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

Yıl 2016, , 0 - 0, 20.05.2016

Melahat Yıldırım Raziye Desdicioglu , Ali İpek Halil Kara , Gülcan Dauletkazin Ayşe Filiz Yavuz Avşar

https://doi.org/10.17098/amj.7218

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

Öz

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.

Anahtar Kelimeler

vitamin D, pregnancy, fetal measurement, vitamin D deficiency

Kaynakça

• Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2010.
• DeLuca HF. Overview of general physiologic features and functions of vitamin D. American Journal of Clinical Nutrition 2004;80:1689–96.
• Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008;88:582-6.
• Theodoropoulos C, Demers C, Delvin E, Ménard D, Gascon-Barré M. Calcitriol regulates the expression of the genes encoding the three key vitamin D3 hydroxylases and the drug-metabolizing enzyme CYP3A4 in the human fetal intestine. Clinical Endocrinology 2003;58:489–99.
• Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, eds. Modern Nutrition in Health and Disease, 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
• De-Regil L. M, Palacios C, Ansary A, Kulier R, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2012;2(CD008873).
• Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? Journal of Steroid Biochemistry and Molecular Biology 2014;144(Pt A):138–45.
• Lapillonne A. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Medical Hypotheses 2010;74(1), 71-5.
• O’Riordan MN, Kiely M, Higgins JR, Cashman KD. Prevalence of suboptimal vitamin D status during pregnancy. Irish Medical Journal 2008;101(8):240-3.
• Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. Journal of Clinical Endocrinology and Metabolism 2007;92(9):3517–22.
• Li Y, Kong J, Wei M, Chen ZF, Liu S, Cao LP. 1,25- dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. Journal of Clinical Investigation 2002;110(2):229–39.
• Holick MF. Vitamin D deficiency: a worldwide problem with health consequences. American Journal of Clinical Nutrition 2008;87(4):1080–6.
• Farrant HJ, Krishnaveni GV, Hill JC, et al. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. European Journal of Clinical Nutrition 2009;63(5):646–52.
• Zhang C, Qiu C, Hu FB, et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS ONE 2008;3(11):e3753.
• Cooper C, Javaid K, Westlake S, Harvey N, Dennison E. Developmental origins of osteoporotic fracture: the role of maternal vitamin D insufficiency. The Journal of Nutrition 2005;135(11):2728-34.
• Pawley N & Bishop NJ Prenatal and infant predictors of bone health: the influence of vitamin D. Am J Clin Nutr 2004;80:6,1748–51.
• Scholl TO, Chen X. Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Early Hum Dev 2009;85:231e4.
• Leffelaar ER, Vrijkotte TG, van Eijsden M. Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: results of the multi-ethnic Amsterdam Born Children and their Development cohort. British Journal of Nutrition 2010;104:108-17.
• Salle BL, Delvin EE, Lapillonne A, Bishop NJ, Glorieux FH. Perinatal metabolism of vitamin D. Am J Clin Nutr 2000;71:1317–24.
• Devereux, Graham, Turner SW. et al. Maternal vitamin D intake during pregnancy and early childhood wheezing. The American journal of clinical nutrition 2007;85:853-9.
• Arunabh S, Pollack S, Yeh J, Aloia JF. Body fat content and 25-hydroxyvitamin D levels in healthy women. Journal of Clinical Endocrinology and Metabolism 2003;88(1):157–61.
• De-Regil LM, Palacios C, Ansary A, Kulier R, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2012;2(CD008873).
• Morley R, Carlin JB, Pasco JA, Wark JD. Maternal 25-hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size. The Journal of Clinical Endocrinology & Metabolism 2006;91(3):906-12.
• Javaid MK, Crozier SR, Harvey NC, et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006;367:36–43.
• Brooke OG, Brown IRF, Bone CDM, et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980;280:751–4.
• van Driel M, Pols HA, van Leeuwen JP. Osteoblast differentiation and control by vitamin D and vitamin D metabolites. Curr Pharm Des 2004;10:2535–55.
• Mannion CA, Gray-Donald K, Koski KG. Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. CMAJ 2006;174:1273–77.
• Farrant HJ, Krishnaveni GV, Hill JC, et al. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. European Journal of Clinical Nutrition. 2009;63(5):646-52.
• Prentice A, Jarjou LM, Goldberg GR, Bennett J, Cole TJ, Schoenmakers I. Maternal plasma 25-hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants. Acta Paediatr 2009;98:1360–2.
• Mahon P, Harvey N, Crozier S, et al. Low maternal vitamin D status and fetal bone development: cohort study. Journal of Bone and Mineral Research 2010;25(1):14-9.