Витамины и минералы абсолютно необходимы для обеспечения нормального зачатия, беременности, развития плода и ребенка, и широкое распространение микронутриентной недостаточности в современной популяции неблагоприятно отражается на состоянии здоровья матерей и детей. Дотация витаминов и минералов 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, причем оптимальным способом введения необходимых микронутриентов признается использование витаминно-минеральных комплексов. Витаминно-минеральные комплексы имеют очевидные преимущества по сравнению с дотацией отдельных микронутриентов у беременных женщин. В обзоре освещается роль витаминов и минералов в успешном течении беременности и обосновывается их профилактическое применение. Ключевые слова: беременность, витамины, минералы, микронутриентный дефицит, осложнения беременности, пороки развития новорожденных.
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Vitamins and minerals are essential for normal conception, pregnancy, fetal and child's development. Widespread micronutrient deficiency in the modern population adversely affects the health of both mothers and children. The use of vitamins and minerals in step pregravidal preparation and during pregnancy is an important factor in the prevention of miscarriage, premature delivery, impaired function of the fetoplacental complex, fetal malformations and weight lacking infants or immature ones, and, the best way to introduce the necessary micronutrients is the use of vitamin-mineral complexes .Vitamin and mineral complexes have obvious advantages in comparison with a subsidy of some micronutrients in pregnant women. The review highlights the role of vitamins and minerals in a successful pregnancy and justified their prophylactic use. Key words: pregnancy, vitamins, minerals, micronutrient deficiency, pregnancy complications, neonatal malformations.
1. Беременность и роды. Кохрановское руководство. Под ред. Г.Т.Сухих. М.: Логосфера, 2010.
2. Генетический паспорт – основа индивидуальной и предиктивной медицины. Под ред. В.С.Баранова. СПб.: Изд-во Н-Л, 2009.
3. Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of NTDs. Eur J Pediatr 2011; 170: 1391–400.
4. Guillette JrLJ, Moore BC. Environmental contaminants, fertility, and multioocytic follicles: a lesson from wildlife? Semin Reprod Med 2006; 24 (3): 134–41.
5. Torshin IY, Gromova OA. Magnesium and pyridoxine: fundamental studies and clinical practice. Nova Science 2009.
6. Маталыгина О.А. Питание беременных и кормящих женщин. Решенные и нерешенные проблемы. Вопр. соврем. педиатрии. 2008; 7 (5): 23–9.
7. Хорошилов И.Е., Успенский Ю.В. Новые подходы в лечебном питании беременных и кормящих женщин. Гинекология. 2008; 4: 67–77.
8. Lennard L. Methyltransferases. In: Guengerich FP (ed) Bio-transformation. Comprehensive toxicology, 2010; 4 (Chap 21). Elsevier, Oxford, UK.
9. Wu X, Zou T, Cao N et al. Plasma homocysteine levels and genetic polymorphisms in folate metablism are associated with breast cancer risk in chinese women. Hered Cancer Clin Pract 2014; 12 (1): 2.
10. Berenson AB, Rahman M. Effect of hormonal contraceptives on vitamin B12 leveland the association of the latter with bonemineraldensity. Contraception 2012; 86 (5): 481–7.
11. Monteiro JP, Wise C, Morine MJ et al. Methylation potential associated with diet, genotype, protein, and metabolite levels in the Delta Obesity Vitamin Study. Genes Nutr 2014; 9: 403–22.
12. Baumgartner MR. Vitamin-responsive disorders: cobalamin, folate, biotin, vitamins B1 and E. Handb Clin Neurol 2013; 113: 1799–10.
13. Abe I, Shirato Y, Hashizume Y et al. Folate-deficiency induced cell-specific changes in the distribution of lymphocytes and granulocytes in rats. Environ Health Prev Med 2013; 18: 78–84.
14. Mujawar SA, Patil VW, Daver RG. Study of serum homocysteine, folic acid and vitamin B12 in patients with preeclampsia. Indian J Clin Biochem 2011; 26 (3): 257–60.
