مقایسه سطح سرمی ویتامین D در بیماران تهدید به سقط و زنان با حاملگی نرمال

نوع مقاله: اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد مامایی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 دانشیار گروه مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

4 دانشجوی دکترای آمار زیستی، دانشکده پیراپزشکی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

چکیده

مقدمه: سقط خود‌به‌خود، شایع‌ترین عارضه حاملگی است. شناخت عوامل مرتبط با آن می‌تواند نقش مهمی در پیشگیری از آن و بهبود پیامد‌های بارداری ایفا کند. برخی مطالعات ارتباط بین کمبود ویتامین D در بارداری و سقط را مطرح کرده‌اند، لذا مطالعه حاضر با هدف مقایسه سطح سرمی ویتامین D در بیماران تهدید به سقط و زنان با حاملگی نرمال انجام شد.
روش‌کار: این مطالعه مورد شاهدی در سال 1397 بر روی 46 نفر از زنان باردار مراجعه‌کننده به بیمارستان‌های لقمان حکیم و مهدیه شهر تهران در دو گروه تهدید به سقط و بارداری نرمال کمتر از 20 هفته انجام شد. نمونه خون افراد مورد مطالعه از نظر سطح ویتامین D ارزیابی شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 16) و آزمون‌های تی مستقل، من‌ویتنی و کای دو انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: میانگین غلظتD (OH)25 در گروه مورد 22/9±49/22 و در گروه شاهد 03/10±36/30 نانوگرم بر میلی‌لیتر بود که اختلاف آماری معنی‌داری بین دو گروه وجود داشت (008/0=p).
نتیجه‌گیری: سطح سرمیD (OH)25 در زنان باردار تهدید به سقط پایین‌تر از زنان با بارداری نرمال است و سطح سرمی پایین ویتامین D می‌تواند به‌عنوان یک عامل خطر برای تهدید به سقط محسوب شود.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of serum vitamin D levels in threatened abortion patients and women with normal pregnancy

نویسندگان [English]

  • Elham Moghadas Inanloo 1
  • Zohre Keshavarz 2
  • Zahra Naeiji 3
  • Marziyeh Asgari 4
1 M.Sc. student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Ph.D. student in Biostatistics, School of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
چکیده [English]

Introduction: Spontaneous abortion is the most common complication of pregnancy. Identifying the associated factors can play an important role in preventing it and improving pregnancy outcomes. Some studies have suggested an association between vitamin D deficiency in pregnancy and abortion. Therefore, this study was performed with aim to compare serum levels of vitamin D in threatened-abortion patients and women with normal pregnancy.
Methods: This case-control study was performed in 2016 on 46 pregnant women referred to Loghman Hakim and Mahdieh hospitals in Tehran in two groups of threatened-abortion and normal pregnancy less than 20 weeks. Blood samples of the subjects were assessed for vitamin D serum level. Data were analyzed using SPSS software (version 16) and independent t-test, Mann-Whitney, and chi-square tests. P<0.05 was considered statistically significant.
Results: The mean of 25(OH)D concentration was 22.49 ±9.22 ng/ml in case group and 30.36 ±10.03 ng/ml in control group and there was a significant difference between the two groups (p = 0.008).
Conclusion: Serum 25(OH)D levels in threatened-abortion pregnant women are lower than in women with normal pregnancy. Low serum levels of vitamin D can be considered as a risk factor for threatened-abortion.

