Vitamin D for pregnant women: the role in the formation of the bone system

Vitamin D for pregnant women: the role in the formation of the bone system

I. Vitamin D: Foundations and metabolism

1. Definition and chemical structure: Vitamin D is a group of fat -soluble runners playing a key role in the regulation of calcium and phosphorus in the body. The main forms of vitamin D are vitamin D2 (ergocalciferol), obtained from plant sources and mushrooms under the influence of ultraviolet radiation, and vitamin D3 (cholecalciferol), synthesized in human skin under the influence of sunlight (UVB) of 7-dehydroxyles. Chemically, vitamin D refers to the class of second -steroids, structurally similar to steroid hormones, but with a torn ring B.

2. Sources of vitamin D:

   • Sunlight: The main source of vitamin D3. The intensity of the synthesis depends on the geographical latitude, time of year, time of day, cloudiness, air pollution, skin color and age. People with darker skin synthesize less vitamin D3, since melanin absorbs more UVB radiation.
   • Food:
     • Fat fish: Salmon, scuber, tuna, herring, sardine – excellent sources of vitamin D3.
     • Egg yolk: Contains vitamin D3, but its amount varies depending on the diet of chicken.
     • Mushrooms: Some types of mushrooms, especially grown under ultraviolet radiation, contain vitamin D2.
     • Enriched products: Milk, yogurt, orange juice, cereals, bread is often enriched with vitamin D.
   • Supplements: Vitamin D2 and D3 are available in the form of additives. Vitamin D3 is usually considered more effective, as it is better absorbed and persisted longer in the body.

3. Vitamin D metabolism:

   • The first hydroxylation in the liver: Vitamin D3 (cholecalciferol), synthesized in the skin or obtained with food, and vitamin D2 (ergocalciferol) are metabolized in the liver using the 25-hydroxylase (CYP2R1) in 25-hydroxyvitamin di [25(OH)D]also known as calciol. This process is not strictly regulated and is an indicator of vitamin D reserves in the body. Level 25 (OH) D in blood serum is used to assess the status of vitamin D.
   • The second hydroxylation in the kidneys: Calcidia is transported to the kidneys, where the 1-alpha-hydroxylase enzyme (CYP27B1) converts it into an active form of vitamin D-1.25-dihydroxyvitamin D [1,25(OH)2D]also known as calcitriol. This process is strictly regulated by parathyroid hormone (PTH), the level of calcium and phosphorus in the blood. The high level of PTG stimulates, and the high level of calcium and phosphorus suppresses the activity of 1-alpha-hydroxylase.
   • Calcitriol action: Calcitriol binds to vitamin D (VDR) receptor, which is located in many body tissues, including intestines, bones, kidneys and immune cells. The complex of calcitriol-VDR is associated with DNA, regulating the expression of genes involved in the metabolism of calcium, phosphorus, cell growth, differentiation and immune response.

4. Regulation of the metabolism of calcium and phosphorus:

   • In the intestines: Calcitriol stimulates the absorption of calcium and phosphorus from the intestines, ensuring the sufficient intake of these minerals to maintain bone tissue and other functions of the body.
   • In the kidneys: Calcitriol increases the reabsorption of calcium and phosphorus in the kidneys, preventing their loss in urine.
   • In bones: Calcitriol interacts with a parathormone (PTG) to regulate the exchange of calcium in the bones. With a low level of calcium in the blood, PTG stimulates the release of calcium from bones (bone resorption) to maintain the normal level of calcium in the blood. Calcitriol can both stimulate and suppress bone resorption, depending on concentration and physiological context.

II. The role of vitamin D in the formation of the bone system of the fetus

1. Transplacental transfer of vitamin D: During pregnancy, vitamin D is transmitted from mother to fruit through the placenta through passive diffusion. Level 25 (OH) D in the blood of the fetus is closely related to the level of 25 (OH) D in the blood of the mother. The fruit is completely dependent on the maternal status of vitamin D for its bone development and general health.

2. Influence on the skeleton of the fetus:

   • Mineralization of bones: Vitamin D plays a decisive role in the mineralization of the bones of the fetus. The sufficient intake of vitamin D provides adequate absorption of calcium and phosphorus necessary for the formation of strong and healthy bone tissue. The deficiency of vitamin D in the mother can lead to a deficiency of calcium in the fetus and a violation of bone mineralization, which can lead to rickets of newborns.
   • The development of cartilage: Vitamin D is involved in the differentiation of chondrocytes (cartilage cells) and the formation of cartilage matrix, which is the precursor of bone tissue.
   • Regulation of genes involved in the formation of bones: Vitamin D regulates the expression of genes encoding proteins necessary for the formation of bones, such as type I collagen, osteocalcin and osteonectin.

