang sau sinh,
Phan tfch va xd ly so lieu: Sd lieu du'dc nhap bang phan mem ACCESS 2007 va phan tieh bang phan mem IBM SPSS version 20.0 (IBM Corp.
2011. IBM SPSS Statistics for Window/s).
Dao ddc nghien edu: Nghien edu da du'dc Hdi ddng khoa hoc va dao ddc nghien ciTu tinh Ha Nam phe duyet. Tat ca eae ddi tu'dng nghien culi deu du'dc gial thich ve nghien cu'u va ty' nguyen tham gia va ky vao phieu ddng y tham gia nghien edu.
III. KET QUA NGHIEN CO'U
Tong sd cd 404 phu nu" mang thai 6-16 tuan tham gia can thiep gdm 202 PNMT d nhdm da vi chat va 202 PNMT d nhdm sat-aeid folic. Khong ed su" khac biet ed y nghia thdng ke giu'a 2 nhdm ve eae dac diem dan tde, trinh dd van hda, nghe nghiep, lioan canh kinh te ho gia dinh, dp tuoi, so con trung binh.
VIETNAM MEDICAL JOURNAL N°1 . OCTOBER - 2017 Bang 1. Oac diem tfinft du'dng liai nham tru'dc khi can thiep
Chi so BMI trirdc khi CO thai (kq/m2)
Can nanq Ckq) Chieu cao (cm) Vonq canh tay (cm) Nonq do Hemoqiobin (q/L)
Nonq do TfR HT (mq/L) Nonq do Ferritin HT (ijq/L)
Nhom Sat-Acid folic C n = 2 0 2 ) ( T B i S D ;
19,69 ± 1,94 46,93 ± 5,46 154,3 ± 4,89 23,81 ± 1,97 118,24 ± 11,43 2,84 ± 0,65 TV (2^-7^)
55,5 (36 - 86)
Nhom Oa vi chat (n
= 2 0 2 ) (TB±SD) 19,65 ± 1,95 46,04 ± 5,31 153,02 ± 4,50 23,76 ± 2,12 118,14 ± 10,03
2,92 ± 0,62 TV (2^" - 7^°)
58 (39 - 83) p»
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05 p**
>0,05
*^ T-test doc lip cho 2 gia tri trung binh;
**) Test Mann Whitney cho 2 gia tri trung vi.
Ket qua nghien ciTu bang 1 eho thay khdng cd su" khac biet ed y nghTa thdng ke (p>0,05) ve cac ehi sd BMI, chieu eao, can nang, vdng canh tay, ndng do hemoglobin, tranferin receptor, ferritin huyet thanh giu'a hai nhdm da vi chat va sat - acid folic trong dieu tra ban dau tru'dc khi can thiep.
Bing 2. So sanh dae die'm ve thai sin eua hai nhdm
Chi so
Tuoi thai l<hi sinh: Sinh non (<34 tuan) Sinh sdm (34-37 tuan) Du thang (38-41 tuan) Gia thang (>41 tuan) Hinh thii'c de: £)e thu'dnq
De mo De chi huy
Nhom Sat-Acid folic n=191) n 0 8 182
1 165
23 3
%
0 4,2 95,3 0,5 86,4 12,0 1,6Nhom Da vi chat (n=190) n 2 9 177
2 151
35 4
1,1
%
4,7 93,2 1,1 79,5 18,4 2,1
P ,
> 0,05*
> 0,05*
Bang 2 cho thay ty le sinh non (thai <34 tuan) d nhdm da vi chat la 1,1%, nhdm sat - acid folic la 0%. Ty le sinh sdm (thai 34-37 tuan) d nhdm da vi chat la 4,7%, d nhdm sat - acid folic la 4,2%. Ty le sinh dii thang (thai 38-41 tuan) d nhdm da vi chat la 93,2%, nhdm sat - acid folic la 95,3%. Ty le sinh gia thang (thai > 41 tuan) d
*Flsher's Exact Test, Bootstrap 1000 samples, nhdm da vl chat la 1,1%, nhdm sat - acid folic la 0,5%. Ty le de thu'dng d nhdm da vi chat la 79,5%, d nhdm sat - acid folic la 86,4%. Ty le de md d nhdm da vl chat la 18,4%, d nhdm sat -add folic la 12%; Ty le de chi huy d nhdm da vi chat la 2 , 1 % , d nhdm sat -acid folic la 1,6%. Su' khac biet khdng cd y nghTa thdng ke (p>0,05).
