Division of Endocrinology and Metabolism, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Metabolism. 2018 Sep;86:112-123. doi: 10.1016/j.metabol.2017.10.001. Epub 2017 Oct 21.
This critical time frame of intrauterine life development is considered of major importance on the metabolic imprinting of overall health of the offspring, in later life. This requires a delicate immune balance that nurtures the allogeneic fetus, while maintaining reactivity against pathogens. Dysregulation of these tightly controlled biophenomena at a systemic and placental level, have been considered as a potential mechanism mediating pathogenesis of preeclampsia and spontaneous birth. In this context, vitamin D has been considered as a significant regulator of both innate and adaptive immunity by regulating cell proliferation, differentiation and apoptosis. Vitamin D metabolism during pregnancy manifests striking differences as compared to the non-pregnant state. Calcitriol is increasing >2-3 fold in the first weeks of pregnancy whereas maternal 25-hydroxyvitamin D crosses the placental barrier and represents the main pool of vitamin D in the fetus. Moreover, during pregnancy, vitamin D receptor and regulatory metabolic enzymes are expressed in the placenta and decidua, indicating a potential critical point in the immunomodulation at the maternal-fetal interface. Considering these effects, maternal hypovitaminosis D during pregnancy has been associated with pregnancy related disorders. This review focuses on the mechanistic basis of these adaptive changes, as a background for the development of pregnancy related disorders, with a discourse on the pathophysiology relating hypovitaminosis D and clinical outcomes.
这段时期是宫内生命发育的关键时期，被认为对后代整体健康的代谢印记具有重要意义，这种代谢印记会持续到生命后期。这需要一种微妙的免疫平衡，既能滋养异体胎儿，又能保持对病原体的反应性。在系统性和胎盘水平上，这些受到严格控制的生物现象失调，被认为是介导子痫前期和自发性分娩发病机制的潜在机制。在这种情况下，维生素 D 被认为是先天和适应性免疫的重要调节剂，通过调节细胞增殖、分化和凋亡来实现。与非妊娠状态相比，妊娠期间的维生素 D 代谢表现出显著差异。钙三醇在妊娠的前几周增加了 2-3 倍，而母体 25-羟维生素 D 穿过胎盘屏障，成为胎儿中维生素 D 的主要来源。此外，在怀孕期间，维生素 D 受体和调节代谢的酶在胎盘和蜕膜中表达，表明在母体-胎儿界面的免疫调节中存在一个潜在的关键点。鉴于这些影响，妊娠期间母体维生素 D 缺乏症与妊娠相关疾病有关。这篇综述重点介绍了这些适应性变化的机制基础，作为妊娠相关疾病发展的背景，并讨论了维生素 D 缺乏症与临床结局的病理生理学关系。