3. The consequences of vitamin D deficiency for the fetus:

   • Racitus of newborns: The most serious consequence of vitamin D deficiency is in the fetus. Rachite is characterized by a violation of bone mineralization, which leads to deformation of the skeleton, growth retardation, muscle weakness and increased susceptibility to fractures. In newborns with rickets, signs such as craniotabes (softening of the bones of the skull), thickening of the ribs (rickets), deformation of the extremities and delaying teething can be observed.
   • Low body weight at birth: The deficiency of vitamin D in the mother is associated with an increased risk of birth of a child with a low body weight. This may be due to impaired fetal growth due to insufficient mineralization of bones and other factors.
   • Increased risk of fractures in childhood: Children born of mothers with vitamin D deficiency have an increased risk of fractures in childhood, even if they do not have obvious signs of rickets. This may be due to insufficient bone density and a violation of the bone microarchitecture.
   • Increased risk of developing asthma and other diseases: Some studies show that the deficiency of vitamin D in the fetus may be associated with an increased risk of developing asthma, type 1 diabetes and other chronic diseases in the future. This may be due to the influence of vitamin D on the development of the immune system and other organs and systems of the fetus.
   • Development of development: Vitamin D deficiency can negatively affect the development of the brain and the nervous system of the fetus, which can lead to a delay in development.

III. Recommendations for vitamin D consumption during pregnancy

1. Optimal level 25 (OH) D: Most experts recommend maintaining the level of 25 (OH) D in blood serum at a level of 30-50 ng/ml (75-125 nmol/l) during pregnancy to ensure the health of the mother and fetus. Some experts believe that higher levels (40-60 ng/ml) can be optimal.

2. Recommended daily dose (RSD) of vitamin D:

   • Current recommendations: Most organizations, such as the American College of Obstetrons and Gynecologists (ACOG), recommend that pregnant women receive at least 600 IU (15 μg) of vitamin D per day.
   • Alternative recommendations: Some experts believe that 600 IM is not enough to maintain the optimal level of 25 (OH) D during pregnancy, especially in women with risk factors for vitamin D. They recommend higher doses such as 1000-2000 IU (25-50 mcg) per day.
   • Individual approach: The optimal dose of vitamin D during pregnancy can vary depending on individual factors, such as the initial level 25 (OH) D, skin color, geographical breadth, diet and lifestyle. Before taking the additives of vitamin D, it is recommended to consult a doctor and take a blood test to determine the level of 25 (OH) D.

3. Ways to ensure sufficient consumption of vitamin D:

   • Sunlight: Regular stay in the sun can help increase the level of vitamin D. However, it is important to observe precautions to protect the skin from the harmful effects of ultraviolet radiation, such as the use of sunscreen and limiting the time of stay in the sun in peak hours.
   • Food: Include products rich in vitamin D in your diet, such as oily fish, egg yolk and enriched products.
   • Supplements: Reception of vitamin D additives is the most reliable way to provide sufficient vitamin D consumption during pregnancy. Choose additives containing vitamin D3 (cholecalciferol), as it is better absorbed than vitamin D2 (ergocalciferol). Take vitamin D additives in accordance with the doctor’s recommendations.

4. Risk factors for vitamin D deficiency in pregnant women:

   • Dark skin: People with darker skin synthesize less vitamin D under the influence of sunlight.
   • Obesity: Vitamin D is fat -soluble and can accumulate in adipose tissue, which reduces its accessibility for the body.
   • Limited Sun stay: People who spend little time in the sun are at risk of vitamin D.
   • Geographical latitude: People living in the northern latitudes receive less sunlight, especially in winter.
   • Insufficient consumption of vitamin D with food: People who do not use enough products rich in vitamin D are at increased risk of deficiency.
   • Vegetarianism and veganism: Vegetarians and vegans that do not use dairy products and fish may experience a deficiency of vitamin D.
   • Some diseases: Some diseases, such as kidney, liver and intestinal diseases, can disrupt vitamin D.’s metabolism.
   • Reception of some drugs: Some drugs, such as glucocorticoids and anticonvulsants, can reduce vitamin D.

5. Vitamin D intake safety during pregnancy:

   • Toxicity of vitamin D: Vitamin D is a fat -soluble vitamin, and its excessive consumption can lead to toxicity (hypervitaminosis D). Symptoms of hypervitaminosis D include nausea, vomiting, constipation, weakness, loss of appetite, increased thirst and rapid urination. In severe cases, hypervitaminosis D can lead to damage to the kidneys, cardiac arrhythmias and calcification of soft tissues.
   • Recommended upper limit of consumption: The US Institute of Medicine (IOM) has established the upper border of vitamin D consumption for pregnant women at 4000 IU (100 mcg) per day. However, some studies show that higher doses (up to 10,000 IU per day) may be safe under the supervision of a doctor.
   • Monitoring level 25 (OH) D: It is important to regularly control the level 25 (OH) D in the blood during pregnancy, especially when taking high doses of vitamin D in order to avoid toxicity.
   • Consultation with a doctor: Before taking the additives of vitamin D during pregnancy, it is necessary to consult a doctor in order to determine the optimal dose and exclude possible contraindications.

