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Особенности обмена кальция при беременности в зависимости от насыщенности организма витамином D
Особенности обмена кальция при беременности в зависимости от насыщенности организма витамином D
Шелепова Е.С., Зазерская И.Е., Хазова Е.Л. и др. Особенности обмена кальция при беременности в зависимости от насыщенности организма витамином D. Гинекология. 2016; 18 (2): 8–10.
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Аннотация
Цель – оценка влияния насыщенности организма витамином D на обмен кальция при беременности.
Материалы и методы. Когортное ретроспективное и проспективное исследование. Обследованы 110 беременных (средний возраст 29,64±2,3 года), срок беременности – 30–38 нед. Время включения – с сентября 2013 по июнь 2014 г. Всем беременным произведен забор биообразцов крови с последующим определением уровня 25-гидроксикальциферола (25-OH-D), кальция, паратиреоидного гормона (ПТГ). Все пациентки проживали в Санкт-Петербурге и Ленинградской области, с 12-й недели беременности получали поливитаминный комплекс, содержащий 400 МЕ витамина D.
Результаты. Проанализированы данные обследования 110 беременных. Нормальный уровень 25-OH-D в сыворотке крови выявлен у 49 (44,5%) из них, недостаточность – у 22 (20%), а дефицит – у 39 (35,5%). Содержание кальция в сыворотке крови у беременных при нормальном насыщении организма витамином D составило 2,32±0,06 ммоль/л, при недостаточном – 2,17±0,03 ммоль/л, при дефиците – 2,08±0,02 ммоль/л. Содержание ПТГ в сыворотке крови у беременных при нормальном насыщении организма витамином D составило 23,63±1,9 пг/мл, при недостаточном насыщении – 31,±2,3 пг/мл, при дефиците насыщения – 46,17±2,5 пг/мл.
Выводы. При недостаточном насыщении организма беременной женщины витамином D имеет место повышение ПТГ в сыворотке крови. У беременных с дефицитом и недостаточностью витамина D наблюдается относительная гипокальциемия. Полученные данные подтверждают взаимосвязь между насыщенностью организма витамином D и обменом кальция при беременности.
Ключевые слова: беременность, витамин D, обмен кальция, минеральный обмен, 25-OH-D.
Materials and methods. Cohort retrospective and prospective study. 110 pregnant women (mean age 29,64±2,3 years) at 30–38 weeks of pregnancy were examined. Investigation time lasted from September 2013 to June 2014. All patients had blood sampling done with the following determination of the levels of 25-hydroxycalciferol, calcium, parathyroid hormone. All patients lived in Saint Petersburg and Leningrad region. From 12 gestational week all patients were using a multivitamin complex, which contained 400 IU of vitamin D.
Results. 110 pregnant were analyzed. Among all examined pregnant women the normal blood serum level of 25-OH-D was in 49 (44,5%) pregnant, 25-OH-D insufficiency – in 22 (20%) patients, 25-OH-D deficiency – in 39 (35,5%) pregnant. Calcium level in blood serum in pregnant with normal vitamin D saturation was 2,32±0,06 mmol/L, with insufficiency – 2,17±0,03 mmol/L, with vitamin D deficiency – 2,08±0,02 mmol/L Parathyroid hormone levels in blood serum in pregnant with normal vitamin D saturation was 23,63±1,9 pg/ml, with vitamin D deficiency – 31,±2,3 pg/ml.
Conclusion. The increase of parathyroid hormone in blood serum occurs during the insufficient saturation of vitamin D in pregnant women. In pregnant with vitamin D deficiency and insufficiency relative hypocalcemia occurs. Received data confirm correlation between body saturation of vitamin D and calcium metabolism during pregnancy.
Key words: pregnancy, vitamin D, mineral metabolism, 25-ОН-D.
