IMPACT OF VITAMIN D DEFICIENCY ON THE RATE OF BONE METABOLISM DURING PREGNANCY

Objective. To estimate the rate of bone metabolism depending on the saturation of vitamin D during pregnancy. Materials and methods. Cohort retrospective and prospective study. There were examined 110 pregnant women in Saint Petersburg and Leningrad region. Mean age 29,64±2,3 years, 30-38 weeks of gestation. Time of inclusion is from September till June. All pregnant women had blood sampling with the following estimation of the level of 25-hydroxycalciferol, parathyroid hormone, osteocalcin and ß-isomer of C-terminal telopeptide of type I collagen. From 12 gestational weeks all patients received multivitamin complex, containing 400 IU of vitamin D. Results. There have been analyzed three subgroups of pregnant women. Insufficiency and deficiency are found in 55,5% of pregnant women. Blood serum level of parathyroid hormone was 23,47±5,90 pg/ml in pregnant with normal saturation of vitamin D, with vitamin D insufficiency- 31,36±9,44 pg/ml, with vitamin D deficiency 46,96±18,44 pg/ml (p<0,05). Mean levels of biochemical markers of bone tissue remodeling were the following: in pregnant women with normal saturation of vitamin D - osteocalcin was 14,68±3,54 ng/ ml, ß-CTX was 0,637±0,210 ng/ml, with vitamin D insufficiency - osteocalcin was 24,5±8,29 ng/ml, ß-CTX was 0,705±0,170 ng/ml, with vitamin D deficiency - osteocalcin was 34,01±7,25 ng/ml, ß-CTX was 0,831±0,140 ng/ml (p<0,05). Conclusions. Insufficient saturation of pregnant women with vitamin D is associated with the changes of the rate and way of bone metabolism. It increases both osteosynthesis and osteoresorption: level of osteocalcin increases 2 times in blood serum, level of ß-CTX increases 1,3 times. Pregnant women with the insufficient saturation of vitamin D show the increase of parathyroid hormone. That means the possibility to save bone metabolism with the function of osteosynthesis and osteoresorption. Pregnant women with the revealed insufficiency and deficiency of vitamin D refer to the group of risk for the development of osteopenia and postpartum ruptures.

беременность, витамин D, костный обмен, 25(OH) D, pregnancy, vitamin D, bone metabolism, 25(OH) D

1. Holick M.F. Vitamin D deficiency. N. Engl. J. Med. 2007; 357: 266-281.

2. Thorne-Lyman A, Fawzi W.W. Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2012; 26 Suppl 1:75-90.

3. Ross A.C, Taylor C.L, Yaktine A.L, Del Valle H.B. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011.

4. Gale C.R, Robinson S.M, Harvey N.C, et al. Maternal vitamin D status during pregnancy and child outcomes. Eur J Clin Nutr. 2008; 62(1): 68-77.

5. Wagner C.L, Greer F.R. Prevention of Rickets and Vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008; 122(5):1142-1152.

6. Bischoff-Ferrari H.A, 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. http://www.iccidd. org/p142000804.html

7. Dawson-Hughes B, Mithal A, Bonjour J.P, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int. 2010; 21(7): 1151-1154

8. Gomez de Tejada Romero M.J, Sosa Henriquez M, Del Pino Montes J, et al. Position document on the requirements and optimum levels of vitamin D. Rev Osteoporos Metab Miner. 2011; 1:53-64.

9. Лесняк О.М., Беневоленская Л.И. Остеопороз. 2-е изд, М.: ГЭОТАР-Медиа, 2009 с.272.

10. The North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010;17(1):25-54

11. Carneiro R.M, Prebehalla L, Tedesco M.B, et al. Lactation and bone turnover: a conundrum of marked bone loss in the setting of coupled bone turnover. J Clin Endocrinol Metab. 2010; 95(4):1767-76.

12. Кеттайл В. М., Арки Р. А. Патофизиология эндокринной системы: пер. с англ. М.: БИНОМ, 2007. с. 336

13. Судаков Д.С., Зазерская И.Е., Галкина О.В. и др. Факторы риска развития нарушений костного обмена во время беременности. Журнал акушерства и женских болезней. 2011; LX(1): 66-75

14. Kovac C.S., Fuleihan G. Calcium and bone disorders during pregnancy and lactation. Endocrinol Metab Clin North Am. 2006 Mar;35(1):21-51

15. Абрамченко, В.В. Профилактика и лечение нарушений обмена кальция в акушерстве, гинекологии и перинатологии. СПб.: ЭЛБИ, 2006. с.240