IV. Vitamin D and other aspects of pregnant women’s health

1. Precomports: Some studies show that vitamin D deficiency during pregnancy can be associated with an increased risk of pre -electelampsia, a serious complication of pregnancy, characterized by high blood pressure and proteinuria (the presence of protein in the urine). Vitamin D can play a role in the regulation of blood pressure and endothelial function (inner vascular membrane), which can explain its connection with preeclampsia.

2. Gestational diabetes: Vitamin D deficiency can also be associated with an increased risk of developing gestational diabetes, diabetes that develops during pregnancy. Vitamin D can play a role in the regulation of insulin secretion and insulin sensitivity, which can explain his connection with gestational diabetes.

3. Premature birth: Some studies show that vitamin D deficiency can be associated with an increased risk of premature birth (childbirth up to 37 weeks of pregnancy). Vitamin D can play a role in the regulation of the immune system and inflammation, which can explain its connection with premature birth.

4. Infections: Vitamin D plays an important role in the immune system and can help protect against infections. Vitamin D deficiency during pregnancy can increase susceptibility to infections such as respiratory tract infections and urinary tract infections.

5. Postpartum depression: Some studies show that vitamin D deficiency may be associated with an increased risk of development of postpartum depression. Vitamin D can play a role in the regulation of mood and function of the brain, which can explain its connection with postpartum depression.

V. Methods for assessing the status of vitamin D

1. Blood test for 25 (oh) d: The gold standard for assessing the status of vitamin D is a blood test for 25-hydroxyvitamin D [25(OH)D]. This analysis measures level 25 (OH) D in blood serum, which reflects vitamin D reserves in the body.

2. Interpretation of analysis results:

   • Deficiency: Level 25 (OH) D less than 20 ng/ml (50 nmol/l).
   • Failure: Level 25 (OH) D 20-29 ng/ml (50-74 nmol/l).
   • Sufficient level: Level 25 (OH) D 30-50 ng/ml (75-125 nmol/l).
   • Potentially toxic level: Level 25 (OH) D is more than 100 ng/ml (250 nmol/l).

3. Recommendations for analysis: A blood test for 25 (OH) D is recommended for pregnant women, especially those who have risk factors for vitamin D. Analysis can be carried out at any time of pregnancy.

VI. New areas of studies of vitamin D and pregnancy

1. Influence on the development of the brain of the fetus: Studies continue to study the effect of vitamin D on the development of the brain of the fetus and its connection with cognitive functions and the risk of developing neuropsychic disorders in the future.

2. Influence on the immune system of the fetus: The role of vitamin D is studied in the development of the fetal immune system and its effect on the risk of developing allergic diseases and autoimmune diseases in the future.

3. Optimum doses of vitamin D for pregnant women: Studies continue to determine the optimal doses of vitamin D for pregnant women to ensure the health of the mother and fetus.

4. Influence on the composition of the intestinal microbiots: The effect of vitamin D is studied on the composition of the microbiots of the intestinal of the mother and the fetus and its effect on health and development.

5. Genetic factors: Genetic factors are studied that affect vitamin D metabolism and individual vitamin D needs during pregnancy.

VII. Conclusion (in this case – continuation with the preservation of the structure)

Continuing to delve into the theme of vitamin D and pregnancy, it is important to consider practical aspects regarding the selection of additives, monitoring, and the influence of various environmental factors on the assimilation of vitamin.

6. The choice of vitamin D additives for pregnant women:

   • Vitamin D: As already mentioned, vitamin D3 (cholecalciferol) is usually considered preferable compared to vitamin D2 (ergocalciferol) due to its better digestibility and efficiency in increasing the level of 25 (OH) D in the blood.
   • Dosage: Choose additives with a dosage corresponding to your needs based on the doctor’s recommendations and blood tests for 25 (OH) D.
   • Quality and safety: Buy vitamin D additives from trusted manufacturers that adhere to quality and safety standards. Pay attention to the availability of certificates of independent laboratories confirming the composition and purity of the product.
   • Output form: Vitamin D is available in various forms of release, such as tablets, capsules, drops and chewing tablets. Choose the form that is most convenient for you to use.
   • Compatibility with other additives: Check the compatibility of vitamin D with other additives that you accept during pregnancy to avoid undesirable interactions.

