Eremkina A K, Mokrysheva N G, Pigarova E A, Mirnaya S S
National Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia.
Ter Arkh. 2018 Nov 22;90(10):115-127. doi: 10.26442/terarkh20189010115-127.
A high prevalence of vitamin D deficiency and its negative consequences for health is identified as area of primary concern for scientists and clinicians worldwide. Vitamin D deficiency affects not only bone health but many socially significant acute and chronic diseases. Observational studies support that pregnant and lactating women, children and teenagers represent the high risk groups for developing vitamin D deficiency. Current evidence highlights a crucial role of vitamin D in providing the fetal life-support system and fetus development, including implantation, placental formation, intra- and postpartum periods. Hypovitaminosis D during pregnancy is associated with a higher incidence of placental insufficiency, spontaneous abortions and preterm birth, preeclampsia, gestational diabetes, impaired fetal and childhood growth, increased risk of autoimmune diseases for offsprings. Potential mechanisms for the observed associations contain metabolic, immunomodulatory and antiinflammatory effects of vitamin D. Epigenetic modifications in vitamin D-associated genes and fetal programming are of particular interest. The concept of preventing vitamin D deficiency is actively discussed, including supplementation in different ethnic groups, required doses, time of initiation and therapy duration, influence on gestation and childbirth. An adequate supply of vitamin D during pregnancy improves the maternal and fetal outcomes, short and long term health of the offspring. Still current data on relationship between maternal vitamin D status and pregnancy outcomes remains controversial. The large observational and interventional randomized control trials are required to create evidence-based guidelines for the supplementation of vitamin D in pregnant and lactating women.
维生素D缺乏的高患病率及其对健康的负面影响被确定为全球科学家和临床医生主要关注的领域。维生素D缺乏不仅影响骨骼健康，还影响许多具有社会意义的急慢性疾病。观察性研究表明，孕妇、哺乳期妇女、儿童和青少年是维生素D缺乏的高危人群。目前的证据强调了维生素D在提供胎儿生命支持系统和胎儿发育（包括着床、胎盘形成、产前和产后阶段）方面的关键作用。孕期维生素D缺乏与胎盘功能不全、自然流产和早产、先兆子痫、妊娠期糖尿病、胎儿和儿童生长发育受损、后代自身免疫性疾病风险增加的发生率较高有关。观察到的关联的潜在机制包括维生素D的代谢、免疫调节和抗炎作用。维生素D相关基因的表观遗传修饰和胎儿编程尤其令人感兴趣。预防维生素D缺乏的概念正在积极讨论中，包括不同种族群体的补充、所需剂量、开始时间和治疗持续时间、对妊娠和分娩的影响。孕期充足的维生素D供应可改善母婴结局以及后代的短期和长期健康。然而，目前关于母亲维生素D状态与妊娠结局之间关系的数据仍存在争议。需要进行大规模的观察性和干预性随机对照试验，以制定基于证据的孕妇和哺乳期妇女补充维生素D的指南。
