Gebe Kadınlarda Serum D Vitamin Konsantrasyon Düzeyi ve Bunun Fetal Antropometrik Ölçümler Üzerine Etkisi

Öz

Amaç: D vitamini yağda çözünen bir vitamin olup güneş ışığından elde edilir. Gebelikte D vitamini  eksikliği (DVE) preeklampsi, hipertansiyon, sezaryen doğumlar, preterm doğum gibi kötü gebelik sonuçları ile ilişkili bulunmuştur. Bu çalışmada tekil gebeliği olan kadınlarda DVE ile fetal antropometrik ölçümler, amnion sıvısı anormallikleri ve plasental lokalizasyonu arasında ilişki incelendi.

Materyal ve Metot: Bu prospektif çalışma ikinci trimesterde rutin ultrason değerlendirmesi için antenatal kliniğe başvuran 268 gebeden oluşmaktadır. D vitamini ile ilgili kriterlere dayanılarak DVE serum vitamin D <30 nmol/L (12 ng/ml) olarak tanımlandı. Çalışma popülasyonu D vitamini düzeylerine göre 2 gruba ayrıldı. Grup 1 - DVE grubu (n= 190); 25(OH)D <12 ng/ml, ve grup 2 - normal D vitamini (NVD) grup (n= 78); 25(OH)D ≥12 ng/ml. Fetal antropometrik ölçümler, plasental lokalizasyon ve amniotik sıvı anormallikleri iki grup arasında karşılaştırıldı. P <0.05 istatistiksel olarak anlamlı kabul edildi.

Bulgular: Ortalama D vitamin düzeyi DVE grubunda 7.52±2.26 ng/ml ve NVD grubunda 22.61±19.40 ng/ml idi. İki grup arasında fetal biparyetal çap, femur uzunluğu, abdominal çap, sisterna magna, lateral ventrikül, ve transserebellar çap ölçümleri bakımından farklılık tespit edilmedi (p> 0.05).  DVE grubunun %55 inde ve NVD grubunun %46.6 sında korpus posteriorda lokalize plasenta tespit edildi (p=0.145). DVE grubunda  190 kadının 10 unda ve NVD grubunda  78 kadının 7 sinde polihidramniyoz tespit edildi (p= 0.457).

Sonuç: Bu çalışmada 20-25. haftadaki gebe kadınlarda DVE ile fetal antropometrik ölçümler, plasental lokalizasyon ve amniotik sıvı anormallikleri arasında ilişki tespit edilemedi. Literatürdeki çalışmalara dayanarak, DVE den fetüsü koruyan başka mekanizmaların varlığı olduğunu düşünebilir ya da bu dönemde fetüsün kemik kütlesi küçük olduğundan, çok fazla Ca ve D vitaminine ihtiyaç duymuyor olabilir.  Bununla beraber DVE nin fetal kemik gelişimine olan negatif etkisini önlemek için gebelikte uygun tedavi verilmelidir.

Anahtar Kelimeler

• D vitamini,gebelik,fetal ölçümler,D vitamini eksikliği

Serum Vitamin D Concentrations Among Pregnant Women and Its Influence on the Fetal Anthropometric Measurements

Abstract

Objectives: Vitamin D is a fat-soluble vitamin which comes primarily from exposure to sunlight. Vitamin D deficiency (VDD) in pregnancy is found to be related to adverse pregnancy outcomes including preeclampsia, hypertension, caesarean section, preterm birth, etc. In this current study, we aimed to evaluate the relationship between VDD and fetal anthropometric measurements, amniotic fluid abnormalities, and placental location in pregnant women with singleton pregnancies.

Materials and Methods: This prospective study consisted of 268 pregnant women who attended to the antenatal clinics for their routine second trimester prenatal ultrasound screening. VDD is defined as <30 nmol/L (equals to 12 ng/ml) based on the criteria regarding the vitamin D status. Study population was subdivided into two groups with respect to their serum 25(OH)D levels: Group 1 - VDD  group (n= 190); 25(OH)D <12 ng/ml, and Group 2 - normal vitamin D (NVD) group (n= 78); 25(OH)D ≥12 ng/ml. Fetal anthropometric measurements, placental location, and amniotic fluid abnormalities were compared between groups. A p-value < 0.05 was considered statistically significant.

Results: The mean vitamin D was 7.52±2.26 ng/ml in VDD group, and 22.61±19.40 ng/ml in NVD group (p=0.001). There were no differences in the measurements of fetal biparietal diameter, femur length, abdominal circumference, cisterna magna, lateral ventricles and transverse cerebellar diameter between groups (p> 0.05).  Fifty five % of women in VDD group and 46.6% of the cases in NVD group had their placenta located in corpus posterior of the uterus (p= 0.145). Ten out of 190 women in VDD group and 7 out of 78 women in NVD group had polyhydramnios in the study (p= 0.457).

Conclusion: The current study failed to demonstrate the relationship between VDD and fetal anthropometric measurements, amniotic fluid abnormalities, and placental location in pregnant women at 20-25 weeks of gestation. Based on the findings in literature, we can assume that other protective mechanisms may play role in preventing fetus from the influence of VDD during the second trimester or fetus has not been affected from the disease, because fetus does not require much calcium and vitamin D due to its small bone mass during this period. The adverse impact of VDD on the fetal bone development can be prevented by appropriate treatment in pregnancy.

Keywords

• vitamin D,pregnancy,fetal measurement,vitamin D deficiency

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