CLINICAL AND LABORATORY FEATURES OF THE EXAMINATION OF PREGNANT WOMEN WITH DIFFERENT LEVELS OF VITAMIN D

Abstract

The aim of the study – to study the clinical and laboratory features of the examination results of pregnant women with different levels of vitamin D.

Materials and Methods. A prospective cohort study was conducted of 60 pregnant women with a difficult course of pregnancy (main group) and 68 women with physiological pregnancy (control group), who were undergoing inpatient treatment at the Ternopil City Communal Hospital No. 2 from November 2020 to January 2022 and the Department of Obstetrics and Gynecology, Faculty of Postgraduate Education, I. Horbachevsky Ternopil National Medical University (approved by the Ethics Commission of I. Horbachevsky Ternopil National Medical University - protocol No. 61 of November 13, 2020). All participants were informed about the goals, organization, methods of the study and signed the informed consent to participate in it, and all measures were taken to ensure the anonymity of the patients. When performing the work, the basic provisions of international standards of ethical norms, quality of scientific research and proper clinical practice of GCP (1996), Declaration of Helsinki "World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects" (2001) were observed. The inclusion criterion was the period of pregnancy from 30 to 34 weeks of gestation. Pregnant women with a history of liver and kidney dysfunction were excluded from the study. In addition, women who had previously received vitamin D supplements were also excluded from the study. The level of vitamin 25(OH)D was determined by the immunoenzymatic method using the Multiskan FC analyzer and the 25-OH Vitamin D ELISA test kit (EUROIMMUN, Germany) in the third trimester of pregnancy. The research was conducted in autumn and winter. Blood sampling to determine the level of 25(OH)D was carried out in the morning, on an empty stomach, after a 10–12 hour overnight fast. Vitamin D deficiency is considered a clinical syndrome with a low level of 25(OH)D in blood serum (less than 20.0 ng/ml).

Results and Discussion. Diseases of the gastrointestinal tract and organs of the hepatobiliary complex (chronic gastritis, enterocolitis, cholecystitis, hepatitis) were detected 5.7 times more often (OR=5.27; 95 % CI: (1.89–12.03); p<0.05) in the main group of patients, diseases of the cardiovascular system (hypertension, hypotension) – in 53 (48.2 %), thyroid dysfunction – in 18 (16.4 %), mastopathy, chronic inflammatory diseases of the upper respiratory tract – in 34 ( 30.9 %), chronic pyelonephritis – in 18 (16.4 %). The main and control groups of examined pregnant women were divided into 4 groups depending on the level of vitamin D (with and without vitamin D deficiency). The ratio of pregnant women with vitamin D deficiency and without vitamin D deficiency in the control group was 61.8 % and 38.2 %, respectively. This ratio in the main group was 76.7 % and 33.3 %, respectively. In the control group, the average level of 25(OH)D was 35.85±2.10 ng/ml against 28.95±1.41 ng/ml, P1<0.05 in the main group. When comparing indicators with vitamin D deficiency in the control group, the level of 25(OH)D was 19.13±1.06 ng/ml versus 14.45±3.31 ng/ml, P1>0.05 in the main group. Differences between groups 1 and 2 and groups 3 and 4 were P<0.05.

Conclusions. According to our data, vitamin D deficiency was detected in 61.8–76.7 % of pregnant women, and only 33–38 % had a sufficient level of vitamin D. In order for newborn children to be healthy, it is necessary to provide medical correction of the level of vitamin D for optimal conditions for their development in the womb.