کلیدواژه‌ها [English]

  • Abortion
  • pregnancy
  • Threatened-abortion
  • Vitamin D
  • Women
  1. Lok IH, Neugebauer R. Psychological morbidity following miscarriage. Best Pract Res Clin Obstet Gynaecol 2007; 21(2):229-47.
  2. Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, et al. Incidence of early loss of pregnancy. N Engl J Med 1988; 319(4):189-94.
  3. Rossen LM, Ahrens KA, Branum AM. Trends in Risk of Pregnancy Loss Among US Women, 1990-2011. Paediatr Perinat Epidemiol 2018; 32(1):19-29.
  4. Bloom SL, Corton MM, Spong CY, Dashe JS, Leveno KJ. Williams Obstetrics 24/E: McGraw-Hill Education; 2014.
  5. Mouri M, Rupp TJ. Threatened Abortion.  StatPearls [Internet]: StatPearls Publishing; 2019.
  6. Maiti GD, Ibgnait P, Pillai AK, Shukla V. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester. Journal of Marine Medical Society 2013; 15(2):98-102.
  7. Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology 2010; 117(3):245-57.
  8. Amro B, Almahdi S. Outcome of pregnancy among women with threatened miscarriage in Latifa Hospital-Dubai. Hamdan Medical Journal 2019; 12(2):72-79.
  9. Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med 2005; 353(8):761-9.
  10. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SE, Horne AW. The role of infection in miscarriage. Hum Reprod Update 2016; 22(1):116-33.
  11. Lee HJ, Park TC, Kim JH, Norwitz E, Lee B. The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis. BioMed Res Int 2017;2017:3616875.
  12. Yassaee F, Shekarriz-Foumani R, Afsari S, Fallahian M. The effect of progesterone suppositories on threatened abortion: a randomized clinical trial. J Reprod Infertil 2014;15(3):147-51.
  13. Brannon PM. Vitamin D and adverse pregnancy outcomes: beyond bone health and growth. Proc Nutr Soc 2012; 71(2):205-12.
  14. Franasiak JM, Lara EE, Pellicer A. Vitamin D in human reproduction. Curr Opin Obstet Gynecol 2017; 29(4):189-194.
  15. Monastra G, De Grazia S, De Luca L, Vittorio S, Unfer V. Vitamin D: a steroid hormone with progesterone-like activity. Eur Rev Med Pharmacol Sci 2018; 22(8):2502-2512.
  16. Boonstra A, Barrat FJ, Crain C, Heath VL, Savelkoul HF, O’Garra A. 1alpha,25-Dihydroxyvitamin d3 has a direct effect on naive CD4(+) T cells to enhance the development of Th2 cells. J Immunol 2001; 167(9):4974-80.
  17. Shobeiri SS, Abediankenari S, Rahmani Z, Hossein Nataj H, Azadeh H. Evaluation of NK cell level and HLA-G1 expression in peripheral blood in threatened-abortion. Tehran University Medical Journal 2015; 73(2):93-100.
  18. Ota K, Dambaeva S, Han AR, Beaman K, Gilman-Sachs A, Kwak-Kim J. Vitamin D deficiency may be a risk factor for recurrent pregnancy losses by increasing cellular immunity and autoimmunity. Hum Reprod 2013; 29(2):208-19.
  19. Nandi A, Sinha N, Ong E, Sonmez H, Poretsky L. Is there a role for vitamin D in human reproduction? Horm Mol Biol Clin Investig 2016; 25(1):15-28.
  20. Vigano P, Mangioni S, Pompei F, Chiodo I. Maternal-conceptus cross talk--a review. Placenta 2003; 24:S56-61.
  21. Dawodu A, Wagner CL. Mother-child vitamin D deficiency: an international perspective. Arch Dis Child 2007; 92(9):737-40.
  22. Kazemi A, Sharifi F, Jafari N, Mousavinasab N. High prevalence of vitamin D deficiency among pregnant women and their newborns in an Iranian population. J womens Health 2009; 18(6):835-9.