Материалы и методы. Когортное ретроспективное и проспективное исследование. Обследованы 110 беременных (средний возраст 29,64±2,3 года), срок беременности – 30–38 нед. Время включения – с сентября 2013 по июнь 2014 г. Всем беременным произведен забор биообразцов крови с последующим определением уровня 25-гидроксикальциферола (25-OH-D), кальция, паратиреоидного гормона (ПТГ). Все пациентки проживали в Санкт-Петербурге и Ленинградской области, с 12-й недели беременности получали поливитаминный комплекс, содержащий 400 МЕ витамина D.
Результаты. Проанализированы данные обследования 110 беременных. Нормальный уровень 25-OH-D в сыворотке крови выявлен у 49 (44,5%) из них, недостаточность – у 22 (20%), а дефицит – у 39 (35,5%). Содержание кальция в сыворотке крови у беременных при нормальном насыщении организма витамином D составило 2,32±0,06 ммоль/л, при недостаточном – 2,17±0,03 ммоль/л, при дефиците – 2,08±0,02 ммоль/л. Содержание ПТГ в сыворотке крови у беременных при нормальном насыщении организма витамином D составило 23,63±1,9 пг/мл, при недостаточном насыщении – 31,±2,3 пг/мл, при дефиците насыщения – 46,17±2,5 пг/мл.
Выводы. При недостаточном насыщении организма беременной женщины витамином D имеет место повышение ПТГ в сыворотке крови. У беременных с дефицитом и недостаточностью витамина D наблюдается относительная гипокальциемия. Полученные данные подтверждают взаимосвязь между насыщенностью организма витамином D и обменом кальция при беременности.
Ключевые слова: беременность, витамин D, обмен кальция, минеральный обмен, 25-OH-D.
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Materials and methods. Cohort retrospective and prospective study. 110 pregnant women (mean age 29,64±2,3 years) at 30–38 weeks of pregnancy were examined. Investigation time lasted from September 2013 to June 2014. All patients had blood sampling done with the following determination of the levels of 25-hydroxycalciferol, calcium, parathyroid hormone. All patients lived in Saint Petersburg and Leningrad region. From 12 gestational week all patients were using a multivitamin complex, which contained 400 IU of vitamin D.
Results. 110 pregnant were analyzed. Among all examined pregnant women the normal blood serum level of 25-OH-D was in 49 (44,5%) pregnant, 25-OH-D insufficiency – in 22 (20%) patients, 25-OH-D deficiency – in 39 (35,5%) pregnant. Calcium level in blood serum in pregnant with normal vitamin D saturation was 2,32±0,06 mmol/L, with insufficiency – 2,17±0,03 mmol/L, with vitamin D deficiency – 2,08±0,02 mmol/L Parathyroid hormone levels in blood serum in pregnant with normal vitamin D saturation was 23,63±1,9 pg/ml, with vitamin D deficiency – 31,±2,3 pg/ml.
Conclusion. The increase of parathyroid hormone in blood serum occurs during the insufficient saturation of vitamin D in pregnant women. In pregnant with vitamin D deficiency and insufficiency relative hypocalcemia occurs. Received data confirm correlation between body saturation of vitamin D and calcium metabolism during pregnancy.
Key words: pregnancy, vitamin D, mineral metabolism, 25-ОН-D.
Полный текст
Список литературы
1. Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr 2004;80 (Suppl. 6):1752S–8S.
2. Lee JM, Smith JR, Philipp BL et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007; 46 (1): 42–4.
3. Bodnar LM, Simhan HN, Powers RW et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 2007; 137 (2): 447–52.
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6. Gómez de Tejada Romero MJ, Sosa Henríquez M, Del Pino Montes J et al. Position document on the requirements and optimum levels of vitamin D. Rev Osteoporos Metab Miner 2011; 3 (1): 53–64.
7. Singht H J, Mohammad NH, Nila A. Serum calcium and parathormone during normal pregnancy in Malay women. J Maternal-Fetal med 1999; 8 (Issue 3): 95–100.
8. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol 2007; 103 (3–5): 631–4.
