Cevval ULMAN, Betül ERSOY, Yeşim BÜLBÜL, Nermin TANSUĞ, Ebru CANDA

Anne ve Term Bebeklerin Vitamin D ve Kalsiyum Metabolizmasının Değerlendirilmesi ve Bebeklerin Kemik Gücünün Kantitatiif Ultrason ile Tayini

GİRİŞ ve AMAÇ: Yetersiz D vitamin alımı kemik mineralizasyonunu ve döngüsünü olumsuz etkilemektedir. Gebelikte annenin kemik döngüsü üzerindeki değişiklikler fetusun kemik mineral içeriğinde değişikliğe neden olmaktadır. Bu çalışmada fetal kemik minerilizasyonu üzerinde belirleyici olan D vitamin metabolizmasını etkileyen faktörler, biyokimyasal kemik göstergeleri ve yenidoğanlarda kantitatif ultrason ile değerlendirilen kemik yapısı arasındaki ilişkinin saptanması amaçlanmıştır. YÖNTEM ve GEREÇLER: Celal Bayar Üniversitesi Tıp Fakültesi Hastanesinde doğan 90 term bebek ve annesi çalışmaya alındı. Serum kalsiyum, fosfor, alkalen fosfataz, kemik alkalen fosfataz, 1,25(OH)2D, 25(OH)D, paratiroid hormone ve osteokalsin düzeyleri ölçüldü. Yaşamın ilk 96 saati içinde kantitatif ultrason cihazı ile tibial ölçümleri yapıldı. BULGULAR: Annelerin ortalama 25(OH)D ve 1,25(OH)2D düzeyleri normal sınırlarda saptandı. Yenidoğanlarda ölçülen ortalama Ca düzeyleri ortalama 10.1 ±0.6 mg/dl, P düzeyleri 6.2±1 mg/dl saptandı. D vitamini desteği almayan annelerde serum 25 (OH)D değerleri yüksek (p = 0.02), D vitamini desteği almayan annelerde PTH değerleri yüksek ve osteokalsin değerleri düşük bulundu (sırasıyla P = 0.02 ve p = 0.03). Anneleri D vitamini desteği almayan yenidoğanlarda PTH değerleri daha düşüktü (P= 0.004). Ca takviyesi yapılan annelerde 25 (OH) D değeri yüksekti (P = 0.009). Yenidoğanların SOS değerleri 3127 ± 107 (2900-3389), ortalama Z skoru 0.3 ± 0.7 (-1.4 - 2.6) idi. TARTIŞMA ve SONUÇ: Yenidoğanların SOS skorları ile Ca ve ALP değerleri arasında anlamlı korelasyon gözlendi. Kemik yapısının kantitatif ultrason ile değerlendirilmesi, invaziv olmayan ve pratik bir yöntemdir.

Determination of Vitamin D Metabolism and Bone Strength by Quantitative Ultrasound in Term Newborns

INTRODUCTION: Insufficient intake of vitamin D negativelyeffects bone mineralization and turnover. Changes in mothers’bone turnover during pregnancy effects bone mineralcomposition of the fetus. The aim of this study was to evaluatethe factors, biochemical markers and bone structure assessedby quantitative ultrasonography effecting vitamin Dmetabolism.METHODS: Ninety term newborn and their mothers includedin the study. Serum levels of Ca, P, alkaline phosphatase(ALP), bone ALP (BALP), 1,25(OH)2D, 25(OH)D, parathyroidhormone (PTH), and osteocalcine levels were analyzed fromthe serums of mothers. Quantitative ultrasound from the tibialbone was performed for all infants during the first 96 hoursRESULTS: Mean values for 25(OH)D and 1,25(OH)2D werewithin normal ranges in mothers. Mean blood Ca levels of thenewborns was 10.1 ±0.6 mg/dl, and mean P levels of thenewborns was 6.2±1 mg/dl. Serum 25(OH)D values were highin mother who used vitamin D supplementation (P=0.02), PTHvalues were high and osteocalcine values were low in motherswho did not used vitamin D supplementation (P=0.02 andP=0.03, respectively). PTH values were low in newbornswhose mothers did not received vitamin D supplementation(P=0.004). 25(OH)D values were high in mothers whoreceived Ca supplementation (P=0.009). SOS values ofnewborns were 3127±107 (range, 2900-3389), and mean Zscores were 0.3±0.7 (range, -1.4 - 2.6).DISCUSSION AND CONCLUSION: Significant correlationwas observed between the SOS scores and Ca and ALP valuesof the newborns. Assessment of the structure of bone withquantitative ultrasound is a noninvasive and practical method.

