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Dzhumanov B. A., Zufarova Sh.A., Tashkent Pediatric Medical Institute E-mail: mbshakur@mail.ru
NFLUENCE OF THE LEVEL OF VITAMIN D ON THE FEATURES OF THE COURSE OF PRESENT PREGNANCY IN WOMEN
Abstract: This study was based on the survey data of 106 pregnant women, among whom the features of the course of this pregnancy in women with different levels of vitamin D were studied. Studies have shown that vitamin D levels corresponding to its deficiency in blood less than 20 ng/ml. Keywords: vitamin D, pregnancy, outcomes.
Large-scale studies in recent years have revealed a link between vitamin D deficiency and the prevalence of a number of diseases. Particular attention is drawn to the study of the role of vitamin D in pregnancy. It has been shown that 1.25 (OH) 2D3 regulates the secretion and secretion of human chorionic gonadotropin in the syncyto-trophoblast [1] and increases the placental production of sex steroids [3]. It turned out that calcitriol promotes calcium transport to the placenta [2], stimulates the secretion ofplacental lactogen [4], and also regulates the expression of H0XA10 (gene determining the development of the genital organs) in human stromal endometrial cells [4]. The level of vitamin D in the serum of women in the third trimester of pregnancy is 2 times higher than that of non-pregnant women [1].
Vitamin D deficiency causes a number of adverse complications of pregnancy: hypertension and especially preeclampsia (PE) [1; 3], an increase in the incidence of cesarean section and spontaneous premature birth [4], the development of bacterial vaginosis in early pregnancy [2], gestational diabetes mellitus [1].
The results of studies examining the relationship between 25 (OH) D levels and the incidence of adverse pregnancy outcomes are not always unambiguous.
Objective: to study the features of the course of this pregnancy in women with different levels of vitamin D.
Materials and research methods: the study was based on the data of examinations of 106 pregnant women in the III trimester of gestation. The average age ofwomen was 27.0 ± 2.5 years. The control group consisted of 30 pregnant women with a normal level of vitamin D.
For the diagnosis of vitamin D deficiency, a serum concentration of 25 (OH) D was determined. Vitamin D deficiency was defined as a decrease in the level of 25 (OH) D below 20 ng / ml, while vitamin D deficiency was in the range of 21-29 ng / ml.
In order to determine the effect of vitamin D on the course and outcome of pregnancy, the patient was divided
into 3 groups depending on the level of vitamin D in the blood. The 1st subgroup included 46 pregnant women with vitamin D deficiency in the blood, which corresponds to the level of 25 (OH) D below 20 ng/ml, the 2nd subgroup - 30 pregnant women with insufficient levels of vitamin D in the blood, which corresponds to the level of 21-29 ng/ml and the 3rd group (control) included pregnant women with normal levels of vitamin D, over 30 ng/ml.
In order to assess the course of pregnancy in women with different levels of vitamin D, in addition to an objective examination during pregnancy, the determination of bacterial and viral infections was also carried out.
The results of the study and their discussion: considering the data on the possible effect of vitamin D on the course of pregnancy, we analyzed the relationship between the level of vitamin D in pregnant women and the factors influencing the course of gestation. In this connection, we evaluated the parity in the groups. We found no significant differences in the level of vitamin D in women depending on the number of pregnancies. The distribution of primigravidas and reobsbirths in the groups was not statistically significant (p> 0.05), which allows us to consider the women of the studied groups comparable.
A direct relationship is determined between the level ofvi-tamin D and the likelihood of an infectious process (RR = 1.2; p < 0.05). Infectious load in pregnant women of the 1st group with vitamin D deficiency (< 20ng ml) is 1.2 times higher than that in patients of the 2nd group with vitamin D deficiency (< 30ng ml) and 2.8 times higher than the infectious load of pregnant women 3 s of the control group with physiological pregnancy (RR = 2.78; p < 0.05). It should be noted that in most cases in pregnant women of the 1st and 2nd groups, infection was associated with the presence of a mixed bacterial and viral infection: in 20(43%) pregnant women of the 1st group (p < 0.05) and 7(23%) pregnant women of group II (p < 0.05), in contrast to the control group.
Bacterial viral infection was characterized by the presence of Mycoplasma genitalium, Ureaplasma urealiticum.
Medical science
Chlamydia trachomatis in cervical canal cells and CMV DNA, HSV type 1 and 2, EBV in the blood and cells of the cervical canal, as well as the presence of bacterial vaginosis and Candida albicans. Positive values of IgM in the blood of pregnant women were also attributed to the activation of a viral infection. At that time, as in the control group, only 9 (36%) pregnant women noted the presence of conditionally pathogenic flora.
We also conducted a study of vaginal microbiocenosis. The indicators of eubiosis were taken to contain lactobacilli not less than 7 lg CFU/g and the presence of conditionally pathogenic microflora (UPM) not more than 3-4 lg CFU/g.
In evaluating the microbiocenosis of the vagina, it was revealed that in all groups of pregnant women the microflora was not identical in its composition and was represented by both typical eubiotic bacteria and UPM. Analysis of the vaginal microflora showed that in the I group of pregnant women Staphylococcus aureus was seeded in 7.7% of cases (colonization intensity - 5.9 ± 0.8 lg CFU/g) (p < 0.05). Enterococci occurred in 16.7% of cases (colonization intensity - 3.7 ± ± 0.2 lg CFU/g). While in the 2nd subgroup of pregnant women, Staphylococcus aureus was seeded in 4.0% of cases with a colonization rate of 6.4 ± 0.6 lg CFU/g. Eubacteria occurred in 1.3% of cases with a colonization rate of 4.5 ± 0.2 lg CFU/g.
