Didenkul N. Vitamin D status in placental dysfunction and intrauterine

Thesis for the degree of Doctor of Philosophy in 222 "Medicine" (22 "Health"). - Odessa National Medical University of the Ministry of Health of Ukraine, Odesa, 2020. The aim of the study was to reduce the incidence of obstetric and perinatal complications by developing differentiated methods for predicting and preventing placental dysfunction on the background of intrauterine infection in patients with vitamin D deficiency. The study consisted of two stages. The first stage included 96 women in the period from 24 to 34 weeks of gestation, of which the main group consisted of 56 pregnant women with a diagnosis of placental dysfunction and signs of intrauterine infection. The control group consisted of 40 women with a physiological course of pregnancy. Both groups analyzed the body's supply of vitamin D, levels of procalcitonin, lactate, and C-reactive protein and their ratio to the level of 25 (OH) D in the blood of pregnant women, analyzed the genotype distribution of BsmI gene polymorphisms encoding vitamin D receptors. The average level of vitamin D in the blood of patients from the main group was significantly lower than in pregnant women with physiological pregnancy (31.73 vs. 43.38 ng/ml; p <0.01). In the main group, vitamin D-deficiency status was diagnosed in 39.29%, vitamin D deficiency was diagnosed in 37.5% of the main group and in 15% of the control group. There is a direct relationship between mean placental dysfunction and the A / G genotype of the BsmI VDR polymorphism. The content of C-reactive protein, procalcitonin, and lactate in the blood of pregnant women of the main group significantly exceeded this indicator of the control group (p <0,01). There was a significant inverse correlation between vitamin D and SSRI markers (p <0.01). In the second phase, the study included 57 women whose previous pregnancies were complicated by the development of placental dysfunction, and who were deficient in vitamin D at the time of admission to the women's clinic. Of these, 27 women were included in the pre-pregnancy training group, and 30 pregnant women up to 12 weeks of pregnancy were in the comparison group. Both groups received 4000 IU of cholecalciferol in combination with vitamin-mineral complex for three months, after which the level of VD was determined a second time. After receiving target values ​​of 30 ng/ml and more, continued therapy with calcitriol at a dose of 2000 IU, vitamin-mineral complex was prescribed until 16 weeks of pregnancy. In women of the pre-pregnancy group, the level of vitamin D was determined for the third time at the diagnosed pregnancy. It was found that in women of the pre-pregnancy training group in the first trimester the level of VD was significantly higher than in pregnant women of the comparison group. The incidence of pregnancy and childbirth complications in patients who did not receive comprehensive pre-pregnancy training was significantly higher than in women who received a vitamin D supplement at the planning stage of pregnancy.