15. Rodriguez-Guillen MR, Torres-Sánchez L, Chen J et al. Hernández-Valero, Lizbeth López-Carrillo. Dietary consumption of B vitamins, maternal MTHFR polymorphisms and risk for spontaneous abortion. Salud Publica Mex 2009; 51 (1): 19–25.
16. Schmidt RJ, Tancredi DJ, Ozonoff S et al. Maternal periconceptionalfolic acid intake and risk of autism spectrum disorders and developmental delay in the CHARGE (CHildhoodAutism Risks from Genetics and Environment) case-control study. Am J Clin Nutr 2012; 96 (1): 80–9.
17. Orjuela MA, Cabrera-Muñoz L, Paul L et al. Risk of retinoblastoma is associated with a maternal polymorphism in dihydrofolatereductase (DHFR) and prenatal folic acid intake. Cancer 2012; 118 (23): 5912–19.
18. De-Regil LM, Fernández-Gaxiola AC, Dowswell T, Peña-Rosas JP. Effects and safety of periconceptionalfolate supplementation for preventing birth defects. Cochrane Database Syst Rev 2010; 10: CD007950.
19. Imbard A, Benoist J-F, Blom HJ. Neural Tube Defects, Folic Acid and Methylation. Int J Environ Res Public Health 2013; 10 (9): 4352–89.
20. Mosley BS, Cleves MA, Siega-Riz AM et al. Neural tube defects and maternal folate intake among pregnancies conceived after folic acid fortification in the United States. Am J Epidemiol 2009; 169: 9–17.
21. Oyama K. Folic acid prevents congenital malformations in the offspring of diabetic mice. Endocr J 2009; 56 (1): 29–37.
22. Громова О.А., Торшин И.Ю., Тетруашвили Н.К., Сидельникова В.М. Нутрициальный подход к профилактике избыточной массы тела новорожденных. Гинекология. 2010; 12 (5): 56–61.
23. Krawinkel MB, Strohm D, Weissenborn A et al. Revised D-A-CH intake recommendations for folate: how much is needed? Eur J Clin Nutr 2014; 68 (6): 719–23.
24. Громова О.А., Торшин И.Ю. Применение фолиевой кислоты в акушерстве и гинекологии. М.: РСЦ ЮНЕСКО, 2009.
25. Bailey SW, Ayling JE. Rapid folate repletion: an adjunct approach for reduction of risk for neural tube and other birth defects. Abstr 18th World Congr Controvers Obstet Gynecol Infert 2013; 90.
26. Brämswig S, Prinz-Langenohl R, Lamers Y et al. Supplementation with a multivitamin containing 800 microg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women. Int J Vitam Nutr Res 2009; 79 (2): 61–70.
27. Yoshino K, Nishide M, Sankai T et al. Validity of brief food frequency questionnaire for estimation of dietary intakes of folate, vitamins B6 and B12, and their associations with plasma homocysteine concentrations. Int J Food Sci Nutr 2010; 61 (1): 61–7.
28. Scaglione F, Panzavolta G. Folate, folicacidand 5-methyltetrahydrofolate are notthesamething. Xenobiotica 2014; 44 (5): 480–8.
29. Molloy AM, Kirke PN, Troendle JF. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification. Pediatrics 2009; 123 (3): 917–23.
30. Zhang T, Xin R, Gu X, Wang F. Maternal serum vitamin B12, folate and homocysteine and the risk of neural tube defects in the offspring in a high-risk area of China. Public Health Nutr 2009; 12 (5): 68086.
31. Chan J, Deng L, Mikael LG. Low dietary choline and low dietary riboflavin during pregnancy influence reproductive outcomes and heart development in mice. Am J Clin Nutr 2010; 91 (4): 1035–43.
32. Robitaille J, Carmichael SL, Shaw GM, Olney RS. Maternal nutrient intake and risks for transverse and longitudinal limb deficiencies: data from the National Birth Defects Prevention Study, 1997–2003. Birth Defects Res A Clin Mol Teratol 2009; 85 (9): 773–9.
