Mineral metabolism at pregnancy and its adequate correction

И. П. Мазур, Т. Ф Татарчук, В. А. Габаль

Abstract


Disorders of bone and mineral metabolism during gestation affect bone health in women (vitamin D and gestational diabetes, pre-eclampsia, infection associations with pregnancy are established) and fetus, leading to fetal growth retardation, low birth weight and birth children with symptoms of bone mineralization insufficiency. This is due to the calcium redistribution in pregnancy and prerequisites for changing bone mineral metabolism, that may lead to a decrease in bone mineral density, i.e. osteopenia.

It is proved that supplementation with calcium and vitamin D during pregnancy can significantly reduce the level of obstetrical and perinatal complications. Women who plan to become pregnant should start/continue to take vitamin D at doses as recommended for adults (200–2000 IU/day (20.0–50.0 mg/day) depending on body weight). Vitamin D at 1500–2000 IU/day (37.5–50.0 micrograms/day) is prescribed at least to II trimester. If possible, it is necessary to periodically monitor the 25(OH)D level in the blood serum to determine the optimal dose of the drug and test its effectiveness.

Prophylactic therapy should include pharmacological preparations containing a sufficient concentration of elemental calcium in the composition of high-salt biological availability.

Combination of calcium carbonate with physiological doses vitamin D is particularly advantageous, because the results of comparative observations showed calcium carbonate as a most effective and bioavailable form that makes it the drug of choice in pregnancy. Given the combination of nutrient deficiency of mineral and vitamin a Calcium-D3 Nycomed is a drug of choice. In pharmacoeconomic analysis and randomized multicentral clinical study this drug have been demonstrated efficacy and safety of long-term use, and high adherence to treatment by patients.


Keywords


mineral metabolism; bone metabolism; pregnancy; calcium; vitamin D

References


Shurpiak, S.A., Zhemela, N.I. “Role of the minerals and vitamins balance in gestation process.” Women’s Health 5.91 (2014): 37–40.

Obstetrics / Ed. by G.M. Savelieva. Moscow. Medicine (2000): 816 p.

Arden, N.K., Major, P., Poole, J.R., et al. “Size at birth, adult intestinal calcium absorption and 1.25(OH) (2) vitamin D.” QJM : monthly journal of the Association of Physicians 95.1 (2002): 15–21.

Li H., Hou, S., Wang, L., et al. “Relationship between calcium content and its character in fetal tissues and calcium deficiency of minor.” Wei Sheng Yan Jiu 3.5 (2003): 443–6.

Strukov, V.I., Radchenko, L.G., Kamardina, L.V. “Rickets in children born in mothers with osteopenia.” Materials of Russian Osteoporosis Congress. Yaroslavl. Litera-M (2003): 95 p.

Scheplyagina, L.A., Moiseeva, T.Y., Kruglova, I.V. “Reduced bone mineral density in children: pediatrician view.” Attending Doctor 9 (2002): 26–30.

Hsu, S.C., Levine, M.A. “Perinatal calcium metabolism: physiology and pathophysiology.” Semin Neonatal 9.1 (2004): 23–36.

Jones, G., Riley, M.D., Dwyer, T. “Maternal diet during pregnancy is associated with bone mineral dencity in children: a longitudinal study.” Eur J Clin Nutr 54.10 (2000): 749–56.

Sokolova, M.Y. “Calcium deficiency during pregnancy.” Gynecology 5.5 (2004): 268–70.

Namgung, R., Tsang, R.C. “Bone in the pregnant mother and newborn at birth.” Clin Chim Acta 333.1 (2003): 1–11.

Shilin, D.E., Spirichev, V.B. “Mineral homeostasis and bone metabolism in the body of pregnant woman, fetus, baby.” Osteoporosis and osteopathy 2 (2006): 26–32.

Gadieva, F.G. “Relationship of the immune and endocrine system in women of reproductive age.” Obstetrics and gynecology 1 (2001): 11–3.

