В настоящей статье приведены результаты рандомизированного проспективного контролируемого исследования оценки насыщенно- сти организма беременной витамином D с исходным дефицитом или недостатком 25(ОН)D в сыворотке. В 12–16 нед произведены пер- вый забор крови и рандомизация. Проанализированы 2 группы женщин, которые ежедневно с I триместра до родов в течение 25 нед при- нимали колекальциферол в дозировке 500 МЕ (1-я группа, n=45) и 2000 МЕ (2-я группа, n=45). Исходный средний уровень 25(ОН)D у всех бе- ременных не имел значимых различий (16,45 и 16,5 нг/мл соответственно). Ни у одной из женщин 1-й группы не был зарегистрирован итоговый уровень 25(ОН)D, соответствующий значению нормы; 95,55% пациентов 2-й группы (n=43) достигли уровня 25(ОН)D в сыво- ротке 30 нг/мл (средний уровень 39,11 нг/мл). Исследование показало эффективность применения 2000 МЕ колекальциферола, что может быть рекомендовано беременным женщинам с уровнем 25(ОН)D<30 нг/мл в сыворотке крови.
This article presents the results of a randomized prospective controlled study assessing the saturation of pregnant women with vitamin D deficiency with the original difficiency or a lack of 25(OH)D, the first blood sampling and randomization was produced at 12-16 weeks. two groups of women who have been daily recieving сolecalciferol in doses of 500 IU (Group 1, n = 45) and 2000 IU (group 2, n = 45) from first trimester until delivery was analyzed . Ini- tial average level of 25(OH)D in all pregnant women had no significant difference (16,45 ng/ml and 16,5 ng/ml, respectively). None of women of first group reached the final level of 25(OH)D corresponding to the value of the norm; 95,55% of patients in group 2 (n=43) reached the level of serum 25(OH)D 30 ng/ml (mean level of 39,11 ng/ml). Research has shown the efficacy of сolecalciferol intake in doses of 2,000 IU, which may be recommended for pregnant women with 25(OH)D serum <30 ng/ml.
1. J Clin Endocrinol Metab 2013; 98: 2337–46.
2. De-Regil LM, Palacios C, Ansary A et al. Vitamin D supplementation for women during pregnancy. Cochrane Collaboration, 2012.
3. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an En- docrine Society Clinical Practice Guideline. 2011.
4. Holick MF. Vitamin D deficiency. N Engl J Med 2009; 357: 266–81.
5. Karras SN. Maternal vitamin D status during pregnancy: the Mediterra- nean reality. Eur J Clin Nutr 2014.
6. Bess Dawson-Hughes and Robert Josse. Vitamin D status in North Ame- rica, Osteoporosis International, 2010.
7. Parlak M. Severe vitamin D deficiency among pregnant women and their newborns in Turkey. J Matern Fetal Neonatal Med 2014.
8. Dietary reference intakes for calcium and vitamin D. Institute of medi- cine 2010.
9. Dietary Supplement Fact Sheet: Vitamin D. Office of Dietary Supplements National Institutes of Health Bethesda, Maryland 20892 USA. 2009.
10. Dawodu A, Hollis BW. Cincinnati Children’s Hospital Medical Center, Medicine and Health Sciences, United Arab Emirates University, and Ta- wam Hospital (G.B.), Al-Ain, United Arab Emirates; and Department of Pe- diatrics (B.W.H.), Medical University of South Carolina. 2014.
11. Walker VP et al. Vitamin D connection to pediatric infections and im- mune function. Pediatr Research 2009.
12. Forouhi NG, Luan J, Cooper A et al. Baseline serum 25-hydroxy vitamin D is predictive of future glycaemic status and insulin resistance: The MRC Ely prospective study 1. Diabetes 2008.
13. Maghbooli Z, Hossein-Nezhad A, Karimi F et al. Correlation between vi- tamin D(3) deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24: 27–32.
14. Clifton-Bligh RJ, McElduff P, McElduff A. Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med 2008; 25: 678–84.
15. Gale CR et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr 2008.
16. Wagner CL et al. Prevention of Rickets and Vitamin D Deficiency in In- fants, Children, and Adolescents, Pediatrics, 2008.
17. Pinelli NR. Serum 25-Hydroxy Vitamin D and Insulin Resistance, Meta- bolic Syndrome, and Glucose Intolerance Among Arab Americans; Articles from Diabetes Care, American Diabetes Association. 2010.
18. Weinert LS. Maternal-Fetal Impact of Vitamin D Deficiency: A Critical Review. Maternal Child Health J 2014.
19. Yap C. Vitamin d supplementation and the effects on glucose metabo- lism during pregnancy: a randomized controlled trial. Diabetes Care 2014.
20. Skowrońska-Józwiak E. Assessment of adequacy of vitamin D supple- mentation during pregnancy. Ann Agric Environ Med 2014.