33. Wallenstein MB, Shaw GM, Yang W, Carmichael SL. Periconceptional nutrient intakes and risks of orofacial clefts in California. Pediatr Res 2013; 74 (4): 457–65.
34. Shaw GM, Carmichael SL, Yang W, Lammer EJ. Periconceptional nutrient intakes and risks of conotruncal heart defects. Birth Defects Res A Clin Mol Teratol 2010; 88 (3): 144–51.
35. Nakajima Y1, Imanaka-Yoshida K. New insights into the developmental mechanisms of coronary vessels and epicardium. Int Rev Cell Mol Biol 2013; 303: 263–317.
36. Hill B, Holroyd R, Sullivan M. Clinical and pathological findings associated with congenital hypovitaminosis A in extensively grazed beef cattle. Aust Vet J 2009; 87 (3): 94–8.
37. Clagett-Dame M, Knutson D. Vitamin A in Reproduction and Development. Nutrients 2011; 3 (4): 385–428.
38. Beurskens LW, Tibboel D, Retinol status of newborn infants is associated with congenital diaphragmatic hernia. Pediatrics 2010; 126 (4): 712–20.
39. Chen K, Zhang X, Wei XP. Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life. Early Hum Dev 2009; 85 (7): 421–7.
40. Askin DF, Diehl-Jones W. Pathogenesis and prevention of chronic lung disease in the neonate. Crit Care Nurs Clin North Am 2009; 21 (1): 11–25.
41. Thorne-Lyman AL, Fawzi WW. Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2012; 26 (1): 10.1111/j.1365-3016.2012.01284.x.
42. Dheen ST, Tay SS. Recent studies on neural tube defects in embryos of diabetic pregnancy: an overview. Curr Med Chem 2009; 16 (18): 2345–54.
43. Carmichael SL, Rasmussen SA, Lammer EJ et al. Craniosynostosis and nutrient intake during pregnancy. Birth Defects Res A Clin Mol Teratol 2010; 88 (12): 1032–9.
44. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2009; 202 (5): 429.
45. Houben ML, Bont L, Wilbrink B et al. Clinical prediction rule for RSV bronchiolitis in healthy newborns: Prognostic birth cohort study. Pediatrics 2011; 127: 35–41.
46. Hollis BW, Johnson D, Hulsey TC et al. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011; 26: 2341–57.
47. Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol 2005; 3: 28.
48. Hara K, Akiyama Y. Collagen-related abnormalities, reduction in bone quality, and effects of menatetrenone in rats with a congenital ascorbic acid deficiency. J Bone Miner Metab 2009; 27 (3): 324–32.
49. Формулярная система. Федеральное руководство. М.: ГЭОТАР-Мед, 2010.
50. Munoz C, Carson AF, McCoy MA et al. Effect of supplementation with barium selenate on the fertility, prolificacy and lambing performance of hill sheep. Vet Rec 2009; 164 (9): 265–71.
51. Kasimanickam RK, Kasimanickam VR, Rodriguez JS et al. Tocopherol induced angiogenesis in placental vascular network in late pregnant ewes. Reprod Biol Endocrinol 2010; 8: 86.
52. Klemmensen A, Tabor A, Osterdal ML. Intake of vitamin C and E in pregnancy and risk of pre-eclampsia: prospective study among 57346 women. BJOG 2009; 116 (7): 964–74.
53. Saffery R, Ellis J, Morley R. A convergent model for placental dysfunction encompassing combined sub-optimal one-carbon donor and vitamin D bioavailability. Med Hypotheses 2009; 73 (6): 1023–8.
54. Wagner CL, Taylor SN, Dawodu A et al. Vitamin D and Its Role During Pregnancy in Attaining Optimal Health of Mother and Fetus. Nutrients 2012; 4 (3): 208–230.
55. James MF. Magnesium in obstetrics. Best Pract Res Clin Obstet Gynec 2010; 24 (3): 327–37.
56. Стуров Н.В. Некоторые аспекты применения пероральных препаратов магния. Трудный пациент. 2012; 7: 28–31.
