Фолиевая кислота и ее роль в женской репродукции

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Аннотация

Адекватный фолатный статус – необходимое условие нормального течения беременности, развития плода и ребенка. Современные клинические исследования позволили расширить классические рекомендации по приему фолиевой кислоты для предотвращения акушерских осложнений и пороков развития плода. Дотация фолиевой кислоты на этапе прегравидарной подготовки и во время беременности служит важным фактором профилактики самопроизвольного выкидыша, преждевременных родов, нарушений функции фетоплацентарного комплекса, пороков развития плода и рождения незрелых или маловесных детей. Оптимальная доза фолатов, необходимая для компенсации их недостатка (в дополнение к фолатам, получаемым с продуктами питания), колеблется в пределах от 400 до 800 мкг. Применение фолиевой кислоты в комплексе с другими витаминами и минералами, необходимыми во время беременности, оказывает лучший эффект по сравнению с монотерапией препаратами фолиевой кислоты. В настоящее время существуют препараты, в состав которых вместо фолиевой кислоты входит L-метилфолат. В Европе было проведено сравнительное плацебо-контролируемое исследование, в котором сравнили влияние применения L-метилфолата ([6S]-5-метилтетрагидрофолата) и фолиевой кислоты на концентрацию фолатов в плазме и эритроцитах. Данные исследования свидетельствуют о том, что метилфолат и фолиевая кислота увеличивают концентрацию фолатов в крови на аналогичном уровне, таким образом, не имеет смысла использовать метилфолат вместо фолиевой кислоты, которая имеет широкую доказательную базу.

Ключевые слова: фолаты, фолиевая кислота, дефицит фолатов, сравнение фолиевой кислоты и L-метилфолата, гипергомоцистеинемия, невынашивание беременности, витамины у беременных.

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Adequate folate status is a necessary condition for a normal pregnancy, the development of the fetus and child. Recent clinical studies have enhanced the classic recommendations for folic acid intake for the prevention of obstetric complications and fetal malformations. Subsidy of folic acid in the stage of pregravidal preparation and during pregnancy is an important factor in the prevention of miscarriage, premature birth, dysfunction of the fetoplacental complex, fetal malformations and birth weight of infants or immature children. The optimal dose of folate required to compensate for their lack (in addition to folate derived from food), ranges from 400 to 800 micrograms. The use of folic acid in combination with other vitamins and minerals needed during pregnancy has a better effect compared with monotherapy with folic acid. At the moment, there are drugs with structure that, instead of folic acid includes L-methylfolate. In Europe, a comparative, placebo-controlled study, which compared the effects of the use of L-methylfolate ([6S] -5-methyltetrahydrofolate) and folic acid in folate concentration in plasma and erythrocytes was recently held. These studies suggest that folic acid and methylfolate increase the concentration of folate in the blood at the same level, so it makes no sense to use methylfolate instead of folic acid, which has a broad evidence base.

Key words: folate, folic acid, folate deficiency, a comparison of folic acid and L-methylfolate, hyperhomocysteinemia, miscarriage, vitamins in pregnancy.

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Авторы

И.В.Кузнецова1, 2, В.А.Коновалов3, 4

1. ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России;
2. ФГБОУ ВПО Российский университет дружбы народов, Москва
3. ФДПО ГБОУ ВПО Рязанский государственный медицинский университет им. акад. И.П.Павлова Минздрава России;
4. ГБУ РО Женская консультация №1

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I.V.Kuznetsova, V.A.Konovalov

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