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Title:Sezonska nihanja vitamina D pri nosečnicah in novorojenčkih v mariborski regiji
Authors:ID Dovnik, Andraž (Author)
ID Takač, Iztok (Mentor) More about this mentor... New window
Files:.pdf DOK_Dovnik_Andraz_2016.pdf (4,10 MB)
MD5: 99535BE28ECF643E7E7CB7495B40EA05
 
Language:Slovenian
Work type:Doctoral dissertation
Organization:MF - Faculty of Medicine
Abstract:Izhodišča: Vitamin D je v maščobah topen vitamin, katerega pomanjkanje v nosečnosti povezujejo z različnimi zapleti v nosečnosti in boleznimi pri novorojenčku. V mariborski regiji še ni bilo raziskave, ki bi ugotavljala koncentracijo vitamina D pri nosečnicah in novorojenčkih. Namen raziskave je bil ugotoviti povprečne koncentracije vitamina D pri nosečnicah in novorojenčkih, pogostnost pomanjkanja vitamina D, dejavnike, ki vplivajo na koncentracjo vitamina D pri nosečnicah in novorojenčkih, in vpliv koncentracije vitamina D na pojav zapletov pri nosečnici in novorojenčku. Bolniki in metode: Opravili smo prospektivno opazovalno raziskavo na 400 nosečnicah in njihovih novorojenčkih v štirih različnih letnih časih. Izbrani meseci so bili na koncu vsakega izmed letnih časov. Mesec september je predstavljal poletno skupino, december jesensko, marec zimsko in junij pomladno skupino. V raziskavo smo vključili nosečnice kavkazijske rase, ki so živele na širšem področju Maribora in so podpisale osveščen pristanek. Iz anketnih vprašalnikov smo pridobili podatke o prehrani in izpostavljenosti soncu v nosečnosti. Iz zdravstvene dokumentacije smo pridobili podatke o zdravstvenem stanju nosečnice pred in med nosečnostjo, podatke o zapletih v nosečnosti in načinu poroda ter podatke o zdravstvenem stanju novorojenčka. Vzorec krvi nosečnice smo odvzeli tekom hospitalizacije, vendar ne kasneje kot dva dni po porodu. Odvzem vzorca krvi iz popkovnice smo opravili takoj po prekinitvi popkovnice po porodu. Koncentracije vitamina D smo razdelili glede na priporočila iz literature: > 80 nmol/L – zadostne koncentracije, 50‒80 nmol/L – nezadostne koncentracije, 25‒50 nmol/L – pomanjkanje in < 25 nmol/L – hudo pomanjkanje vitamina D. Rezultati: Povprečna koncentracija vitamina D pri nosečnicah v vseh štirih skupinah je bila 43,7 ± 23,8 nmol/L. 23,6 % nosečnic je imelo hudo pomanjkanje vitamina D, 41,5 % jih je imelo pomanjkanje vitamina D, 27,9 % jih je imelo nezadostne koncentracije vitamina D. Zadostne koncentracije vitamina D smo izmerili pri 7,0 % nosečnic. Povprečna koncentracija vitamina D pri novorojenčkih je bila 55,2 ± 30,9 nmol/L. Pri analizi vpliva posameznih dejavnikov na koncentracijo vitamina D pri nosečnicah so se kot pomembni pokazali letni čas (F = 33,979; p < 0,001), trajanje sončnega obsevanja 30 dni pred porodom (r = 0,371, p < 0,001), povprečna temperatura 30 dni pred porodom (r = 0,401, p < 0,001), uživanje rib (t = 2,183; p = 0,030), količina rib na obrok (F = 3,131; p = 0,026), uživanje prehranskih nadomestkov z dodanim vitaminom D (t = ‒4,271; p < 0,001), pogostnost sončenja (F = 3,144; p = 0,025) in trajanje ene epizode sončenja (F = 3,719; p = 0,012). Izmed omenjenih dejavnikov sta v multivariatni analizi statistično značilnost ohranila trajanje ene epizode sončenja (β = 0,185; p = 0,031) in jemanje prehranskih nadomestkov z dodanim vitaminom D (β = ‒0,098; p < 0,001). Nosečnice, ki so rodile prezgodaj (t = 2,296; p = 0,022), in tiste, ki so rodile s carskim rezom (t=2,053; p=0,041), so imele značilno nižje koncentracije vitamina D v primerjavi s kontrolami. Zaključki: Koncentracije vitamina D so bile pri veliki večini nosečnic v mariborski regiji nižje od priporočenih vrednosti. Paradoksalno so imeli novorojenčki višjo povprečno koncentracijo vitamina D kot nosečnice. V vseh štirih skupinah smo opažali močno pozitivno korelacijo med koncentracijami vitamina D pri materi in v popkovnični krvi. Med posameznimi letnimi časi smo ugotovili značilno razliko v koncentraciji vitamina D, pri čemer smo najvišje vrednosti ugotovili v junijski (pomladni) skupini, najnižje pa v marčevski (zimski)skupini. Koncentracija vitamina D je bila višja pri nosečnicah, ki so se v času nosečnosti več sončile, in pri tistih, ki so jemale prehranske nadomestke z vitaminom D.
Keywords:vitamin D, izid nosečnosti, stanje novorojenčka, prehranski dodatki, sončna svetloba, letni čas
Place of publishing:Maribor
Year of publishing:2016
PID:20.500.12556/DKUM-59146 New window
COBISS.SI-ID:5915967 New window
NUK URN:URN:SI:UM:DK:UCAQAELW
Publication date in DKUM:15.02.2017
Views:3082
Downloads:309
Metadata:XML DC-XML DC-RDF
Categories:MF
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Secondary language

