Ramazan DENİZLİ, Önder SAKİN, Zehra Meltem PİRİMOĞLU, İSMET GÜN, Muzaffer Seyhan ÇIKMAN, Ali DOĞUKAN ANĞIN

Gebelerde D Vitamininin Maternal ve Fetal Etkilerinin İncelenmesi

Amaç: Gebelerde D vitamininin maternal ve fetal etkilerinin incelenmesi. Gereçler ve Yöntem: Çalışmamızda Mart ile Mayıs 2017 tarihleri arasında Sağlık Bilimleri Üniversitesi Kartal Dr. Lütfi Kırdar Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde doğum yapan hastalar incelendi. Üçüncü trimesterde gebelerde 25 (OH) vitamin D düzeylerine bakıldı. D vitamin ilacı kullanmayan, tek ve canlı doğum yapan 276 hasta çalışmaya alındı. Bulgular: Hastaların 9 tanesinde D vitamini düzeyi normal seviye olarak tanımlanan 30 ng/ml üzerindedir (%3,26), 25 tanesinde 20-30 ng/ml arasında yetersizlik düzeyindedir (%9,06) ve geriye kalan 242 gebede 20 ng/ml altındadır yani eksiklik düzeyindedir. (%87,68). Maternal D vitamini eksikliği ile preeklampsi, sezaryen oranı, doğum şekli, preterm doğum, doğum kilosu, doğum haftası ve polihidroamnios ile anlamlı ilişki bulunmadı. D vitamini seviyesi ile yenidoğan boy ve APGAR skorları arasında pozitif yönde zayıf düzeyde anlamlı bir korelasyon saptandı (sırasıyla r:0,133 0,135 ve 0,123 p:0,027 0,025 ve 0,042). Sonuç: Gebelik komplikasyonlarında anlamlı bir artışa yol açmadığı için rutin olarak gebelerde D vitamini kullanımının iyi değerlendirilmesi gerektiğini düşünüyoruz. Gebeler için doğru referans aralıkları belirlendikten ve gebelik komplikasyonları ile ilişkileri daha da açıklığa kavuşturulduktan sonra rutin olarak kullanılmasının daha doğru olacağını kanaatindeyiz.

Investigation of Maternal and Fetal Effects of Vitamin D in Pregnancies

Objective: Investigation of maternal and fetal effects of vitamin D in pregnancies. Material and Methods: In our study, we examine patients who gave birth in Sağlık Bilimleri Üniversitesi Kartal Dr. Lütfi Kırdar Research and Education Hospital, date between March and May 2017. At the third trimester 25 (OH) vitamin D levels were measured. A total of 276 patients who did not use vitamin D drugs and giving a single live birth were included in the study. Results: Vitamin D levels in 9 of the patients were above 30 ng / ml (3,26%), which was defined as normal level, 25 of the patients were inadequate between 20-30 ng / ml (9.06%) and the remaining 242 patients were below 20 ng / ml deficiency level (87.68%). With vitamin D deficiency we can not show any significant correlation with preeclampsia, cesarean section ratio, delivery methods, preterm delivery, birth weight, birth weeks and polihydroamnios. There was a low but significant positive correlation between the level of vitamin D and the neonatal height and APGAR scores in the positive direction. (respectivly r: 0,133 0,135 and 0,123 p:0,027 0,025 and 0,042). Conclusion: We think that the use of vitamin D in pregnancies should be evaluated carefully. Because no significant increase in pregnancy complications is observed. We believe that it is better to use it routinely once the correct reference intervals for pregnancies have been established and the implications for pregnancy complications become clearer.

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Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol. 2015; 125(2): 439-47.
Wagner CL, McNeil RB, Johnson DD, Hulsey TC, Ebeling M, Robinson C, et al. Health characteristics and outcomes of two randomized vitamin D supplementation trials during pregnancy: a combined analysis. J Steroid Biochem Mol Biol. 2013; 136: 313-20.
Practice A.C.o.O., ACOG Committee Opinion No. 495: Vitamin D: Screening and supplementation during pregnancy. Obstet Gynecol, 2011. 118(1): p. 197-8.
Pirdehghan A et al., High Prevalence of Vitamin D Deficiency and Adverse Pregnancy Outcomes in Yazd, a Central Province of Iran. J Reprod Infertil. 2016; 17(1): 34-8.
Dawodu A, Akinbi H. Vitamin D nutrition in pregnancy: current opinion. Int J Womens Health. 2013; 5: 333– 43.
Song SJ, Zhou L, Si S, Liu J, Zhou J, Feng K, et al. The high prevalence of vitamin D deficiency and its related maternal factors in pregnant women in Beijing. PLoS One. 2013; 8 (12): e85081.
Parlak, M., et al., Severe vitamin D deficiency among pregnant women and their newborns in Turkey. The Journal of Maternal-Fetal & Neonatal Medicine, 2014(0): p. 1-12.
Shibata M, Suzuki A, Sekiya T, et al. High prevalence of hypovitaminosis D in pregnant Japanese women with threatened premature delivery. Journal of bone and mineral metabolism. 2011;29(5):615-620.
Zhou J.. et all., Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: a prospectiveobservational study in southern China.Eur J Clin Nutr. 2014 Aug;68(8):925-30
Rodriguez A, Garcia-Esteban R, Basterretxea M, et al. Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG. 2015; 122(12): 1695-1704.
Bodnar LM, Klebanoff MA, Gernand AD, Platt RW, Parks WT, Catov JM, et al. Maternal vitamin D status and spontaneous preterm birth by placental histology in the US Collaborative Perinatal Project. American Journal of Epidemiology. 2014; 179(2): 168–176.
Pittas AG, Sun Q, Manson JE, Dawson-Hughes B, Hu FB. Plasma 25-hydroxyvitamin D concentration and risk of incident type 2 diabetes in women. Diabetes Care 2010; 33: 2021–3.
Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013; 346: f1169.
Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care 2004; 27: 2813–8.
Gulseth HL, Gjelstad IM, Tierney AC, Lovegrove JA, Defoort C, Blaak EE, et al. Serum vitamin D concentration does not predict insulin action or secretion in European subjects with the metabolic syndrome. Diabetes Care 2010; 33: 923–5.
Zuhur SS, Erol RS, Kuzu I, Altuntas Y. The relationship between low maternal serum 25-hydroxyvitamin D levels and gestational diabetes mellitus according to the severity of 25-hydroxyvitamin D deficiency. Clinics. 2013; 68(5): 658-664.
Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013; 26: 889-99.
Shand AW, Nassar N, Von Dadelszen P, Innis SM, Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre-eclampsia. BJOG 2010;117:1593–8.
Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Karumanchi SA, et al. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension 2010; 56: 758–63.
Morley R, Carlin JB, Pasco JA, Wark JD. Maternal 25-hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size. J Clin Endocrinol Metab 2006; 91: 906–12.
Lee DH et al., Effects of Serum 25-hydroxy-vitamin D and Fetal Bone Growth during Pregnancy. J Bone Metab. 2015; 22(3): 127-33.
Principi, N., et al., Implications of maternal vitamin D deficiency for the fetus, the neonate and the young infant. Eur J Nutr, 2013; 52(3): p. 859-67.
Walsh, J.M., et al., Pregnancy in dark winters: implications for fetal bone growth? Fertil Steril, 2013; 99(1): p. 206-11.
Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab 2009; 94: 940–5.
Gernand AD, Simhan HN, Caritis S, Bodnar LM. Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol. 2014; 123(1): 40-8.