57. Недогода С.В. Роль препаратов магния в ведении пациентов терапевтического профиля. Лечащий врач. 2009; 6: 16–9.
58. Буданова М.В., Асланова П.А., Буданов П.В. Клинические проявления и эффекты коррекции дефицита магния у детей. Трудный пациент. 2009; 1–2: 17–22.
59. Шмаков Р.Г. Применение магния в акушерстве. Лечащий врач. 2010; 11: 15–20.
________________________________________________
1. Беременность и роды. Кохрановское руководство. Под ред. Г.Т.Сухих. М.: Логосфера, 2010.
2. Генетический паспорт – основа индивидуальной и предиктивной медицины. Под ред. В.С.Баранова. СПб.: Изд-во Н-Л, 2009.
3. Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of NTDs. Eur J Pediatr 2011; 170: 1391–400.
4. Guillette JrLJ, Moore BC. Environmental contaminants, fertility, and multioocytic follicles: a lesson from wildlife? Semin Reprod Med 2006; 24 (3): 134–41.
5. Torshin IY, Gromova OA. Magnesium and pyridoxine: fundamental studies and clinical practice. Nova Science 2009.
6. Маталыгина О.А. Питание беременных и кормящих женщин. Решенные и нерешенные проблемы. Вопр. соврем. педиатрии. 2008; 7 (5): 23–9.
7. Хорошилов И.Е., Успенский Ю.В. Новые подходы в лечебном питании беременных и кормящих женщин. Гинекология. 2008; 4: 67–77.
8. Lennard L. Methyltransferases. In: Guengerich FP (ed) Bio-transformation. Comprehensive toxicology, 2010; 4 (Chap 21). Elsevier, Oxford, UK.
9. Wu X, Zou T, Cao N et al. Plasma homocysteine levels and genetic polymorphisms in folate metablism are associated with breast cancer risk in chinese women. Hered Cancer Clin Pract 2014; 12 (1): 2.
10. Berenson AB, Rahman M. Effect of hormonal contraceptives on vitamin B12 leveland the association of the latter with bonemineraldensity. Contraception 2012; 86 (5): 481–7.
11. Monteiro JP, Wise C, Morine MJ et al. Methylation potential associated with diet, genotype, protein, and metabolite levels in the Delta Obesity Vitamin Study. Genes Nutr 2014; 9: 403–22.
12. Baumgartner MR. Vitamin-responsive disorders: cobalamin, folate, biotin, vitamins B1 and E. Handb Clin Neurol 2013; 113: 1799–10.
13. Abe I, Shirato Y, Hashizume Y et al. Folate-deficiency induced cell-specific changes in the distribution of lymphocytes and granulocytes in rats. Environ Health Prev Med 2013; 18: 78–84.
14. Mujawar SA, Patil VW, Daver RG. Study of serum homocysteine, folic acid and vitamin B12 in patients with preeclampsia. Indian J Clin Biochem 2011; 26 (3): 257–60.
15. Rodriguez-Guillen MR, Torres-Sánchez L, Chen J et al. Hernández-Valero, Lizbeth López-Carrillo. Dietary consumption of B vitamins, maternal MTHFR polymorphisms and risk for spontaneous abortion. Salud Publica Mex 2009; 51 (1): 19–25.
16. Schmidt RJ, Tancredi DJ, Ozonoff S et al. Maternal periconceptionalfolic acid intake and risk of autism spectrum disorders and developmental delay in the CHARGE (CHildhoodAutism Risks from Genetics and Environment) case-control study. Am J Clin Nutr 2012; 96 (1): 80–9.
17. Orjuela MA, Cabrera-Muñoz L, Paul L et al. Risk of retinoblastoma is associated with a maternal polymorphism in dihydrofolatereductase (DHFR) and prenatal folic acid intake. Cancer 2012; 118 (23): 5912–19.