Language:English
Title:Seasonal variations of vitamin D concentrations in pregnant women and neonates in Slovenia
Abstract:Introduction: Vitamin D is a lipid soluble vitamin. Its deficiency has been connected to various complications during pregnancy and neonatal complications. Vitamin D concentrations in pregnant women and neonates in the Maribor region have never been investigated. The main purpose of this study was to determine the average vitamine D concentrations in pregnant women at term and in their neonates, to determine the incidence of vitamin D deficiency, the factors influencing vitmain D concentrations, and possible connection between vitamin D concentrations and pregnancy and neonatal compliations. Materials and methods: A prospective observational study on 400 pregnant women at term and their neonates was conducted in four different seasons. The months at the end of each season were chosenas representative. September represented the summer group, December the autumn, March the winter and June the spring group. Caucasian women living in the Maribor area who signed an informed consent were included in the study. Participants were asked to fill in a questionnaire from which we obtained the information regarding the diet and sun exposure during pregnancy. Information about the health condition of each participant was obtained from hospital computer information system. Pregnancy complications and neonatal health condition were also analysed. The blood sample of pregnant women was obtained in the course of hospitalisation no later than two days after birth. The cord blood sample was obtained immediately after birth after umbillical cord clamping. Vitamin D concentrations were divided into groups according to the literature: >80 nmol/L – sufficient concentrations, 50‒80 nmol/L – insufficient concentrations, 25‒50 nmol/L – deficiency, and <25 nmol/L – severe deficiency. Results: The average vitamin D concentration in pregnant women in all four groups was 43.7±23.8 nmol/L. 23.6% of participants had severe vitamin D deficiency, 41.5% had vitamin D deficiency, and 27.9% had vitamin D insufficiency. Sufficient concentrations were present in 7.0%. The average neonatal vitamin D concentration was 55.2±30.9 nmol/L. In the analysis of various factors influencing maternal vitamin D concentrations, statistically significant associations were found with season (F=33.979; p<0.001), average duration of sunshine 30 days before delivery (r=0.371, p<0.001), average temperature 30 days before delivery (r=0.401, p<0.001), fish consumption (t=2.183; p=0.030), quantity of fish per meal (F=3.131; p=0.026), use of nutritional supplements containing vitamin D (t=‒4.271; p<0.001) frequency of sunbathing (F=3.144; p=0.025), and the duration of one episode of sunbathing (F=3.719; p=0.012). In multivariate analysis, statistical significance was retained for the intake of nutritional supplements containing vitamin D (β=‒0.098; p<0.001) and the duration of one episode of sunbathing (β=0.185; p=0.031). Women with preterm labor (t=2.296; p=0.022) and with caesarean section(t=2.053; p=0.041) had significantly lower vitamin D concentrations compared with controls. Conclusions: Maternal vitamin D concentrations in the Maribor region were much lower than the recommended values. Paradoxically, higher vitamin D concentrations were found in neonates than in their mothers. Marked seasonal variations were present with the highest vitamin D concentrations noted in the June (spring) group and the lowest in the March (winter) group. Vitamin D concentrations were higher in women who sunbathed for longer periods of time during pregnancy and in those who took nutritional supplements containing vitamin D.
Keywords:vitamin D, pregnancy outcome, neonatal outcome, nutritional supplements, sunlight, season


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