Features of delivery tactics in pregnant women with placental dysfunction and taking into account the concentration of vitamin D

The high prevalence of the vitamin D (VD) deficiency states (VDDS) among adults, as well as the data on the pleiotropic effects of calcitriol suggests its participation in the development of various complications and pregnancy outcomes. The objective of the present study is to analyze the pregnancy course and delivery tactics of pregnant women with placental dysfunction (PD) depending on the calcitriol availability. We examined 56 patients with PD (I – main group) and 40 conditionally healthy women with physiological pregnancy (II – control group). In addition to the standard clinical and laboratory examination, the level of vitamin D in the blood was determined by ELISA. The statistical analysis used the software Biostat, Statistica 6.0. In 76.8 % of group I women, the VD content corresponded to the deficit (38.4 %) and to the suboptimal status (38.4 %), (RR = 3.0; 95 % CI 2.39–3.76). In group II, VDDS was not detected and the suboptimal status was diagnosed in 31.45 %. The average VD level in group I was significantly lower than that in group II (31.4 ± 8.6 ng/ml vs 43.54 ± 11.2 ng/ml; Uemp = 42.5; p < 0.05). The caesarean section rate in group I was 3.4 times higher than that in group II (42.85 % vs 12.5 %; F = 0.00001; p < 0.01). The weight of newborns in group II significantly exceeded the weight of children in group I (3643.24 ± 136 g vs 3299.11 ± 128 g; t = 4.17; p < 0.01); a strong direct correlation was found between the weight of the newborn and the VD level in the blood of pregnant women (r = 0.71). VDDS increases 2 times the risk of abdominal delivery (RR = 1.27; 95 % CI 0.95–1.66). The VD status of a pregnant woman can have a certain influence on the formation of optimal adaptive-compensatory mechanisms in the utero-placental-fetal system and on the pregnancy outcome for mother and fetus.

1. Pérez-Hernández N., Aptilon-Duque G., Nostroza-Hernández M. C., Vargas-Alarcón G., Rodríguez-Pérez J. M., Blachman-Braun R. Vitamin D and its effects on cardiovascular diseases: a comprehensive review [Electronic resource]. Korean Journal of Internal Medicine, 2016, vol. 31, no. 6, pp. 1018–1029. https://doi.org/10.3904/kjim.2015.224

2. Rosen C. J., Adams J. S., Bikle D. D., Black D. M., Demay M. B., Manson J. E., Murad M. H., Kovacs Ch. S. The nonskeletal effects of vitamin D: an endocrine society scientific statement. Endocrine Reviews, 2012, vol. 33, no. 3, pp. 456– 492. https://doi.org/10.1210/er.2012-1000

3. Povoroznyuk V. V., Balats’ka N. I., Klimovits’kii F. V., Sinen’kii O. V., Muts V. Ya. Riven 25 (OH) vitamin D in the overgrowing population of the winter regions of Ukraine. Problemi osteologії [Problems of osteology], 2011, vol. 4, no. 14, pp. 3–8 (in Ukrainian).

4. Manasova G. S., Zelinsky A. A., Didenkul N. V., Zhovtenko O. V., Kuzmin N. V. Faulty placentation and attitude in pregnant women with placental dysfunction: revisited of calcitirol possible role in the formation of pathology. Deutscher Wissenschaftsherold. German Science Gerald, 2018, no. 4, pp. 23–28.

5. Dovnik A., Mujezinović F. The Association of Vitamin D Levels with Common Pregnancy Complications. Nutrients, 2018, vol. 10, no. 7, p. 867. https://doi.org/10.3390/nu10070867

6. Kalinchenko S. Yu., Zhilenko M. I., Gusakova D. A., Tyuzikov I. A., Mskhalaya G. Zh., Sablin K. S., Dymova A. V. Vitamin D and women’s reproductive health. Problemy reproduktsii [Reproduction problems], 2016, no. 4, pp. 28–36 (in Russian).

7. Karras S. N., Wagner C. L., Castracane V. D. Understanding vitamin D metabolism in pregnancy: from physiology to pathophysiology and clinical outcomes. Metabolism, 2018, vol. 86, pp. 112–123. https://doi.org/10.1016/j.metabol.2017.10.001

8. WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections [Electronic resource]. World Health Organization. Available at: https://www.who.int/reproductivehealth/publications/non-clinical-interventions-toreduce-cs/en/ (accessed 08.03.2019).

9. European Board and College of Obstetrics and Gynaecology (EBCOG). EBCOG position statement on caesarean section in Europe [Electronic resource]. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2017, vol. 219, p. 129.

10. Merewood A., Mehta S. D., Chen T. C., Bauchner H., Holick M. F. Association between vitamin D deficiency and primary cesarean section. Journal of Clinical Endocrinology and Metabolism, 2009, vol. 94, no. 3, pp. 940–945. https://doi.org/10.1210/jc.2008-1217

11. Scholl T. O., Chen X., Stein P. Maternal vitamin D status and delivery by cesarean. Nutrients, 2012, vol. 4, no. 4, pp. 319–330. https://doi.org/10.3390/nu4040319

12. Fiscaletti M., Stewart P., Munns C. F. The importance of vitamin D in maternal and child health: a global perspective. Public Health Reviews, 2017, vol. 38, no. 1, art. 19. https://doi.org/10.1186/s40985-017-0066-3

13. Agarwal S., Kovilam O., Agrawal D. K. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: a critical review. Critical Reviews in Food Science and Nutrition, 2018, vol. 58, no. 5, pp. 755–769. https://doi.org/10.1080/10408398.2016.1220915

14. Roth D. E., Leung M., Mesfin E., Qamar H., Watterworth J., Papp E. Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomized trials. BMJ, 2017, vol. 359, p. j5237. https://doi.org/10.1136/bmj.j5237

15. Ojo O., Weldon S. M., Thompson T., Vargo E. J. The effect of vitamin D supplementation on glycaemic control in women with gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials [Electronic resource]. International Journal of Environmental Research and Public Health, 2019, vol. 16, no. 10, pii E1716. https://doi.org/10.3390/ijerph16101716

16. The average monthly level of solar radiation in the cities of Ukraine. Available at: https://www.atmosfera.ua/statigeliosistemy/solar-insulation-ukraine (accessed 08.08.2019) (in Russian).

17. Nikolaeva L. B., Ushakova G. A. First pregnancy and first birth: a guide for doctors. Moscow, GEOTAR-Media Publ., 2013. 261 p. (in Russian).