Bang 3. So sanh dac diem nhan trSc tre sdsinh ciia hai nhom Chi so
Tre trai Nhe can so vdi tuoi thai
Nhe can sd sinh So tuan tuoi thai khi sinh
Can nang sd sinh (g) Chieu cao sd sinh (cm)
Nhom Sat-Acid folic(n=191)
nm) 101 (52,9%)
14 (7,3%) 7 (3,7%) (TB±SD) 39,2 ± 1,5 3161 ± 335 49,0 ± 2,21
Nhom Da vi chat (n=190)
nC/o) 98 (51,6%)
5 (2,6%) 3 (1,6%) (TBISD) 39,0 ± 1,6 3233 ± 359 49,8 ± 2,8
P
> 0,05'
< 0 , 0 5 "
> 0,05"
>0,05'
< 0 , 0 5 '
< 0 , 0 5 ' a) Test / ; b) Fisher's Exact Test, bootstrap
1000 samples; c) T-test dpc lap cho 2 gia tri trung binh.
Bang 3 cho thay ty le tre trai d nhdm DVC la 51,6% va nhdm SAF la 52,9%; sd khac biet khdng cd y nghTa thdng ke (p>0,05). Ty le nhe can so vdi tuoi thai d nhdm da vl chat la 2,6%, d nhdm SAF la 7,3%; sy' khac biet cd y nghTa
thdng ke (p <0,05). Ty le nhe can sd sinh (<2500g) d nhdm da vi chat la 1,6%, d nhom sat - acid folic la 3,7%, su' khac biet khdng cd '^
nghTa thdng ke (p>0,05). Sd tuan mang thai trung binh d nhdm da vi chat la 39,0 ± 1,6 tuan nhd hdn d nhdm sat - acid folic la la 39,2 ± 1,5 tuan; su' khac biet khdng cd y nghTa thdng k§.
CNSS trung binh d nhdm da vi chat (3233 ± 359
TAP CHi Y HOC VIET HAM TAP 459 - T H A N G 10 - S 0 1 • 2017 g) eao hdn nhdm sat - acid folic (3161 ± 335 g);
SLi" khac biet cd y nghTa thdng ke (p<0,05). CCSS trung binh d nhdm da vi chat (49,8 ± 2,8 em) cao hdn nhdm sat - acid folic (49,0 ± 2,21cm);
SLT khac biet cd y nghTa thong ke (p<0,05). sd khac biet ed y nghTa thdng ke (p<0,05).
IV. BAN LUAN
Bosung da vl chat cho PNf^T da cai thien can nang sd sinh tdt hdn bd sung sat - acid folic vdi mdc cd y nghia thong ki. CNSS trung binh d nhom da vl chat (3233 ± 359 g) cao hdn nhdm sat - add folic (3161 ± 335 g) sy" chenh lech cd y nghTa thdng ke (p<0,05). Ket qua nay tu'dng td ket qua nghien ciTu ciia Nguyen Do Huy (2009) d Kim Sdn, VTnh Bao [4] vdi can nang trung binh nhdm da vi chat la 3131 ± 422g va d nhdm sat - add folic la 3070 ± 428 g. Xu hu'dng CNSS trung binh d nhdm da vl chat cao hdn nhdm sat - acid folic cung thay d mot sd nghien ciru khac d Bangladesh, Nepal, Burkina Faso [ 3 ] . Tuy nhien, nghiSn ciTu d mdt sd ndi khac lai cho thay viec bd sung da vi eliat khdng lam t^ng CNSS trung binh nhu' nghien cuti d Mexico, Anh [ 3 ] . Cd mdt sd gia thiet giai thich sy" khac biet lien quan den CNSS nhu' tinh trang dinh duSng ngu'di me, tinh trang kinh te van hda xa hdi, che dp an udng, benh tat, nhiem triing. Ket qua nghien eiTu eua Lg Thi Hdp theo ddi trong hai thap nien eho thay d Viet Nam nhu'ng nam 1981 - 1984 khi kinh te kho khan thi CNSS trung binh d Ha Ndi la 3,03kg den nhu'ng nam 1998 -1999, dieu kien kinh te van hda xa hdi tot len, can nang sd sinh trung binh d Ha Ndi da tang len 3,22 kg [5].
Bosung da vi chat co hieu qua tdt hdn sat - add folic trong viec lam giam ty IS nhe can so vdi tudi thai. Ty le nhe can so vdi tudi thai da dieu chinh theo gidi tinh d nhdm da vi chat la 2,6%, d nhdm sat - acid folic la 7,3%. Sy' khac biet ed y nghTa thong ke (p<0,05). Xu hu'dng nay cung thay d cac nghien eiTu ciia Frlis (2007) [6], Roberfrold (2008) [7].