21. Zhou J. Associations between 25-hydroxyvitamin D levels and pre- gnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr 2014.
22. Новикова Т.В., Зазерская И.Е. и др. Насыщенность организма ви- тамином D и течение перинатального периода. Обзор. Журн. аку- шерства и женских болезней. 2014; LXIII; 3.
23. Heaney R et al. Human serum 25-hydrocholecalciferol response to ex- tended oral dosing with cholecalciferol. Am J Clin Nutr 2013; 74: 204–10.
24. Солнцев В.Н., Черкашин Д.В. Анализ корреляционной структуры факторов сердечно-сосудистого риска. Тезисы Всероссийской на- учно-практической конференции с международным участием «Высокотехнологические методы диагностики и лечения заболева- ний сердца, крови и эндокринных органов». Бюллетень федераль- ного центра сердца, крови и эндокринологии им. В.А.Алмазова. 2010; 2: 217–8.
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1. J Clin Endocrinol Metab 2013; 98: 2337–46.
2. De-Regil LM, Palacios C, Ansary A et al. Vitamin D supplementation for women during pregnancy. Cochrane Collaboration, 2012.
3. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an En- docrine Society Clinical Practice Guideline. 2011.
4. Holick MF. Vitamin D deficiency. N Engl J Med 2009; 357: 266–81.
5. Karras SN. Maternal vitamin D status during pregnancy: the Mediterra- nean reality. Eur J Clin Nutr 2014.
6. Bess Dawson-Hughes and Robert Josse. Vitamin D status in North Ame- rica, Osteoporosis International, 2010.
7. Parlak M. Severe vitamin D deficiency among pregnant women and their newborns in Turkey. J Matern Fetal Neonatal Med 2014.
8. Dietary reference intakes for calcium and vitamin D. Institute of medi- cine 2010.
9. Dietary Supplement Fact Sheet: Vitamin D. Office of Dietary Supplements National Institutes of Health Bethesda, Maryland 20892 USA. 2009.
10. Dawodu A, Hollis BW. Cincinnati Children’s Hospital Medical Center, Medicine and Health Sciences, United Arab Emirates University, and Ta- wam Hospital (G.B.), Al-Ain, United Arab Emirates; and Department of Pe- diatrics (B.W.H.), Medical University of South Carolina. 2014.
11. Walker VP et al. Vitamin D connection to pediatric infections and im- mune function. Pediatr Research 2009.
12. Forouhi NG, Luan J, Cooper A et al. Baseline serum 25-hydroxy vitamin D is predictive of future glycaemic status and insulin resistance: The MRC Ely prospective study 1. Diabetes 2008.
13. Maghbooli Z, Hossein-Nezhad A, Karimi F et al. Correlation between vi- tamin D(3) deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24: 27–32.
14. Clifton-Bligh RJ, McElduff P, McElduff A. Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med 2008; 25: 678–84.
15. Gale CR et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr 2008.
16. Wagner CL et al. Prevention of Rickets and Vitamin D Deficiency in In- fants, Children, and Adolescents, Pediatrics, 2008.
17. Pinelli NR. Serum 25-Hydroxy Vitamin D and Insulin Resistance, Meta- bolic Syndrome, and Glucose Intolerance Among Arab Americans; Articles from Diabetes Care, American Diabetes Association. 2010.
18. Weinert LS. Maternal-Fetal Impact of Vitamin D Deficiency: A Critical Review. Maternal Child Health J 2014.
19. Yap C. Vitamin d supplementation and the effects on glucose metabo- lism during pregnancy: a randomized controlled trial. Diabetes Care 2014.
20. Skowrońska-Józwiak E. Assessment of adequacy of vitamin D supple- mentation during pregnancy. Ann Agric Environ Med 2014.
21. Zhou J. Associations between 25-hydroxyvitamin D levels and pre- gnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr 2014.
22. Новикова Т.В., Зазерская И.Е. и др. Насыщенность организма ви- тамином D и течение перинатального периода. Обзор. Журн. аку- шерства и женских болезней. 2014; LXIII; 3.
23. Heaney R et al. Human serum 25-hydrocholecalciferol response to ex- tended oral dosing with cholecalciferol. Am J Clin Nutr 2013; 74: 204–10.
24. Солнцев В.Н., Черкашин Д.В. Анализ корреляционной структуры факторов сердечно-сосудистого риска. Тезисы Всероссийской на- учно-практической конференции с международным участием «Высокотехнологические методы диагностики и лечения заболева- ний сердца, крови и эндокринных органов». Бюллетень федераль- ного центра сердца, крови и эндокринологии им. В.А.Алмазова. 2010; 2: 217–8.
Авторы
Е.Л.Хазова, В.А.Барт, И.Е.Зазерская, Е.Н.Беляева
ФГБУ Федеральный медицинский исследовательский центр им. В.А.Алмазова Минздрава России, Санкт-Петербург