Статья журнала

Денисова Т.Г., Самойлова А.В., Васильева Э.Н., Герасимова Л.И.

Влияние витамина D на репродуктивное здоровье (обзор литературы)

Ключевые слова: дефицит витамина D, репродуктивное здоровье женщин, беременность, развитие плода и новорожденного, профилактика

В настоящее время не менее 30-50% населения планеты имеют низкую обеспеченность витамином D. Согласно современным представлениям, витамин D играет важную роль в многочисленных физиологических процессах, превращаясь в организме в активные метаболиты. Почечная продукция витамина D осуществляет «классические» функции, влияет на регуляцию артериального давления, оказывает иммунотропное и нейропротекторное действие. Внепочечная продукция реализует другие биологические эффекты: регуляцию роста и дифференцировку клеток, поддержку процессов синтеза и распада белков, противовоспалительные и иммуномодулирующие свойства, контроль функции мышц, секрецию инсулина, свертывание крови, деятельность центральной нервной системы, регуляцию гаметогенеза, апоптоза и эмбриогенеза, снижение возникновения риска аутоиммунных заболеваний. Из литературных данных известно, что в тканях репродуктивных органов: яичниках, матке, плаценте и гипофизе – обнаружены ядерный рецептор витамина D (VDR) и 1α-гидроксилаза. В связи с этим очевидна ассоциация роли витамина D с состоянием репродуктивного здоровья женщин, течением беременности, родов. На фоне дефицита витамина D во время беременности возрастает частота кесарева сечения в 4 раза по сравнению с таковым у беременных с нормальным уровнем витамина D, частота преждевременных родов и аномалий сократительной деятельности матки, что связано с низким уровнем ионизированного кальция в миоцитах, так как высвобождение ионизированного кальция осуществляется под воздействием витамина D. Витамин D участвует в программировании развития плода и новорожденного, уровень витамина D у беременных имеет прямую связь с массой тела ребёнка при рождении и окружностью головки, гиповитаминоз D матери оказывает значительное влияние на развитие костной ткани и врожденный иммунитет у плода, что имеет большое значение для формирования хронических заболеваний вскоре после рождения, а также в более позднем возрасте. Восполнение дефицита витамина D имеет очень широкие перспективы для оптимизации состояния здоровья женщин и детей и может быть одной из наиболее важных профилактических программ здравоохранения.

Denisova T., Samoylova A., Vasilyeva E., Gerasimova L.

The influence of vitamin D on reproductive health (literature review)

Keywords: vitamin D deficiency, female reproductive health, pregnancy, fetus and newborn development, prevention

Currently, no less than 30-50% of the world's population have a low supply of vitamin D. According to modern concepts, vitamin D plays an important role in numerous physiological processes, turning into active metabolites in the body. Renal production of vitamin D performs "classical" functions, affects blood pressure regulation and has an immunotropic and neuroprotective effect. Extrarenal production implements other biological effects: regulation of cellular growth and differentiation, support of protein synthesis and breakdown processes, anti-inflammatory and immunomodulating properties, muscular function control, insulin secretion, blood coagulation, central nervous system activity, regulation of gametogenesis, apoptosis and embryogenesis, lowering the risk of developing autoimmune diseases. From the literature data it is known that in the tissues of reproductive organs – in the ovaries, uterus, placenta and pituitary gland – vitamin D nuclear receptor (VDR) and 1α-hydroxylase were found. In this regard, association of the role of vitamin D and the condition of female reproductive health, the course of pregnancy and childbirth is obvious. Against the background of vitamin D deficiency during pregnancy, the rate of cesarean section is 4 times higher than that in pregnant women with normal vitamin D levels as well as the frequency of preterm labor and anomalies in uterine contractile activity, which is associated with a low level of ionized calcium in myocytes, since the release of ionized calcium is carried out under the influence of vitamin D. Vitamin D is involved in programming fetal and newborn development, the level of vitamin D in pregnant women has a direct relationship with the body weight of the child at birth and his head circumference, hypovitaminosis D of the mother has a significant effect on the development of bone tissue and congenital immunity in the fetus, which is of great importance for formation of chronic diseases soon after birth, as well as at a later age. Replenishment of vitamin D deficiency has very broad prospects for optimizing the health status of women and children, and may be one of the most important preventive health programs.

