High-risk pregnancy: effectiveness of personalized pregravid preparation and positive perinatal experience

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.62.34-41

Keywords:

high risk pregnancy, micronutrient status, calcitriol, vitamin and mineral complex

Abstract

Research objective: to study the possibilities of improving perinatal results by optimizing pergravid preparation in women with high perinatal risk.
Materials and methods. The first stage – a cross-sectional study – consisted in determining the vitamin D (VD) status and assessing the course of pregnancy in 459 women in the II and III trimester; the second stage was a randomized controlled study of women with VD deficiency in group IIA (planning stage, 54 women) and IIB (I trimester, 60 women), who received the vitamin and mineral complex (VMC) Pregna-5 with a high calcitriol content and perinatal results were evaluated. VD in the blood was determined by the enzyme-linked immunosorbent assay.
Results. VD level was optimal only in 30.7% of pregnant women (group ІА), in 69.3% of women its insufficiency or deficiency was found (group ІB). The frequency of threatened termination (9.9 vs. 45.6%; p < 0.01), preeclampsia (2.0 vs. 11%; p < 0.05), intrauterine growth retardation (7% only in group IIB, p < 0.01) was significantly higher against the background of BD deficiency. Normalization of the VD level (groups IIA and IIB) after VMC administration was observed within 1–3 months. Pregnancy complications value was higher in the group where the VMC was started in the first trimester: early gestosis (15 vs. 28.57%; p < 0.05), the threat of termination (22.2 vs. 36.7%; p < 0.05), bacterial vaginosis (7.4 vs. 31.7%; p < 0.05), placental dysfunction (18.5 vs. 40.0%; p <0.01), placental pathology in group IIB was detected 2–3 times more often. The differences between the preeclampsia (1.9 vs. 6.7%; p > 0.05) and anemia (16.6 vs. 28.3%; p > 0.05) were insignificant. Analysis of the childbirth results showed a significantly higher frequency of cesarean sections in group IIB (38.3 vs. 22.2%; p < 0.05), the average weight of newborns was less (3299.11 ± 128 g vs. 3643.24 ± 136 g; p < 0.01). The most effective was the VMC start at the stage of pregnancy planning (F = 13.35482; p = 0.000016); a significant difference was revealed in the course of pregnancy in the groups where VMC started in the first, second and third trimesters of pregnancy (Q = 4.67, p = 0.00458).
Conclusions. Timely donation of VMC with a high content of cholecalciferol in women with high perinatal risk may lead to a positive course of pregnancy. Further research is required to obtain a convincing evidence base.

Author Biographies

G.S. Manasova, Odesa National Medical University, Odesa

MD, professor, Department of Obstetrics and Gynecology No. 2

N.V. Didenkul, Municipal Non-Profit Enterprise “City Clinical Hospital No. 1” of the Odesa City Council, Odes

PhD, obstetrician-gynecologist

N.V. Kuzmyn, Odesa National Medical University; Municipal Non-Profit Enterprise “Maternity Hospital No. 5” of the Odessa City Council, Odesa

Graduate student, Department of Obstetrics and Gynecology;
Head of the 2nd Obstetrics Department

