В статье рассмотрена история разработки концепции первичной профилактики врожденных пороков развития плода с помощью периконцепционного приема мультивитаминных препаратов, содержащих фолиевую кислоту. Проанализированы результаты венгерских исследований по использованию мультивитаминов. Даны современные представления о механизме профилактического действия фолиевой кислоты с позиции фармакогенетики. Приведены данные об использовании разных биохимических форм фолатов. Ключевые слова: фолиевая кислота, пороки развития плода, дефекты нервной трубки, витаминопрофилактика, MTHFR, мультивитамины, прегравидарная подготовка, питание во время беременности, история медицины.
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The article describes the history of development of the concept of primary prevention of congenital malformations of the fetus via periconceptional receiving of multivitamin preparations containing folic acid. The results of Hungarian studies on the use of multivitamins are also given below as well as the current understanding of the mechanism of the prophylactic action of folic acid from a position of pharmacogenetics. The data on the use of different biochemical forms of folate is presented as well. Key words: folic acid, fetal malformations, neural tube defects, vitamin prophylaxis, the MTHFR, multivitamins, pregravid preparation, nutrition during pregnancy, history of medicine.
1. Smithells RW, Sheppard S, Schorah CJ. Vitamin deficiencies and neural tube defects. Arch Dis Child 1976; 51 (12): 944–50.
2. Smithells RW, Sheppard S, Schorah CJ et al. Possible prevention of neural-tube defects by periconceptional vitamin supplementation. Lancet 1980; 1 (8164): 339–40.
3. Smithells RW, Nevin NC, Seller MJ et al. Further experience of vitamin supplementation for prevention of neural tube defect recurrences. Lancet 1983; 1 (8332): 1027–31.
4. Schorah CJ, Wild J, Hartley R et al. The effect of periconceptional supplementation on blood vitamin concentrations in women at recurrence risk for neural tube defect. Br J Nutr 1983; 49 (2): 203–11.
5. Czeizel AE. Folic Acid/Folic Acid-Containing Multivitamins and Primary Prevention of Birth Defects and Preterm Birth. 2010; 643–72.
6. The Randomized Controlled Trial of Periconceptional Multivitamin Supplementation on Structural Birth Defects and Pregnancy Outcomes, 1984–1994 (http://www.socio.com/cam16.php)
7. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. Lancet 1991; 338 (8760): 131–7.
8. Berry RJ, Li Z, Erickson JD et al. Prevention of neural-tube defects with folic acid in China. China-U.S. Collaborative Project for Neural Tube Defect Prevention. N Engl J Med 1999; 341 (20): 1485–90.
9. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects / MMWR Recomm Rep. 1992; Vol. 41. №RR14. 1–7.
10. Czeizel AE. The primary prevention of birth defects: Multivitamins or folic acid? Int J Med Sci 2004; 1 (1): 50–61.
11. Czeizel AE, Rockenbauer M, Siffel C, Varga E. Description and mission evaluation of the Hungarian case-control surveillance of congenital abnormalities, 1980-1996. Teratology 2001; 63 (5): 176–85.
12. Периконцепционная профилактика врожденных пороков развития: диалог с профессором Эндре Цейзелем. Consilium Medicum Ukraina 2013; 5. / Perikontseptsionnaia profilaktika vrozhdennykh porokov razvitiia: dialog s professorom Endre Tseizelem. Consilium Medicum Ukraina 2013; 5. [in Russian]
13. Czeizel A, Dudás I, Vereczkey A, Bánhidy F. Folate Deficiency and Folic Acid Supplementation: The Prevention of Neural-Tube Defects and Congenital Heart Defects. Nutrients 2013; 5 (11): 4760–75.
14. Fox JT, Stover PJ. Folate-mediated one-carbon metabolism. Vitamins and hormones. 2008; 79: 1–44.
15. Yates JRW, Ferguson-Smith MA, Shenkin A et al. Is disordered folate metabolism the basis for the genetic predisposition to neural tube defects? Clin Genet 2008; 31 (5): 279–87.
16. Silaste ML, Rantala M, Sampi M et al. Polymorphisms of key enzymes in homocysteine metabolism affect diet responsiveness of plasma homocysteine in healthy women. J Nutr 2001; 131 (10): 2643–7.
17. Периконцепционная профилактика врожденных пороков развития: диалог с профессором Эндре Цейзелем. Consilium Medicum. Ukraina 2013; 10. / Perikontseptsionnaia profilaktika vrozhdennykh porokov razvitiia: dialog s professorom Endre Tseizelem. Consilium Medicum. Ukraina 2013; 10. [in Russian]
18. Lakshmaiah N, Bamji MS. Half-life and metabolism of 3H-folic acid in oral contraceptive treated rats. Horm Metab Res 1981; 13 (7): 404–7.
19. Czeizel AE, Dudas I, Paput L, Banhidy F. Prevention of neural-tube defects with periconceptional folic acid, methylfolate, or multivitamins? Ann Nutr Metab 2011; 58 (4): 263–71.
