The analysis of the clinical effectiveness of preventive therapy in pregnant women with moderate obesity and disorder of vitamin D metabolism

Abstract

Annotation. Obesity during pregnancy is associated with an increased risk of serious adverse perinatal outcomes. The aim of our clinical prospective study was to evaluate the clinical effectiveness of preventive therapy in pregnant women with obesity and vitamin D deficiency. Pregnant patients with obesity were divided into clinical subgroups, depending on the dose of vitamin D preparation at the beginning of preventive therapy in accordance with the initial serum level of 25(OH)D. The first subgroup of the clinical group of the prospective study - 24 women who had a level of 25(OH)D in blood serum less than 22.0 ng/ml, in addition to low dose (100 mg per day) of acetylsalicylic acid (ASA) received vitamin D (4000 IU per day), the II-nd clinical subgroup consisted of 26 pregnant women who received ASA (100 mg per day) and vitamin D (2000 IU per day) with an initial serum concentration of 25(OH)D 22.1-28.0 ng/ml and III-d subgroup – 25 patients who received the low dose ASA and vitamin D (1000 IU per day), who had a serum 25(OH)D content of more than 28.1 ng/ml. Practically healthy pregnant women from the control group received 600 IU of vitamin D per day. The prescription of the drugs began at 10-12 weeks of pregnancy, and ended at 36 weeks of gestation. Variational and statistical processing of the research results was performed using the "STATISTICA 10" Enterprise Portable program. According to analysis of the clinical effectiveness of complex preventive therapy we found that a more positive effect was achieved with additional supplementation of vitamin D to pregnant women in a dose of 4000 IU (100 μg) per day with prior – the established level of 25(OH)D <20 nmol/l (12 ng/ml), against the appointment of 2000 IU of vitamin D (50 μg) to patients with a level of 25(OH)D of 20-30 nmol/l (8-12 ng/ml). The clinical effectiveness of the aforementioned preventive strategy was primarily a significant reduction in perinatal pathology cases (by 2 times), de novo hypertensive disorders (by 3.7 times), placental dysfunction (by 5.5 times) and fetal growth restriction (by 4.6 times), fetal distress (3.1 times), uterine subinvolution (3.7 times), postpartum septic complications (7.3 times), early neonatal adaptation disorders (2.5 times), newborn asphyxia (3, 2 times), as well as a significant decrease in cases of anomalies of labor activity (р=0.04), bacterial vaginosis (р=0.03). During and after using the proposed prophylactic therapy, there were no cases of side effects of the drugs, both on the part of the mother, and on the part of the fetus and newborn child.