9. Ritchi LD, King JC. Dietary calcium and pregnancy induced hypertension: is there a relation? Am J Clin Nutrit 2000; 71 (5): 1371–4.
10. O' Brien KO, Nathanson MS, Mancini J, Witter FR. Сalcium absorption is significantly higher in adolescents during pregnancy than in early postpartum period. Am J Clin Nutrit 2003; 78 (6): 1188–93.
11. Абрамченко В.В. Профилактика и лечение нарушений обмена кальция в акушерстве, гинекологии и перинатологии. СПб.: ЭЛБИ, 2006. / Abramchenko V.V. Profilaktika i lechenie narushenii obmena kal'tsiia v akusherstve, ginekologii i perinatologii. SPb.: ELBI, 2006. [in Russian]
12. Cockburn F et al. Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants. Br Med J 1980; 281 (6232): 11–4.
13. Brooke OG et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980; 80: 751–4.
14. Datta S et al. Vitamin D deficiency in pregnant women from a non-European ethnic minority population – an interventional study. BJOG 2002; 109: 905–8.
15. Delvin ЕE et al. Vitamin D supplementation during pregnancy: effect on neonatal calcium gomeostasis. J Pediatr 1986; 109 (2): 328–34.
16. Davis OK et al. Serum parathyroid hormone (PTH) in pregnant women determined by an immunoradiometric assay for intact PTH. J Clin Endocrinol Metab 1988; 67 (4): 850–2.
17. Seely EW et al. A prospective study of calciotropic hormones in pregnancy and post partum: reciprocal changes in serum intact parathyroid hormone and 1,25-dihydroxyvitamin D. Am J Obstet Gynecol 1997; 176 (1): 214–7.
18. Кеттайл В.М., Арки Р.А. Патофизиология эндокринной системы. Пер. с англ. М.: БИНОМ, 2007. / Kettail V.M., Arki R.A. Patofiziologiia endokrinnoi sistemy. Per. s angl. M.: BINOM, 2007. [in Russian]
19. Holick MF. Vitamin D, sunlight and cancer connection. Anticancer Agents Med Chem 2013; 13: 70–82.
2. Lee JM, Smith JR, Philipp BL et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007; 46 (1): 42–4.
3. Bodnar LM, Simhan HN, Powers RW et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 2007; 137 (2): 447–52.
4. Dawson-Hughes B, Mithal A, Bonjour JP et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21 (7): 1151–4.
5. Bischoff-Ferrari HA, Burckhardt P, Quack-Loetscher K et al. Vitamin D deficiency: Evidence, safety, and recommendations for the Swiss population. Report written by a group of experts on behalf of the Federal Commission for Nutrition (FCN) 2012.
6. Gómez de Tejada Romero MJ, Sosa Henríquez M, Del Pino Montes J et al. Position document on the requirements and optimum levels of vitamin D. Rev Osteoporos Metab Miner 2011; 3 (1): 53–64.
7. Singht H J, Mohammad NH, Nila A. Serum calcium and parathormone during normal pregnancy in Malay women. J Maternal-Fetal med 1999; 8 (Issue 3): 95–100.
8. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol 2007; 103 (3–5): 631–4.
9. Ritchi LD, King JC. Dietary calcium and pregnancy induced hypertension: is there a relation? Am J Clin Nutrit 2000; 71 (5): 1371–4.
10. O' Brien KO, Nathanson MS, Mancini J, Witter FR. Сalcium absorption is significantly higher in adolescents during pregnancy than in early postpartum period. Am J Clin Nutrit 2003; 78 (6): 1188–93.
11. Abramchenko V.V. Profilaktika i lechenie narushenii obmena kal'tsiia v akusherstve, ginekologii i perinatologii. SPb.: ELBI, 2006. [in Russian]
12. Cockburn F et al. Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants. Br Med J 1980; 281 (6232): 11–4.
13. Brooke OG et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980; 80: 751–4.
14. Datta S et al. Vitamin D deficiency in pregnant women from a non-European ethnic minority population – an interventional study. BJOG 2002; 109: 905–8.