Bosung da vi chat co xu hu'dng tdt hdn bo^
sung sat - acid folic trong viec lam giam ty le nhe dn sd sinh. Tuy nhien sd l<hac biet khong CO y nghia thong ke. Ty le nhe can sd sinh (<2500g) d nhdm da vl chat la 1,6%, d nhdm sat - acid folic la 3,7% (p>0,05). Xu hu'dng cai thien tinh trang sd sinh nhe can d nhdm da vi chat d nghien ciTu ciia chung tdi phii hdp vdi ket qua nghien ciTu ciia Nguyen Do Huy (2009) d Klm Sdn va VTnh Bao vdi ty le nhe can sd sinh d nhdm da vi chat la 4 % va nhdm s k - acid folic la 10%. Xu hu'dng cai thien tinh trang sd sinh nhe can cung phii hdp vdl mot sd nghien ciTu khac d
Pakistan, Bangladesh [3].
Bd sung da vi chat cho PNPiT da cai thien chieu cao sdsinh tdt hdn bosung sat - add folic vdi mdc co y nghia thdng ke. Chieu eao sd sinh trung binh d nhdm da vl chat (49,8 ± 2,8em) cao hdn nhdm sat - acid folic 0,8cm (49,0 ± 2,21 em) vdi mire cd y nghTa thdng ke (p<0,05). Ket qua nghien ciTu eiia Nguyen Dang Tru'dng d An Lao cung cho thay CCSS trung binh d nhdm da vi chat (49.7 ± 2.2em) ed xu hu'dng eao hdn nhdm sat - acid folic (49.5 ± 2.4em). Xu hu'dng tang chieu eao sd sinh eung thay d eae nghien edu d Nepal, Bukina, Bangladesh [3].
V. KET LUjCiN, KHUYEN NGH[
Bd" sung da vi chat d PNMT da cai thien chieu eao, can nang sd sinh tdt hdn bd sung sat - acid folic vdi mire cd y nghTa thdng ke (p<0,05). Can nang sd sinh trung binh d nhdm da vi chat (3233
± 359g) cao hdn nhdm sat - acid folic (3161 ± 335 g). Ty le nhe can so vdi tuoi thai d nhdm da VI chat la 2,6%, d nhdm sat - add folic la 7,3%, Ty le nhe can sd sinh (<2500g) d nhdm da vi chat la 1,6%, d nhdm sat - add folic la 3,7%.
Chieu eao sd sinh trung binh d nhdm da vi chat (49,8 ± 2,8em) eao hdn nhdm sat - acid folic 0,8cm (49,0 ± 2,21cm).
Bd sung da vi chat eho PNMT cd the la mdt bien phap tdt hdn bo sung sat - acid folic eho PNMT trong viee cai thien chieu cao, can nang sd sinh.
TAI Ll|U THAM KHAO
1 Micronutrient Initiative, Investing in the future:
a united call to action on vitamin and mineral deficiencies. 2009.
2 Vien Dinh du^ng Qudc gia, 'Dieu tra vi chat dinh dudng nam 2014-2015'.
3 Haider BA, Bhutta ZA, 'Multiple-mieronutrient supplementation for women during pregnancy', Cochrane Database of Systematic Reviews 2017, no. 4.Art. ND.CD004905. 2017.
4 Nguyen Do Huy, Le Thi Hop, et al, 'An effectiveness trial of multiple micronutrient supplementation dunng pregnancy in Vietnam:
impact on birthweight and on stunting', Food Nutr.
Bull, vol. 30, no. 4, 2009, pp. 506-516.
5 Le Thi Hop, 'Secular trend in size at birth of Vietnamese newborns during the last 2 decades (1980-2000)', Asia Pac. J. Clin. Nutr., vol. 12, no.
3, 2003, pp.266-270.
6 Friis, H. et al., 'Effect of multimicronutrient supplementation on gestational length and birth size: A randomized, placebo-controlled, double- blind effectiveness trial in Zimbabwe', Am. J. Clin.
Nutr., vol. 80, no. 1, 2004, pp. 178-184.
7 Roberfroid, D. etal., 'Impact of prenatal multiple micronutnents on survival and growth dunng infancy: A randomized controlled trial'. Am. J. Clin.
Nutr., vol. 95, no. 4, 2012, pp. 916-924.