Thus, the total infection in the group of patients with vitamin D deficiency (group 1) was significantly (p < 0.05) higher than in group 2 and in healthy pregnant women (control group) (p < 0.05).
Of all pregnant women studied, 27(35.5%) were hospitalized. Of these, 12(15.8%) cases failed to preserve pregnancy due to ongoing therapy: in 7(9.2%) patients the pregnancy was interrupted by the type of non-developing pregnancy and in 5(6.6%) patients by the type of spontaneous abortion. These patients were removed residual ovum. The gestational age in such patients averaged 11.7 ± 3.5 weeks.
We have identified a clear dependence of the nature of the course of pregnancy on the level of vitamin D.
In women of the 1st group with vitamin D deficiency, abortion was significantly more frequent: in 11 (23.9%) patients compared to the 2nd group, where pregnancy was terminated only in one woman at 8 weeks gestation (p < 0.05). In the control group, all pregnancies progressed.
Thus, by the criterion of the odds ratio on the background of vitamin D deficiency in pregnant women, the chance of abortion is 9 times higher than in pregnant women with vitamin D deficiency in the blood (OR-9.11; p < 0.05).
The results of the analysis of the features of pregnancy showed that the frequency of pregnancy complications was 2 times higher in the 1st group in women with vitamin D deficiency compared with patients with vitamin D deficiency in
the 2nd group (p < 0.01), and 6 times higher compared with the control group (p < 0.01).
Among the complications of pregnancy were: cervical insufficiency (ICN), gestational diabetes mellitus (GDM), gestational hypothyroidism, anemia of pregnant women, hy-percoagulation, not corresponding to the period of gestation. Significantly more often in the 1st group were diagnosed: the threat of abortion in the first trimester, which occurred in 16 (35%; 16/46; p < 0.05) women, the threat of abortion in the second trimester was noted in 21(46%; 21/46; p < 0.05) patients, low placentation - in 20(43%; 20/46; p < 0.05) patients, retrochorial hematomas - in 8(17%; 8/46; p < 0.05) and ARD during the first half of pregnancy - in 16(35%; 16/46; p < 0.05) women.
During gestation in pregnant women of the 2nd group in all cases was less compared with the 1st group. The most significant complication was the threat of abortion (p < 0.01).
The correlation analysis revealed the presence of interrelations between the level ofvitamin D and complications of pregnancy: the vitamin D values corresponding to the deficit had an inverse average relationship with the threat of abortion, the formation of retrochorial hematoma, the development of GDM, anemia of pregnant women, hypercoagulation during pregnancy (t = 0.29; p = 0.001).
Also, correlation analysis showed the presence of an inverse relatively strong correlation between the level ofvitamin D and the acute respiratory disease during the first half of gestation (t = 0.5; p < 0.05).
Our data showed a high incidence of premature birth in the group of pregnant women with vitamin D deficiency (p < 0.05).
A correlation analysis revealed the presence of a relationship between vitamin D levels and pregnancy outcomes.
According to the results of the analysis, a direct relationship was found between vitamin D deficiency and timely delivery (r = 0.3; p < 0.05), as well as the feedback of low vitamin D levels with the risk of premature birth (r = -0.26; p < 0, 05) and delivery by cesarean section (m = -0.23; p < 0.05).
Findings:
1. It is proved that the pathological course of pregnancy is more common in women with vitamin D deficiency (p < 0.01). In pregnant women with vitamin D deficiency, the risk of abortion was 9 times higher than in pregnant women with insufficient provision of vitamin D in the blood (p < 0.05).
2. The conducted correlation analysis revealed the presence of interrelations between the level of vitamin D and complications of pregnancy: the vitamin D values corresponding to the deficit had an inverse average relationship with the threat of abortion, the formation of retrochorial hematoma,
the development of GDM, anemia of pregnant women, hyper-coagulation during pregnancy (t = 0.29; p = 0.001).
3. A direct relationship was found between vitamin D deficiency and timely delivery (g = 0.3; p < 0.05), as well as the
feedback of low vitamin D levels with the risk of premature birth (t = -0.26; p < 0.05) and delivery by cesarean section (t = -0.23; p < 0.05).
References:
1. Vasilyeva E. N., Denisova T. G., Gunin A. G., Trishina E. N. Vitamin D deficiency during pregnancy and breastfeeding // Modern problems of science and education.2015.- No. 4.
2. Schwarz G. Ya. Vitamin D., D-hormone and alfacalcidol: medical, molecular-biological and pharmacological aspects // Ukrainian rheumatological journal.- 2009.- No. 3 (37).- P. 62-66.
3. Association between vitamin D deficiency and primary cesarean section / A. Merewood et al. // J. Clin. Endocrinol. Metab.2009.-Vol. 94.- No. 3.- P. 940-945.
4. Backe F., Takiishi T., Korf H., Gysemans C., Mathieu C. Vitamin D: Modulator of the immune system. Curr. Opin. Pharmacol. 2010.- 10.- P. 482-96.