15. Delvin ЕE et al. Vitamin D supplementation during pregnancy: effect on neonatal calcium gomeostasis. J Pediatr 1986; 109 (2): 328–34.
16. Davis OK et al. Serum parathyroid hormone (PTH) in pregnant women determined by an immunoradiometric assay for intact PTH. J Clin Endocrinol Metab 1988; 67 (4): 850–2.
17. Seely EW et al. A prospective study of calciotropic hormones in pregnancy and post partum: reciprocal changes in serum intact parathyroid hormone and 1,25-dihydroxyvitamin D. Am J Obstet Gynecol 1997; 176 (1): 214–7.
18. Kettail V.M., Arki R.A. Patofiziologiia endokrinnoi sistemy. Per. s angl. M.: BINOM, 2007. [in Russian]
19. Holick MF. Vitamin D, sunlight and cancer connection. Anticancer Agents Med Chem 2013; 13: 70–82.
2. Lee JM, Smith JR, Philipp BL et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007; 46 (1): 42–4.
3. Bodnar LM, Simhan HN, Powers RW et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 2007; 137 (2): 447–52.
4. Dawson-Hughes B, Mithal A, Bonjour JP et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21 (7): 1151–4.
5. Bischoff-Ferrari HA, Burckhardt P, Quack-Loetscher K et al. Vitamin D deficiency: Evidence, safety, and recommendations for the Swiss population. Report written by a group of experts on behalf of the Federal Commission for Nutrition (FCN) 2012.
6. Gómez de Tejada Romero MJ, Sosa Henríquez M, Del Pino Montes J et al. Position document on the requirements and optimum levels of vitamin D. Rev Osteoporos Metab Miner 2011; 3 (1): 53–64.
7. Singht H J, Mohammad NH, Nila A. Serum calcium and parathormone during normal pregnancy in Malay women. J Maternal-Fetal med 1999; 8 (Issue 3): 95–100.
8. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol 2007; 103 (3–5): 631–4.
9. Ritchi LD, King JC. Dietary calcium and pregnancy induced hypertension: is there a relation? Am J Clin Nutrit 2000; 71 (5): 1371–4.
10. O' Brien KO, Nathanson MS, Mancini J, Witter FR. Сalcium absorption is significantly higher in adolescents during pregnancy than in early postpartum period. Am J Clin Nutrit 2003; 78 (6): 1188–93.
11. Абрамченко В.В. Профилактика и лечение нарушений обмена кальция в акушерстве, гинекологии и перинатологии. СПб.: ЭЛБИ, 2006. / Abramchenko V.V. Profilaktika i lechenie narushenii obmena kal'tsiia v akusherstve, ginekologii i perinatologii. SPb.: ELBI, 2006. [in Russian]
12. Cockburn F et al. Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants. Br Med J 1980; 281 (6232): 11–4.
13. Brooke OG et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980; 80: 751–4.
14. Datta S et al. Vitamin D deficiency in pregnant women from a non-European ethnic minority population – an interventional study. BJOG 2002; 109: 905–8.
15. Delvin ЕE et al. Vitamin D supplementation during pregnancy: effect on neonatal calcium gomeostasis. J Pediatr 1986; 109 (2): 328–34.
16. Davis OK et al. Serum parathyroid hormone (PTH) in pregnant women determined by an immunoradiometric assay for intact PTH. J Clin Endocrinol Metab 1988; 67 (4): 850–2.
17. Seely EW et al. A prospective study of calciotropic hormones in pregnancy and post partum: reciprocal changes in serum intact parathyroid hormone and 1,25-dihydroxyvitamin D. Am J Obstet Gynecol 1997; 176 (1): 214–7.