18. De-Regil LM, Fernández-Gaxiola AC, Dowswell T, Peña-Rosas JP. Effects and safety of periconceptionalfolate supplementation for preventing birth defects. Cochrane Database Syst Rev 2010; 10: CD007950.
19. Imbard A, Benoist J-F, Blom HJ. Neural Tube Defects, Folic Acid and Methylation. Int J Environ Res Public Health 2013; 10 (9): 4352–89.
20. Mosley BS, Cleves MA, Siega-Riz AM et al. Neural tube defects and maternal folate intake among pregnancies conceived after folic acid fortification in the United States. Am J Epidemiol 2009; 169: 9–17.
21. Oyama K. Folic acid prevents congenital malformations in the offspring of diabetic mice. Endocr J 2009; 56 (1): 29–37.
22. Громова О.А., Торшин И.Ю., Тетруашвили Н.К., Сидельникова В.М. Нутрициальный подход к профилактике избыточной массы тела новорожденных. Гинекология. 2010; 12 (5): 56–61.
23. Krawinkel MB, Strohm D, Weissenborn A et al. Revised D-A-CH intake recommendations for folate: how much is needed? Eur J Clin Nutr 2014; 68 (6): 719–23.
24. Громова О.А., Торшин И.Ю. Применение фолиевой кислоты в акушерстве и гинекологии. М.: РСЦ ЮНЕСКО, 2009.
25. Bailey SW, Ayling JE. Rapid folate repletion: an adjunct approach for reduction of risk for neural tube and other birth defects. Abstr 18th World Congr Controvers Obstet Gynecol Infert 2013; 90.
26. Brämswig S, Prinz-Langenohl R, Lamers Y et al. Supplementation with a multivitamin containing 800 microg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women. Int J Vitam Nutr Res 2009; 79 (2): 61–70.
27. Yoshino K, Nishide M, Sankai T et al. Validity of brief food frequency questionnaire for estimation of dietary intakes of folate, vitamins B6 and B12, and their associations with plasma homocysteine concentrations. Int J Food Sci Nutr 2010; 61 (1): 61–7.
28. Scaglione F, Panzavolta G. Folate, folicacidand 5-methyltetrahydrofolate are notthesamething. Xenobiotica 2014; 44 (5): 480–8.
29. Molloy AM, Kirke PN, Troendle JF. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification. Pediatrics 2009; 123 (3): 917–23.
30. Zhang T, Xin R, Gu X, Wang F. Maternal serum vitamin B12, folate and homocysteine and the risk of neural tube defects in the offspring in a high-risk area of China. Public Health Nutr 2009; 12 (5): 68086.
31. Chan J, Deng L, Mikael LG. Low dietary choline and low dietary riboflavin during pregnancy influence reproductive outcomes and heart development in mice. Am J Clin Nutr 2010; 91 (4): 1035–43.
32. Robitaille J, Carmichael SL, Shaw GM, Olney RS. Maternal nutrient intake and risks for transverse and longitudinal limb deficiencies: data from the National Birth Defects Prevention Study, 1997–2003. Birth Defects Res A Clin Mol Teratol 2009; 85 (9): 773–9.
33. Wallenstein MB, Shaw GM, Yang W, Carmichael SL. Periconceptional nutrient intakes and risks of orofacial clefts in California. Pediatr Res 2013; 74 (4): 457–65.
34. Shaw GM, Carmichael SL, Yang W, Lammer EJ. Periconceptional nutrient intakes and risks of conotruncal heart defects. Birth Defects Res A Clin Mol Teratol 2010; 88 (3): 144–51.
35. Nakajima Y1, Imanaka-Yoshida K. New insights into the developmental mechanisms of coronary vessels and epicardium. Int Rev Cell Mol Biol 2013; 303: 263–317.
36. Hill B, Holroyd R, Sullivan M. Clinical and pathological findings associated with congenital hypovitaminosis A in extensively grazed beef cattle. Aust Vet J 2009; 87 (3): 94–8.