Литература

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References

  1. Shikh E.V., Milotova N.M. Rol’ polimorfizma gena VDR, kodiruyushchego retseptor vitamina D, v patogeneze arterial’noi gipertonii [The role of coding vitamin D receptor VDR gene polymorphism in pathogenesis of hypertension]. Biomeditsina, 2009, vol. 1, no. 1, pp. 55–67.
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  3. Baker A.M., Haeri S., Camargo C.A., Stuebe A.M., Boggess K.A. First-trimester maternal vitamin D status and risk of gestational diabetes (GDM): A nested case-control study. Diabetes/Metabolism Research and Reviews, 2012, vol. 28, no. 2, pp. 164–168. DOI:10.1002/dmrr.1282.
  4. Bodnar L.M., Catov J.M., Simhan H.N. Maternal vitamin D deficiency increases the risk of preeclampsia. Journal of Clinical Endocrinology and Metabolism, 2007, vol. 92, no. 9, pp. 3517–3522. DOI: 10.1210/jc.2007-0718.
  5. Bodnar L.M., Simhan H.N. The prevalence of preterm birth and season of conception. Paediatric and Perinatal Epidemiology, 2008, vol. 22, no. 6, pp. 538–545. DOI: 10.1111/j.1365-3016.2008.00971.x.
  6. Bodnar L.M., Platt R.W., Simhan H.N. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol, 2015, vol. 125(2), pp. 439–447. DOI: 10.1097/ AQG.0000000000000621.
  7. Choi R., Kim S., Yoo H., Cho Y.Y., Kim S.W., Chung J.H., et al. High prevalence of vitamin D deficiency in pregnant Korean women: the first trimester and the winter season as risk factors for vitamin D deficiency. Nutrients, 2015, vol. 7, pp. 3427–3448. DOI: 10.3390/nu7053427.
  8. Flood-Nichols S.K., Tinnemore D., Huang R.R., Napolitano P.G., Ippolito D.L. Vitamin D deficiency in early pregnancy. PLoS One, 2015, vol. 10(4), p. e0123763. DOI: 10.1371/journal.pone.0123763.
  9. Gale C.R., Robinson S.M.,Harvey N.C., et al. Maternal vitamin D status during pregnancy and child outcomes. European Journal of Clinical Nutrition, 2008, vol. 62, no. 1, pp. 68–77. DOI: 10.1038/sj.ejcn.1602680.
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  11. Gupta V. Vitamin D: Extra-skeletal effects. J Med Nutr Nutraceut, 2012, vol. 1, pp. 17–26.
  12. Harvey N.C., Holroyd C., Ntani G., Javaid K., Cooper P., Moon R. et al. Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess, 2014, vol. 18(45), pp. 1–190. DOI: 10.3310/hta18450 PMID: 25025896.
  13. Holick M.F. Sunlight and Vitamin D for Bone Health and Prevention of Autoimmune Diseases, Cancers, and Cardiovascular Disease. The American Journal of Clinical Nutrition, 2004, vol. 80, pp. S1678–S1688.
  14. Holick M.F. et al. Guidelines on Vitamin D Deficiency. J Clin Endocrinol Metab, 2011, vol. 96(7).
  15. Haugen M., Brantsaeter A.L., Trogstad L. et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology, 2009, vol. 20, no. 5, pp. 720–726.
  16. Heaney R.P. Vitamin D in health and disease. Clinical Journal of the American Society of Nephrology, 2008, vol. 3, no. 5, pp. 1535–1541. DOI: 10.2215/CJN.01160308.
  17. Hewison M. Vitamin D and the immune system: New perspectives on an old theme. Endocrinology and Metabolism Clinics of North America, 2010, vol. 39, no. 2, pp. 365–379. DOI: 10.1016/j.ecl.2010.02.010.
  18. Holick M.F. Medical progress: vitamin D deficiency. New England Journal of Medicine, 2007, vol. 357, no. 3, pp. 266–281. DOI: 10.1056/NEJMra070553.
  19. Hollis B.W., Johnson D., Hulsey T.C. et al. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. Journal of Bone and Mineral Research, 2011, vol. 26, no. 10, pp. 2341—2357. DOI: 10.1002/jbmr.463.
  20. Hollis B.W., Wagner C.L. Vitamin D and Pregnancy: Skeletal Effects, Nonskeletal Effects, and Birth Outcomes. Calcified Tissue International, 2013, vol. 92, pp. 128–139. Available at: http://dx.doi.org/ 10.1007/s00223-012-9607-4.
