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To question of prophylaxis of the complicated motion of pregnancy at insufficiency and deficit of D-vitamin

HEALTH OF WOMAN. 2016.6(112):19–27; doi 10.15574/HW.2016.112.19 

To question of prophylaxis of the complicated motion of pregnancy at insufficiency and deficit of D-vitamin

Pyrohova V., Shurpyak S., Zhemela N. I., Holota L.

Lviv national medical University named Danylo Galitsky

The objective: was an estimation of influence of water-soluble form of cholecalciferol (Akvadetrim) on motion of gestational process.

Patients and methods. For the estimation of prevalence of failing (29–20 ng/ml) or deficit (less than 20 ng/ml) of D-vitamin of 183 women are inspected in age from 20 to 38. A basic group was made by 75 women whom the stage of preconception and the first 12 weeks pregnancy got preparations of folic acid and iodide potassium in officinal doses and water-soluble form of cholecalciferol in doses from 500 до1000 IU. 35 patients who on the stage of preconception and the first 12 weeks pregnancies got only preparations of folic acid and iodide potassium in officinal doses entered in the group of comparison. Influence of water-soluble form of cholecalciferol on motion of pregnancy was estimated after frequency of miscarriage at first and second trimesters, premature births (from 22 to 36 weeks of pregnancy) and preeclampsia, by development of gestational diabetes. Research of level 25(ОН)D in the whey of blood conducted a immunochemical method on the analyzer of Cobas 6000 by kit of Roche Diagnostics (Switzerland) at plugging in research, through 1, 3 and 6 months. By a sufficient level 25(ОН)D in the whey of blood counted a concentration 30–60 ng/ml; by insufficiency – concentration 25(ОН)D 20–29 ng/ml; by a deficit is a level 25(ОН)D less than 20 ng/ml.

Results. It was found out the insufficiency and deficit of D-vitamin state in 68.3% inspected from which 110 women in age from 21 to 35 were plugged in research. A control group was made by 58 women with sufficient well-being the D-vitamin (level 25 (ОН) D in the whey of blood on the average 33.65±2.5 ng/ml). At the deficit of D-vitamin concentration 25(ОН) D in the whey of blood hesitated from 17.1 to 5,0 ng/ml (on the average 11,32±4,23 ng/ml), and at the insufficiency of D-vitamin of made on the average 23.35±1.82 ng/ml (p<0,001). Extremely found out the heavy deficit of D vitamin (6.50±1.05 ng/ml) in 35.7% patients. Frequency of deficit of vitamin of D was for certain higher for women with surplus mass of body (BMI 27–29.9 kg/m2) and obesity (BMI of 30.0–34.9 kg/m2) (p<0.01). The dosage of Akvadetrim was based on expressed of deficit of D-vitamin. Patient I-O sub-groups with the insufficient level of D-vitamin (level 25(ОН)D in the whey of blood on the average 23.80±1.91 ng/ml) got Akvadetrim for 500 IU daily during 3th months to planned pregnancy. Patient II-O sub-groups with the deficit of D-vitamin (level 25(ОН)D in the whey of blood on the average 11.84±4.11 ng/ml) got Akvadetrim for 1000 IU daily during 3th months. In both sub-groups there was growth of concentration 25(ОН)D, here in 64% patients with the insufficiency of D-vitamin (I-O sub-group) at a reception 500 IU Akvadetrim daily during three months the lower limit of sufficient level of vitamin D (31.7±1.2 ng/ml) was attained at 28.5±4.1 on the average in a sub-group. In II-O to the sub-group of growth of level 25(ОН)D on a background a reception 1000 IU Akvadetrim little considerable individual vibrations, in 1 month level 25(ОН)D on the average in 1,5 times exceeded a weekend (p<0.05), and in three months the «change» of laboratory index of «deficit of vitamin D» (11.84±4.11 ng/ml) was attained in «insufficiency of vitamin D» (24.2±1.3 ng/ml) (p<0.05) in 72%. Frequency of miscarriage of pregnancy to 21 week of gestation at the uncorrected deficit of vitamin D was 20% at 2.9% (p<0.001) in a basic group the patients of which got preparation of water-soluble cholecalciferol. Frequency of late complications of pregnancies (development of placenta dysfunction, preeclampsia, very early premature births) for pregnant, which are differentiated got preparation of Akvadetrim from the moment of preparation to pregnancy (500–1000 IU) and for 500 IU on a day during first a trimester, was for certain below, than for pregnant which did not get preparations of vitamin D. Frequency of late complications of pregnancy in a basic group was 5.7% at 20.0% in the group of comparison (p<0.001).

Conclusion. Application of water-soluble form of cholecalciferol (Akvadetrim, «Polpharma», Poland) in the differentiated dosage during the 3th months of preconception allows effectively to conduct the correction of balance of vitamin D. The correction of failing and deficit of vitamin of D is differentiated from the stage of preconception and during first the trimester of gestation allows to decrease frequency of miscarriage of pregnancy from 20% to 2.9% and development of late gestational complications from 20% to 5.7%. Setting of Akvadetrim for patients with an initial shortage and deficit of vitamin of D can not be limited only by preconception and first trimester of pregnancy, as on the late terms of gestation it is necessary to satisfy the enhanceable consumption of Sa for mineralization of skeleton of fetus and requirement in the vitamin of D grows only, that it is necessary to take into account the conducts of pregnant in a plan.

Key words: insufficiency and deficit of vitamin of D, Akvadetrim, miscarriage of pregnancy, gestational diabetes.


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