20. Prinz-Langenohl R, Bramswig S, Tobolski O et al. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C-->T polymorphism of methylenetetrahydrofolate reductase. Br J Pharmacol 2009; 158 (8): 2014–21.
21. Ambrosino P, Lupoli R, Di Minno A et al. Cyclic supplementation of 5-MTHF is effective for the correction of hyperhomocysteinemia. Nutr Res 2015; 35 (6): 489–95.
22. Кузнецова И.В., Коновалов В.А. Фолиевая кислота и ее роль в женской репродукции. Гинекология. 2014; 4: 17–23. / Kuznetsova I.V., Konovalov V.A. Folievaia kislota i ee rol' v zhenskoi reproduktsii. Ginekology. 2014; 4: 17–23. [in Russian]
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1. Smithells RW, Sheppard S, Schorah CJ. Vitamin deficiencies and neural tube defects. Arch Dis Child 1976; 51 (12): 944–50.
2. Smithells RW, Sheppard S, Schorah CJ et al. Possible prevention of neural-tube defects by periconceptional vitamin supplementation. Lancet 1980; 1 (8164): 339–40.
3. Smithells RW, Nevin NC, Seller MJ et al. Further experience of vitamin supplementation for prevention of neural tube defect recurrences. Lancet 1983; 1 (8332): 1027–31.
4. Schorah CJ, Wild J, Hartley R et al. The effect of periconceptional supplementation on blood vitamin concentrations in women at recurrence risk for neural tube defect. Br J Nutr 1983; 49 (2): 203–11.
5. Czeizel AE. Folic Acid/Folic Acid-Containing Multivitamins and Primary Prevention of Birth Defects and Preterm Birth. 2010; 643–72.
6. The Randomized Controlled Trial of Periconceptional Multivitamin Supplementation on Structural Birth Defects and Pregnancy Outcomes, 1984–1994 (http://www.socio.com/cam16.php)
7. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. Lancet 1991; 338 (8760): 131–7.
8. Berry RJ, Li Z, Erickson JD et al. Prevention of neural-tube defects with folic acid in China. China-U.S. Collaborative Project for Neural Tube Defect Prevention. N Engl J Med 1999; 341 (20): 1485–90.
9. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects / MMWR Recomm Rep. 1992; Vol. 41. №RR14. 1–7.
10. Czeizel AE. The primary prevention of birth defects: Multivitamins or folic acid? Int J Med Sci 2004; 1 (1): 50–61.
11. Czeizel AE, Rockenbauer M, Siffel C, Varga E. Description and mission evaluation of the Hungarian case-control surveillance of congenital abnormalities, 1980-1996. Teratology 2001; 63 (5): 176–85.
12. Perikontseptsionnaia profilaktika vrozhdennykh porokov razvitiia: dialog s professorom Endre Tseizelem. Consilium Medicum Ukraina 2013; 5. [in Russian]
13. Czeizel A, Dudás I, Vereczkey A, Bánhidy F. Folate Deficiency and Folic Acid Supplementation: The Prevention of Neural-Tube Defects and Congenital Heart Defects. Nutrients 2013; 5 (11): 4760–75.
14. Fox JT, Stover PJ. Folate-mediated one-carbon metabolism. Vitamins and hormones. 2008; 79: 1–44.
15. Yates JRW, Ferguson-Smith MA, Shenkin A et al. Is disordered folate metabolism the basis for the genetic predisposition to neural tube defects? Clin Genet 2008; 31 (5): 279–87.
16. Silaste ML, Rantala M, Sampi M et al. Polymorphisms of key enzymes in homocysteine metabolism affect diet responsiveness of plasma homocysteine in healthy women. J Nutr 2001; 131 (10): 2643–7.
17. Perikontseptsionnaia profilaktika vrozhdennykh porokov razvitiia: dialog s professorom Endre Tseizelem. Consilium Medicum. Ukraina 2013; 10. [in Russian]
18. Lakshmaiah N, Bamji MS. Half-life and metabolism of 3H-folic acid in oral contraceptive treated rats. Horm Metab Res 1981; 13 (7): 404–7.
19. Czeizel AE, Dudas I, Paput L, Banhidy F. Prevention of neural-tube defects with periconceptional folic acid, methylfolate, or multivitamins? Ann Nutr Metab 2011; 58 (4): 263–71.
20. Prinz-Langenohl R, Bramswig S, Tobolski O et al. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C-->T polymorphism of methylenetetrahydrofolate reductase. Br J Pharmacol 2009; 158 (8): 2014–21.
21. Ambrosino P, Lupoli R, Di Minno A et al. Cyclic supplementation of 5-MTHF is effective for the correction of hyperhomocysteinemia. Nutr Res 2015; 35 (6): 489–95.
22. Kuznetsova I.V., Konovalov V.A. Folievaia kislota i ee rol' v zhenskoi reproduktsii. Ginekology. 2014; 4: 17–23. [in Russian]
Авторы
А.Е.Донников*
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России. 117997, Россия, Москва, ул. Академика Опарина, д. 4
*donnikov@oparina4.ru
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A.E.Donnikov*
V.I.Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4
*donnikov@oparina4.ru