PDF

___

1. Sabour H, Hossein-Nezhad A, Maghbooli Z, Madani F, Mir E, Larijani B. Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: A cross-sectional study. Gynecol Endocrinol. 2006;22(10):585-9.
2. Specker B. Nutrition influences bone development from infancy through toddler years. J Nutr. 2004 ;134(3):691S-95S.
3. Specker B. Vitamin D requirements during pregnancy. Am J Clin Nutr 2004;80(6 Suppl):1740S-7S.
4. Flynn A. The role of dietary calcium in bone health. Proc Nutr Soc. 2003 ;62(4):851-8.
5. Nutrition and bone health: with particular reference to calcium and vitamin D. Report of the Subgroup on Bone Health, Working Group on the Nutritional Status of the Population of the Committee on Medical Aspects of the Food Nutrition Policy. Rep Health Soc Subj (Lond). 1998;49:1-24.
6. Nishimura K, Shima M, Tsugawa N, Matsumoto S, Hirai H, Santo Y, Nakajima S, Iwata M, Takagi T, Kanda Y, Kanzaki T, Okano T, Ozono K. Long-term hospitalization during pregnancy is a risk factor for vitamin D deficiency in neonates. J Bone Miner Metab. 2003;21(2):103- 8.
7. Specker BL. Do North American women need supplemental vitamin D during pregnancy or lactation? Am J Clin Nutr. 1994;59(2 Suppl):484S-90S
8. Namgung R, Tsang RC. Bone in the pregnant mother and newborn at birth. Clin Chim Acta. 2003;333(1):1-11.
9. Foldes AJ, Rimon A, Keinan DD, Popovtzer MM. Quantitative ultrasound of the tibia: a novel approach for assessment of bone status. Bone. 1995;17(4):363-7.
10. Wright LL, Glade MJ, Gopal J. The use of transmission ultrasonics to assess bone status in the human newborn. Pediatr Res. 1987 Nov;22(5):541-4.
11. Molgaard C, Michaelsen KF. Vitamin D and bone health in early life. Proceedings of the Nutrition Society 2003;62:823-28.
12. Prentice A. Micronutrients and the bone mineral content of the mother, fetus and newborn. J Nutr 2003;133:S1693-99.
13. Pawley N, Bishop NJ. Prenatal and infant predictors of bone health: the influence of vitamin D. Am J Clin Nutr 2004;80S:1748S- 51S.
14. Delvin EE, Salle BL, Glorieux FH, Adeleine P, David LS. Vitamin d supplementation during pregnancy: effect on neonatal calcium homeostasis. J Pediatr 1986;109:328-34.
15. 14. Cockburn F, Belton NR, Purvis RJ, Giles MM, Brown JK, Turner TL, Wilkinson EM, Forfar JO, Barrie WJ, McKay GS, Pocock SJ. Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants. Br Med J. 1980;231:1-10.
16. Brooke OG, Brown IR, Bone CD, Carter ND, Cleeve HJ, Maxwell JD, Robinson VP, Winder SM. Vitamin D supplements in pregnant Asian omen: effects on calcium status and fetal growth. Br Med J. 1980;280:751-4.
17. Seller MJ, Bnait KS. Effects of tobocca smoke inhalation on the devloping Mouse embryo and fetus. Reprod Toxicol 1995;9:449-59
18. Jones G, Riley M, Dwyer T. Maternal smoking during pregnancy, growth, and bone mass in prepubertal children. J Bone Miner Res 1999;14:146-51.
19. Gonnelli S, Montagnani A, Gennari L, Martini S, Merlotti D, Cepollaro C, Perrone S, Buonocore G, Nuti R. Feasibility of quantitative ultrasound measurements on the humerus of newborn infants for the assessment of the skeletal status. Osteoporos Int. 2004;15(7):541- 6.
20. Nakomato T, Grant S, Yazdani M. The effects of maternal caffeine intake during pregnancy on mineral contents of fetal rat bone. Res Exp Med 1989; 189:275-80
21. Rauch F, Schoenau E. Skeletal development in premature infants: a review of bone physiology beyond nutritional aspects. Arch Dis Child Fetal Neonatal Ed 2002; 86:82-5.
22. Godfrey K, Walker-Bone K, Robinson S, Taylor P, Shore S, Wheeler T, Cooper C. Neonatal bone mass: influence of parental birthweight, maternal smooking, body composition, and activity during pregnancy. J Bone Min Res 2001;16:1694-1703.
23. Nemet D, dolfin T, Wolach B. Quantitative ultrasound measurements of bone speed of sound in premature infants. Eur J Pediatr 2001 ;160(12):736-40.
24. Littner Y, Mandel D, Mimouni FB. Bone ultrasound velocity curves of newly born term and preterm infants. J Ped Endoc Metab 2003;16(1):43-7.
25. Yiallourides M, Savoia M, May J, Emmerson AJ, Mughal MZ. Tibial speed of sound in term and preterm infants. Biol Neonate. 2004;85(4):225-8.
26. Tansug N, Yildirim SA, Canda E, Ozalp D, Yilmaz O, Taneli F, Changes in quantitative ultrasound in preterm and term infants during the first year of life. Eur J Radiol 2011; 79(3):428-31.
27. McDevitt H, Ahmed SF, Quantitative ultrasound assessment of bone health in the neonate. Neonatalogy 2007;91:2-11.
28. Kara S, Güzoğlu N, Göçer E, Arıkan FI, Dilmen U, Dallar Bilge Y. Evaluation of bone metabolism in newborn twins using quantitative ultrasound and biochemical parameters. J Matern Fetal Neonatal Med. 2016 Mar;29(6):944-8.