18. Кеттайл В.М., Арки Р.А. Патофизиология эндокринной системы. Пер. с англ. М.: БИНОМ, 2007. / Kettail V.M., Arki R.A. Patofiziologiia endokrinnoi sistemy. Per. s angl. M.: BINOM, 2007. [in Russian]
19. Holick MF. Vitamin D, sunlight and cancer connection. Anticancer Agents Med Chem 2013; 13: 70–82.
________________________________________________
2. Lee JM, Smith JR, Philipp BL et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila) 2007; 46 (1): 42–4.
3. Bodnar LM, Simhan HN, Powers RW et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 2007; 137 (2): 447–52.
4. Dawson-Hughes B, Mithal A, Bonjour JP et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int 2010; 21 (7): 1151–4.
5. Bischoff-Ferrari HA, Burckhardt P, Quack-Loetscher K et al. Vitamin D deficiency: Evidence, safety, and recommendations for the Swiss population. Report written by a group of experts on behalf of the Federal Commission for Nutrition (FCN) 2012.
6. Gómez de Tejada Romero MJ, Sosa Henríquez M, Del Pino Montes J et al. Position document on the requirements and optimum levels of vitamin D. Rev Osteoporos Metab Miner 2011; 3 (1): 53–64.
7. Singht H J, Mohammad NH, Nila A. Serum calcium and parathormone during normal pregnancy in Malay women. J Maternal-Fetal med 1999; 8 (Issue 3): 95–100.
8. Hollis BW, Wagner CL, Drezner MK, Binkley NC. Circulating vitamin D3 and 25-hydroxyvitamin D in humans: An important tool to define adequate nutritional vitamin D status. J Steroid Biochem Mol Biol 2007; 103 (3–5): 631–4.
9. Ritchi LD, King JC. Dietary calcium and pregnancy induced hypertension: is there a relation? Am J Clin Nutrit 2000; 71 (5): 1371–4.
10. O' Brien KO, Nathanson MS, Mancini J, Witter FR. Сalcium absorption is significantly higher in adolescents during pregnancy than in early postpartum period. Am J Clin Nutrit 2003; 78 (6): 1188–93.
11. Abramchenko V.V. Profilaktika i lechenie narushenii obmena kal'tsiia v akusherstve, ginekologii i perinatologii. SPb.: ELBI, 2006. [in Russian]
12. Cockburn F et al. Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants. Br Med J 1980; 281 (6232): 11–4.
13. Brooke OG et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980; 80: 751–4.
14. Datta S et al. Vitamin D deficiency in pregnant women from a non-European ethnic minority population – an interventional study. BJOG 2002; 109: 905–8.
15. Delvin ЕE et al. Vitamin D supplementation during pregnancy: effect on neonatal calcium gomeostasis. J Pediatr 1986; 109 (2): 328–34.
16. Davis OK et al. Serum parathyroid hormone (PTH) in pregnant women determined by an immunoradiometric assay for intact PTH. J Clin Endocrinol Metab 1988; 67 (4): 850–2.
17. Seely EW et al. A prospective study of calciotropic hormones in pregnancy and post partum: reciprocal changes in serum intact parathyroid hormone and 1,25-dihydroxyvitamin D. Am J Obstet Gynecol 1997; 176 (1): 214–7.
18. Kettail V.M., Arki R.A. Patofiziologiia endokrinnoi sistemy. Per. s angl. M.: BINOM, 2007. [in Russian]
19. Holick MF. Vitamin D, sunlight and cancer connection. Anticancer Agents Med Chem 2013; 13: 70–82.
Авторы
Е.С.Шелепова*, И.Е.Зазерская, Е.Л.Хазова, Л.В.Кузнецова, Н.Ю.Яковлева, Е.Ю.Васильева
ФГБУ Северо-Западный федеральный медицинский исследовательский центр им. В.А.Алмазова Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2
*garbunchik@mail.ru
V.A.Almazov North-West federal medical research center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2
*garbunchik@mail.ru
ФГБУ Северо-Западный федеральный медицинский исследовательский центр им. В.А.Алмазова Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2
*garbunchik@mail.ru
________________________________________________
V.A.Almazov North-West federal medical research center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2
*garbunchik@mail.ru
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