37. Clagett-Dame M, Knutson D. Vitamin A in Reproduction and Development. Nutrients 2011; 3 (4): 385–428.
38. Beurskens LW, Tibboel D, Retinol status of newborn infants is associated with congenital diaphragmatic hernia. Pediatrics 2010; 126 (4): 712–20.
39. Chen K, Zhang X, Wei XP. Antioxidant vitamin status during pregnancy in relation to cognitive development in the first two years of life. Early Hum Dev 2009; 85 (7): 421–7.
40. Askin DF, Diehl-Jones W. Pathogenesis and prevention of chronic lung disease in the neonate. Crit Care Nurs Clin North Am 2009; 21 (1): 11–25.
41. Thorne-Lyman AL, Fawzi WW. Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2012; 26 (1): 10.1111/j.1365-3016.2012.01284.x.
42. Dheen ST, Tay SS. Recent studies on neural tube defects in embryos of diabetic pregnancy: an overview. Curr Med Chem 2009; 16 (18): 2345–54.
43. Carmichael SL, Rasmussen SA, Lammer EJ et al. Craniosynostosis and nutrient intake during pregnancy. Birth Defects Res A Clin Mol Teratol 2010; 88 (12): 1032–9.
44. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2009; 202 (5): 429.
45. Houben ML, Bont L, Wilbrink B et al. Clinical prediction rule for RSV bronchiolitis in healthy newborns: Prognostic birth cohort study. Pediatrics 2011; 127: 35–41.
46. Hollis BW, Johnson D, Hulsey TC et al. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011; 26: 2341–57.
47. Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol 2005; 3: 28.
48. Hara K, Akiyama Y. Collagen-related abnormalities, reduction in bone quality, and effects of menatetrenone in rats with a congenital ascorbic acid deficiency. J Bone Miner Metab 2009; 27 (3): 324–32.
49. Формулярная система. Федеральное руководство. М.: ГЭОТАР-Мед, 2010.
50. Munoz C, Carson AF, McCoy MA et al. Effect of supplementation with barium selenate on the fertility, prolificacy and lambing performance of hill sheep. Vet Rec 2009; 164 (9): 265–71.
51. Kasimanickam RK, Kasimanickam VR, Rodriguez JS et al. Tocopherol induced angiogenesis in placental vascular network in late pregnant ewes. Reprod Biol Endocrinol 2010; 8: 86.
52. Klemmensen A, Tabor A, Osterdal ML. Intake of vitamin C and E in pregnancy and risk of pre-eclampsia: prospective study among 57346 women. BJOG 2009; 116 (7): 964–74.
53. Saffery R, Ellis J, Morley R. A convergent model for placental dysfunction encompassing combined sub-optimal one-carbon donor and vitamin D bioavailability. Med Hypotheses 2009; 73 (6): 1023–8.
54. Wagner CL, Taylor SN, Dawodu A et al. Vitamin D and Its Role During Pregnancy in Attaining Optimal Health of Mother and Fetus. Nutrients 2012; 4 (3): 208–230.
55. James MF. Magnesium in obstetrics. Best Pract Res Clin Obstet Gynec 2010; 24 (3): 327–37.
56. Стуров Н.В. Некоторые аспекты применения пероральных препаратов магния. Трудный пациент. 2012; 7: 28–31.
57. Недогода С.В. Роль препаратов магния в ведении пациентов терапевтического профиля. Лечащий врач. 2009; 6: 16–9.
58. Буданова М.В., Асланова П.А., Буданов П.В. Клинические проявления и эффекты коррекции дефицита магния у детей. Трудный пациент. 2009; 1–2: 17–22.
59. Шмаков Р.Г. Применение магния в акушерстве. Лечащий врач. 2010; 11: 15–20.
Авторы
И.В.Кузнецова1, В.А.Коновалов2, 3
1. ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России;
2. ФДПО ГБОУ ВПО Рязанский государственный медицинский университет им. акад. И.П.Павлова Минздрава России;
3. ГБУ РО Женская консультация №1, Рязань