Wysolmerski, J.J. “The evolutionary origins of calcium and bone metabolism during lactation.” J Mammary Gland Biol Neoplasia 7.3 (2002): 267–76.

Kovacs, C.S., Kronenberg, H.M. “Maternal-Fetal Calcium and Bone Metabolism During Pregnancy, Pucrpcrium, and Lactation.” Endocrine Reviews 18.6 (1997): 832–72.

Prentice, A. “Maternal calcium metabolism and bone mineral status.” Am J Clin Nutr 71(Suppl) (2000): 1312S.

Naylor, K.E., Iqbal, P., Fledelius, C., Fraser, R.B, Eastell, R. “The effect of pregnancy on bone density and bone turnover.” J Bone Miner Res 15.1 (2000): 129–37.

Black, A.J., Topping, J., Durham, В., et al. “A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy.” J Bone Miner Res 15.3 (2000): 557–63.

Root, A.W., Diamond, F.B. Jr. “Disorders of calcium metabolism in the child and adolescent.” // In: Pediatric endocrinology. Ed. by M.A. Sperling, 2nd ed. Saunders, Philadelphia (2002): 629–88.

Villar, J., et al. “Methodological and technical issues related to the diagnosis, screening, prevention and treatment of pre-eclampsia and eclampsia.” International Journal of Gynecology and Obstetrics

1 (2004): 28–41.

Hofmeyr, G.J., et al. “Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.” Cochrane Database Syst Rev 8 (2010): CD001059.

Buppasiri, P., et al. “Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes.” Cochrane Database Syst Rev 10 (2011): CD007079.

Gasparyan, N.D., Logutova, L.S., Demina, E.B., et al. “Disorders of mineral metabolism and its correction with Calcium-D3 Nycomed in pregnant women with osteopenia.” Reproductive Women’s Health 5.34 (2007): 68–72.

Pludowski, P., Povorozniuk, V., et al. “Guidelines for the treatment and prevention of vitamin D deficiency in the Central Europe population: recommended dose of vitamin D preparations for a healthy population and high-risk groups.” Pain. Joints. Spine 3 (2013): 75–96.

Clinical guidelines. Osteoporosis. Diagnostics, prophylaxis and treatment / Ed. by L.I. Benevolenskaia, O.M. Lesniak. Moscow. GEOTAR-Media (2005): 176 p.


