寻求生育治疗夫妇的补充剂使用与活产及妊娠丢失的关联
该研究基于FAZST与IDEAL两项研究进行二次分析，纳入2370对寻求生育治疗的夫妇，随访≤18个月。发现女性复合维生素使用与活产几率增加相关（aRR=1.22），男性无此关联；双方补充剂使用均与妊娠丢失无关。
要点
- 女性复合维生素使用与活产几率增加相关，男性使用无关。
- 女性复合维生素的活产关联仅见于未接受治疗者。
- 双方复合维生素使用均与妊娠丢失无关联。
核心结论
- 在寻求生育治疗的夫妇中，女性复合维生素使用与活产可能性增加相关。
- 男性或女性补充剂使用均与妊娠丢失无关联。
研究设计与样本
- 基于FAZST和IDEAL研究的二次分析，随访≤18个月。
- 纳入2370对寻求生育治疗的夫妇。
- 采用Poisson模型估计风险比（RR）和95%置信区间（CI），调整混杂因素并加权选择偏倚。
主要发现
- 基线时37%男性和67%女性使用复合维生素，总体35%夫妇获得活产。
- 女性复合维生素使用与活产增加相关（aRR=1.22；95% CI：1.05-1.41），男性无关联（aRR=1.00；95% CI：0.89-1.12）。
- 分层分析中，女性复合维生素的活产关联仅见于未接受治疗者（aRR=1.44；95% CI：1.00-2.08）。
- 女性叶酸（aRR=1.18；95% CI：0.95-1.48）和鱼油（aRR=1.09；95% CI：0.86-1.36）与活产无关联；男性鱼油和维生素C无关联。
- 1054对（44%）夫妇妊娠，其中218对（21%）发生妊娠丢失；双方复合维生素使用与妊娠丢失无关联。
临床怎么用
- 对于寻求生育治疗的女性，可考虑复合维生素补充以可能提高活产机会。
- 男性复合维生素使用未见与活产或妊娠丢失相关。
- 女性复合维生素的活产关联主要见于未接受生育治疗者，需结合治疗状态个体化咨询。
局限性
- 为二次分析，原始研究设计可能限制因果推断。
- 补充剂使用为基线自我报告，可能存在错分。
- 随访时间≤18个月，长期结局未知。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To assess the supplement use patterns among couples seeking fertility treatment and to assess the association between supplement use and live birth and pregnancy loss. DESIGN: A secondary analysis using Folic Acid and Zinc Supplementation Trial (FAZST) and Impact of Diet, Exercise, and Lifestyle on Fertility Study (IDEAL) of couples seeking fertility treatment, followed for ≤18 months. SUBJECTS: Couples seeking fertility treatment. EXPOSURE: Multivitamin and five most common supplements used among females (calcium, fish oil, folic acid, vitamin B12, vitamin C) and males (coenzyme Q10, fish oil, vitamin B12, vitamin C, and zinc) collected at baseline. MAIN OUTCOME MEASURES: Live birth and pregnancy loss were ascertained via self-report and medical records. Poisson models with robust variance estimates were used to estimate risk ratios (RR) and 95% confidence intervals (CI), adjusting for confounders and weighted for selection bias. RESULTS: Among 2,370 couples, 37% of males and 67% of females used a multivitamin at baseline. Overall, 35% of couples achieved a live birth. Multivitamin use in female (adjusted risk ratio [aRR] = 1.22; 95% CI: 1.05-1.41), but not the male (aRR = 1.00; 95% CI: 0.89-1.12) partner, was associated with an increased chance of live birth. When stratified by fertility treatment, female multivitamin use was associated with live birth only among partners who underwent no treatment (aRR = 1.44; 95% CI: 1.00-2.08). Among females, folic acid (aRR = 1.18; 0.95-1.48) and fish oil (aRR = 1.09; 95% CI: 0.86-1.36) showed no live-birth association; males showed null findings for fish oil and vitamin C. 1054 (44%) conceived and of those, 218 (21%) had a pregnancy loss. There was no association between multivitamin use in either partner and pregnancy loss. CONCLUSION: Among couples seeking infertility treatment, supplement use was common among both female and male partners, with the majority taking a multivitamin. There was evidence that multivitamin use in female partners was associated with increased likelihood of live birth.
引用
- Sealy NRZ, Mumford SL, Caniglia EC, et al. Supplement use among couples seeking fertility treatment and associations with live birth and pregnancy loss. Fertil Steril. 2026. PMID: 42031092. doi:10.1016/j.fertnstert.2026.04.008
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。