References

  1. Centers for Disease Control and Prevention. Rates in severe morbidity indicators per 10,000 delivery hospitalizations, 1993–2014. Atlanta (GA): CDC (2017). Available from: [https://www.cdc.gov/reproductivehealth/maternalinfanthealth/smm/rates-severe-morbidity-indicator.htm], last accessed April 15, 2019.
  2. Petersen, E.E. , Davis, N.L., Goodman, D., et al. “Vital signs: pregnancy-related deaths, United States, 2011–2015, and strategies for prevention, 13 states, 2013–2017.” MMWR Morb Mortal Wkly Rep 68.18 (2019): 423–9.
  3. American College of Obstetricians and Gynecologists. “Levels of maternal care: Obstetric care consensus No. 9.” Obstet Gynecol 134.2 (2019): 428–34. DOI: 10.1097/AOG.0000000000003384
  4. Artal-Mittelmark, R. Overview of High-Risk Pregnancy. Saint Louis University School of Medicine (2020). Available from: [https://www.msdmanuals.com/ru].
  5. Hanson, M., Fall, C., Robinson, S., Baird, J. Early life nutrition and lifelong health. London, GB. British Medical Association (2009): 122 p.
  6. Gluckman, P., Hanson, M., Buklijas, T., et al. “Epigenetic mechanisms that underpin metabolic and cardiovascular diseases.” Nature Reviews Endocrinology 5 (2009): 401–8.
  7. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience (2016). Available from: [https://apps.who.int/iris/handle/10665/250796].
  8. Cetin, I., Berti, C., Calabrese, S. “Role of micronutrients in the periconceptional period.” Hum Reprod Update 16.1 (2010): 80–95. DOI: 10.1093/humupd/dmp025
  9. Fernandez-Twinn, D.S., Ozanne, S.E. “Early life nutrition and metabolic programming.” Ann N Y Acad Sci 1212 (2010): 78–96. DOI: 10.1111/j.1749-6632.2010.05798.x
  10. World Health Organization. WHO: Good Maternal Nutrition: the best start in life (2016). Available from: [https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2016/good-maternal-nutrition.-the-best-start-in-life-2016].
  11. Berti, C., Agostoni, C., Davanzo, R., et al. “Early-life nutritional exposures and lifelong health: immediate and long-lasting impacts of probiotics, vitamin D, and breastfeeding.” Nutr Rev 75.2 (2017): 83–97. DOI: 10.1093/nutrit/nuw056
  12. World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations (2020). Available from: [https://www.who.int/publications-detail/9789240000124].
  13. Iodine Global Network. Global Scorecard of Iodine Nutrition in 2017 in the General Population Based on School-Age Children (SAC) With Additional Data for Pregnant Women (PW). Available from: [https://www.ign.org/cm_data/IGN_Global_Scorecard_AllPop_and_PW_May20171.pdf], aссesed 11/12/21.
  14. Amrein, K., Scherkl, M., Hoffmann, M., et al. “Vitamin D deficiency 2.0: an update on the current status worldwide.” Eur J Clin Nutr 74 (2020): 1498–513. DOI: 10.1038/s41430-020-0558-y
  15. Coffey-Vega, K., et al. What are the pregnancy complications of folate deficiency? Updated: Nov 03, 2020. Available from: [https://www.medscape.com/answers/200184-186706/what-are-the-pregnancy-complications-of-folate-deficiency].
  16. Kuznetsova, I.V., Konovalov, V.A. “Folic acid and its role in female reproduction.” Gynecology 16.4 (2014): 17–23. Available from: [https://gynecology.orscience.ru/2079-5831/rt/captureCite/28334/0].
  17. Monteiro, J.P., Wise, C., Morine, M.J., et al. “Methylation potential associated with diet, genotype, protein, and metabolite levels in the Delta Obesity Vitamin Study.” Genes Nutr 9.3 (2014): 403. DOI: 10.1007/s12263-014-0403-9
  18. Fogacci, S., Fogacci, F., Banach, M., et al. “Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials.” Clinical Nutrition 39.6 (2020): 1742–52. DOI: 10.1016/j.clnu.2019.08.015
  19. Tabatabaei, N., Auger, N., Herba, C.M., et al. “Maternal Vitamin D Insufficiency Early in Pregnancy Is Associated with Increased Risk of Preterm Birth in Ethnic Minority Women in Canada.” J Nutr 147.6 (2017): 1145–51. DOI: 10.3945/jn.116.241216
  20. Hubeish, M., Husari, H.A., Itani, S.E., et al. “Maternal Vitamin D Level and Rate of Primary Cesarean Section.” J Clin Gynecol Obstet 7.2 (2018): 43–51. DOI: 10.14740/jcgo473w
  21. Wang, H., Xiao, Y., Zhang, L., Gao, Q. “Maternal early pregnancy vitamin D status in relation to low birth weight and small-for-gestational-age offspring.” J Steroid Biochem Mol Biol 175 (2018): 146–50. DOI: 10.1016/j.jsbmb.2017.09.010
  22. Płudowski, P., Karczmarewicz, E., Bayer, M., et al. “Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe – recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency.” Endokrynol Pol 64.4 (2013): 319–27. DOI: 10.5603/ep.2013.0012
  23. Greenlogic. Solar insolation in the cities of Ukraine. Available from: [https://greenlogic.com.ua/ru/baza/solnechnye-stantsii/solnechnaya-insolyatsiya-v-gorodah-ukrainy].
  24. Lian, R.H., Qi, P.A., Yuan, T., et al. “Systematic review and meta-analysis of vitamin D deficiency in different pregnancy on preterm birth: Deficiency in middle pregnancy might be at risk.” Medicine (Baltimore) 100.24 (2021): e26303. DOI: 10.1097/MD.0000000000026303
  25. Heyden, E.L., Wimalawansa, S.J. “Vitamin D: effects on human reproduction, pregnancy, and fetal well- being.” J Steroid Biochem Mol Biol 180 (2018): 41–50.
  26. Dovnik, A., Mujezinović, F. “The association of vitamin D levels with common pregnancy complications.” Nutrients 10.7 (2018): 867. DOI: 10.3390/nu10070867
  27. Wolf, S.T., Jablonski, N.G., Ferguson, S.B., et al. “Four weeks of vitamin D supplementation improves nitric oxide- mediated microvascular function in college-aged African Americans.” Am J Physiol Heart Circ Physiol 319.4 (2020): H906–H914. DOI: 10.1152/ajpheart.00631.2020
  28. Ganguly, A., Tamblyn, J.A., Finn-Sell, S. et al. “Vitamin D, the placenta and early pregnancy: effects on trophoblast function.” J Endocrinol 236.2 (2018): R93–R103. DOI: 10.1530/JOE-17-0491
  29. NICE. “Vitamin D: supplement use in specific population groups.” NICE Guidance 2021. Available from: [https://www.nice.org.uk/terms-and- conditions#notice-ofrights], last accessed 30 Aug 2017.

Downloads

Published

2021-12-29

How to Cite

Manasova, G., Didenkul, N., & Kuzmyn, N. (2021). High-risk pregnancy: effectiveness of personalized pregravid preparation and positive perinatal experience. REPRODUCTIVE ENDOCRINOLOGY, (62), 34–41. https://doi.org/10.18370/2309-4117.2021.62.34-41

Issue

No. 62 (2021)

Section

Treatment of infertility and pregnancy

License

Copyright (c) 2021 Г.С. Манасова, Н.В. Діденкул, Н.В. Кузьмин

Creative Commons License

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

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.