  23. Rostami M, Ramezani Tehrani F, Simbar M, Hosein Panah F, Alavi Majd H. Prevalence of Vitamin D deficiency and related factors Among Pregnant Women referred to Masjed Soleimam health centers in 2014. Iran J Obstet Gynecol Infertil 2015; 18(164):1-10.
  24. Badfar G, Shohani M, Mansouri A, Soleymani A, Azami M. Vitamin D status in Iranian pregnant women and newborns: a systematic review and meta-analysis study. Expert Rev Endocrinol Metab 2017; 12(5):379-389.
  25. Hou W, Yan XT, Bai CM, Zhang XW, Hui LY, Yu XW. Decreased serum vitamin D levels in early spontaneous pregnancy loss. Eur J Clin Nutr 2016; 70(9):1004-8.
  26. Ozkan S, Jindal S, Greenseid K, Shu J, Zeitlian G, Hickmon C, et al. Replete vitamin D stores predict reproductive success following in vitro fertilization. Fertil Steril 2010; 94(4):1314-9.
  27. Irani M, Mirzaei Kh, Maleki N, Entezari E. The Role of Vitamin D in Male and Female Reproductive Health: A Review Study. Iran J Obstet Gynecol Infertil 2017; 20(3):98-109.
  28. Halhali A, Acker G, Garabedian M. 1,25-Dihydroxyvitamin D3 induces in vivo the decidualization of rat endometrial cells. J Reprod Fertil 1991; 91(1):59-64.
  29. Barrera D, Avila E, Hernandez G, Halhali A, Biruete B, Larrea F, et al. Estradiol and progesterone synthesis in human placenta is stimulated by calcitriol. J Steroid Biochem Mol Biol 2007; 103(3-5):529-32.
  30. Barrera D, Avila E, Hernández G, Méndez I, González L, Halhali A, et al. Calcitriol affects hCG gene transcription in cultured human syncytiotrophoblasts. Reprod Biol Endocrinol 2008; 6:3.
  31. Zhang H, Huang Z, Xiao L, Jiang X, Chen D, Wei Y. Meta‐analysis of the effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss. Int J Gynecol Obstet 2017; 138(3):242-249.
  32. Andersen LB, Jørgensen JS, Jensen TK, Dalgård C, Barington T, Nielsen J, et al. Vitamin D insufficiency is associated with increased risk of first-trimester miscarriage in the Odense Child Cohort.Am J Clin Nutr 2015; 102(3):633-8.
  33. Bärebring L, Bullarbo M, Glantz A, Hulthén L, Ellis J, Jagner Å, et al. Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study. BMC pregnancy and childbirth 2018; 18(1):51.
  34. Mumford SL, Garbose RA, Kim K, Kissell K, Kuhr DL, Omosigho UR, et al. Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss: a prospective cohort study. Lancet Diabetes Endocrinol 2018; 6(9):725-732.
  35. Flood-Nichols SK, Tinnemore D, Huang RR, Napolitano PG, Ippolito DL. Vitamin D Deficiency in Early Pregnancy. PLoS One 2015; 10(4):e0123763.
  36. Schneuer FJ, Roberts CL, Guilbert C, Simpson JM, Algert CS, Khambalia AZ, et al. Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr 2013; 99(2):287-95.
  37. Lee SK, Kim JY, Lee M, Gilman‐Sachs A, Kwak‐Kim J. Th17 and Regulatory T cells in Women with Recurrent Pregnancy Loss. Am J Reprod Immunol 2012; 67(4):311-8.
  38. Sharif K, Sharif Y, Watad A, Yavne Y, Lichtbroun B, Bragazzi NL, et al. Vitamin D, autoimmunity and recurrent pregnancy loss: More than an association. Am J Reprod Immunol 2018; 80(3):e12991.
  39. Gonçalves DR, Braga A, Braga J, Marinho A. Recurrent pregnancy loss and vitamin D: A review of the literature. Am J of Reprod Immunol 2018; 80(5):e13022.
  40. Yan X, Wang L, Yan C, Zhang X, Hui L, Sheng Q, et al. Decreased expression of the vitamin D receptor in women with recurrent pregnancy loss. Arch Biochem Biophys 2016; 606:128-33.