  21. Hollis B.W., Johnson D., Hulsey T.C., Ebeling M., Wagner C.L. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011, vol. 26 (10), pp. 2341–2357. DOI: 10.1002/ibmr.463.
  22. Holmes V.A., Barnes M.S., Alexander H.D., McFaul P., Wallace J.M.W. Vitamin D deficiency and insufficiency in pregnant women: A longitudinal study. British Journal of Nutrition, 2009, vol. 102, no. 6, pp. 876–881. DOI: 10.1017/S0007114509297236.
  23. Hossain N., Kanani F.H., Ramzan S., Kausar R., Ayaz S., Khanani R. et al. Obstetric and neonatal outcomes of maternal vitamin D supplementation: results of an open-label, randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. J Clin Endocrinol Metab., 2014, vol. 99(7), pp. 2448–2455. DOI: 10.1210/jc.2013-3491.
  24. Hossein-Nezhad A., Holick M.F. Vitamin D for health: A global perspective. Mayo Clinic Proceedings, 2013, vol. 88, no. 7, pp. 720-755. DOI: 10.1016/j.mayocp.2013.05.011.
  25. Johnson D.D., Wagner C.L., Hulsey T.C., Vitamin D deficiency and insufficiency is common during pregnancy. American Journal of Perinatology, 2011, vol. 28, no.1, pp. 7-12. DOI: 10.1055/s-0030-1262505.
  26. Castro L.C. The vitamin D endocrine system Arq. Bras Endocrinol Metabol.,2011, vol. 55(8), pp. 566–575.
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  28. Kovacs C.S. Vitamin D in during pregnancy and lactation: Maternal, fetal and neonatal outcomes from human and animal studies. American Journal of Clinical Nutrition, 2008, vol. 88, no. 2, pp. 520S–528S.
  29. Lanham-New S.A., Buttriss J.L., Miles L.M., et al. Proceedings of the rank forum on vitamin D. British Journal of Nutrition, 2011, vol. 105, no. 1, pp. 144–156. DOI: 10.1017/S0007114510002576.
  30. Lapillonne A. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Medical Hypotheses, 2010, vol. 74, no. 1, pp. 71–75. DOI: 10.1016/j.mehy.2009.07.054.
  31. Leffelaar E.R., Vrijkotte T.G.M., 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, vol. 104, no. 1, pp. 108–117. DOI: 10.1017/S000711451000022X.
  32. Lewis S., Lucas R.M., Halliday J., Ponsonby A. -L. Vitamin D deficiency and pregnancy: From preconception to birth. Molecular Nutrition and Food Research, 2010, vol. 54, no. 8, pp. 1092–1102. DOI: 10.1002/mnfr.201000044.
  33. Liu N.Q., Kaplan A.T., Lagishetty V., et al. Vitamin D and the regulation of placental inflammation. Journal of Immunology, 2011, vol. 186, no. 10, pp. 5968–5974. DOI: 10.4049/jimmunol.1003332.
  34. Lucas R.M., Ponsonby A. -L., Pasco J.A., Morley R. Future health implications of prenatal and early-life vitamin D status. Nutrition Reviews, 2008, vol. 66, no. 12, pp. 710–720. DOI: 10.1111/j.1753-4887.2008.00126.x.
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Сведения об авторах

Денисова Тамара Геннадьевна
доктор медицинских наук, профессор кафедры акушерства и гинекологии, Чувашский государственный университет, Россия, Чебоксары (tomadenisova@rambler.ru)
Самойлова Алла Владимировна
доктор медицинских наук, профессор, заведующая кафедрой акушерства и гинекологии, Чувашский государственный университет, Россия, Чебоксары (allasamoi@mail.ru)
Васильева Эльвира Николаевна
кандидат медицинских наук, доцент кафедры акушерства и гинекологии, Чувашский государственный университет, Россия, Чебоксары (elnikvas@mail.ru)
Герасимова Людмила Ивановна
доктор медицинских наук, профессор, заведующая кафедрой общественного здоровья и организации здравоохранения, ректор, Институт усовершенствования врачей, Россия, Чебоксары

Ссылка на статью

Денисова Т.Г., Самойлова А.В., Васильева Э.Н., Герасимова Л.И. Влияние витамина D на репродуктивное здоровье (обзор литературы) [Электронный ресурс] // Acta medica Eurasica. – 2018. – №3. – С. 9-19. – URL: http://acta-medica-eurasica.ru/single/2018/3/2/.