GOST Style Citations


1. Шурпяк, С.А., Жемела Н.И. Роль баланса микроэлементов и витаминов в обеспечении гестационного процесса / С.А. Шурпяк, Н.И. Жемела // Здоровье женщины. – 2014. – № 5 (91). – C. 37–40.
2. Акушерство / Под ред. Г.М. Савельевой. – М.: Медицина. – 2000. – 816 c.
3. Arden, N.K., Major, P., Poole, J.R., et al. “Size at birth, adult intestinal calcium absorption and 1.25(OH) (2) vitamin D.” QJM : monthly journal of the Association of Physicians 95.1 (2002): 15–21.
4. Li H., Hou, S., Wang, L., et al. “Relationship between calcium content and its character in fetal tissues and calcium deficiency of minor.” Wei Sheng Yan Jiu 3.5 (2003): 443–6.
5. Струков, В.И. Рахит у детей, родившихся от матерей с остеопенией / В.И. Струков, Л.Г. Радченко, Л.В. Камардина // Матер. рос. конгр. по остеопорозу. – Ярославль: Литера-М. – 2003. – 95 с.
6. Щеплягина, Л.А. Снижение минеральной плотности у детей: взгляд педиатра / Л.А. Щеплягина, Т.Ю. Моисеева, И.В. Круглова // Леч. врач. – 2002. – № 9. – С. 26–30.
7. Hsu, S.C., Levine, M.A. “Perinatal calcium metabolism: physiology and pathophysiology.” Semin Neonatal 9.1 (2004): 23–36.
8. Jones, G., Riley, M.D., Dwyer, T. “Maternal diet during pregnancy is associated with bone mineral dencity in children: a longitudinal study.” Eur J Clin Nutr 54.10 (2000): 749–56.
9. Соколова, М.Ю. Дефицит кальция во время беременности / М.Ю. Соколова // Гинекология. – 2004. – № 5 (5). – С. 268–270.
10. Namgung, R., Tsang, R.C. “Bone in the pregnant mother and newborn at birth.” Clin Chim Acta 333.1 (2003): 1–11.
11. Шилин, Д.Е. Минеральный гомеостаз и костный метаболизм в организме беременной, плода, ребенка / Д.Е. Шилин, В.Б. Спиричев // Остеопороз и остеопатии. – 2006. – № 2. – С. 26–32.
12. Гадиева Ф.Г. Взаимосвязь иммунной и эндокринной систем у женщин репродуктивного возраста / Ф.Г. Гадиева // Акушерство и гинекология. – 2001. – № 1. – С. 11–13.
Gadieva, F.G. “Relationship of the immune and endocrine system in women of reproductive age.” Obstetrics and gynecology 1 (2001): 11–3.
13. Wysolmerski, J.J. “The evolutionary origins of calcium and bone metabolism during lactation.” J Mammary Gland Biol Neoplasia 7.3 (2002): 267–76.
14. Kovacs, C.S., Kronenberg, H.M. “Maternal-Fetal Calcium and Bone Metabolism During Pregnancy, Pucrpcrium, and Lactation.” Endocrine Reviews 18.6 (1997): 832–72.
15. Prentice, A. “Maternal calcium metabolism and bone mineral status.” Am J Clin Nutr 71(Suppl) (2000): 1312S.
16. Naylor, K.E., Iqbal, P., Fledelius, C., Fraser, R.B, Eastell, R. “The effect of pregnancy on bone density and bone turnover.” J Bone Miner Res 15.1 (2000): 129–37.
17. Black, A.J., Topping, J., Durham, В., et al. “A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy.” J Bone Miner Res 15.3 (2000): 557–63.
18. Root, A.W., Diamond, F.B. Jr. “Disorders of calcium metabolism in the child and adolescent.” // In: Pediatric endocrinology. Ed. by M.A. Sperling, 2nd ed. Saunders, Philadelphia (2002): 629–88.
19. Villar, J., et al. “Methodological and technical issues related to the diagnosis, screening, prevention and treatment of pre-eclampsia and eclampsia.” International Journal of Gynecology and Obstetrics
85.1 (2004): 28–41.
20. Hofmeyr, G.J., et al. “Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.” Cochrane Database Syst Rev 8 (2010): CD001059.
21. Buppasiri, P., et al. “Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes.” Cochrane Database Syst Rev 10 (2011): CD007079.
22. Гаспарян, Н.Д. Нарушение минерального обмена и его коррекция препаратом Кальций-Д3 Никомед у беременных с остеопенией / Н.Д. Гаспарян, Л.С. Логутова, Е.Б. Демина, Д.В. Григорьева, С.А. Витушко, Б.Б. Шойбонов, Е.А. Лебедева // Репродуктивное здоровье женщины. – 2007. – № 5 (34). – С. 68–72.
23. Плудовски, П. Методические рекомендации по лечению и профилактике дефицита витамина D у населения стран Центральной Европы: рекомендованные дозы препаратов витамина D для здоровой популяции и групп риска / П. Плудовски, В. Поворознюк [и др.]. // Боль. Суставы. Позвоночник. – 2013. – № 3. – С. 75–96.
24. Клинические рекомендации. Остеопороз. Диагностика, профилактика и лечение / Под ред. Л.И. Беневоленской, О.М. Лесняк. – М.: ГЭОТАР- Медиа. – 2005. – 176 с.




DOI: http://dx.doi.org/10.18370/2309-4117.2016.27.36-40

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)