7. Vitamin D Monitoring during pregnancy:

   • Regular blood tests: Pass the blood test for 25 (OH) D to track your vitamin D status and adjust the dose of additives if necessary.
   • Intervals between analyzes: The intervals between blood tests can vary depending on your initial level 25 (OH) D, dose of additives and other factors. Discuss the optimal monitoring schedule with your doctor.
   • Symptoms of deficiency or excess: Pay attention to any symptoms of deficiency or excess vitamin D and inform your doctor about them.

8. The influence of environmental factors on the assimilation of vitamin D:

   • Geographical latitude: People living in the northern latitudes receive less sunlight, especially in the winter months. In these regions, it is recommended to more actively use vitamin D.
   • Top of year: The level of vitamin D usually decreases in the winter months and rises in the summer. This is due to a change in the intensity of solar radiation.
   • Air pollution: Air pollution can block ultraviolet radiation and reduce the synthesis of vitamin D in the skin.
   • Cloudness: Cloudy weather reduces the amount of ultraviolet radiation reaching the skin.
   • Altitude: The intensity of ultraviolet radiation increases with a height above sea level.
   • Cloth: Clothing closes most of the skin and can block ultraviolet radiation.

9. Interaction of vitamin D with other nutrients:

   • Calcium: Vitamin D is necessary for the absorption of calcium, so it is important to ensure sufficient consumption of both nutrients during pregnancy.
   • Magnesium: Magnesium plays a role in vitamin D metabolism, and its deficiency can reduce the effectiveness of vitamin D.
   • Vitamin K2: Vitamin K2 helps to direct calcium into the bones and teeth, which can improve vitamin D efficiency in maintaining bone tissue health.
   • Vitamin A: High doses of vitamin A can compete with vitamin D for receptors and reduce its effectiveness.

10. Vitamin D and pregnancy planning:

    • Assessment of vitamin D status before pregnancy: It is recommended to evaluate the status of vitamin D before pregnancy in order to identify the deficit and take measures to eliminate it.
    • Correction of deficiency before pregnancy: Elimination of vitamin D deficiency before pregnancy can improve fertility and reduce the risk of pregnancy complications.
    • Maintaining the optimal level: Maintaining the optimal level of vitamin D until pregnancy and during pregnancy can contribute to the health of the mother and fetus.

11. The role of vitamin D in the formation of fetal tooth tissue:

    • Influence on ameloblasts and odontoblasts: Vitamin D plays a role in differentiation and functioning of ameloblasts (cells that form enamel) and outodoblasts (cells that form dentin).
    • Mineralization of dental tissue: The sufficient intake of vitamin D provides adequate mineralization of the fetal tooth tissue, which reduces the risk of caries in the future.
    • Enamel strength: Vitamin D contributes to the formation of an enamel strong and resistant to acids.

12. Vitamin D and the development of the immune system of the newborn:

    • Immunity transfer: Vitamin D, transmitted from mother to fruit, can affect the development of the newborn immune system and reduce the risk of developing allergic diseases and autoimmune diseases in the future.
    • Modulation of the immune response: Vitamin D can modulate the immune response of the newborn to infection and vaccination.

13. The effect of vitamin D on the microbiota of the mother and fetus:

    • Composition microbiota: Studies show that vitamin D can affect the composition of the microbiots of the intestinal of the mother and fetus.
    • Interaction with microorganisms: Vitamin D can interact with microorganisms in the intestines and modulate their activity.
    • Intestinal health: A healthy intestinal microbiota is important for immunity, digestion and general health of the mother and fetus.

14. Alternative sources of vitamin D:

    • Mushrooms treated with ultraviolet light: Some types of mushrooms, especially treated with ultraviolet light, contain vitamin D2.
    • Fish oil: Fish oil is a good source of vitamin D3 and omega-3 fatty acids.
    • Enriched products: Many products, such as milk, juices and cereals, are enriched with vitamin D.

15. Potential risks and side effects of vitamin D additives:

    • Hypercalcemia: An overdose of vitamin D can lead to hypercalcemia (an increased level of calcium in the blood), which can cause various symptoms, such as nausea, vomiting, constipation, weakness and damage to the kidneys.
    • Toxicity: In rare cases, very high doses of vitamin D can be toxic and cause serious complications.
    • Interactions with drugs: Vitamin D can interact with some drugs, so it is important to inform your doctor about all the medicines that you take.

16. Vitamin D and breastfeeding:

    • Low vitamin D content in breast milk: Breast milk usually contains a low amount of vitamin D, so it is important that the nursing mothers receive enough vitamin D.
    • Vitamin D additives for babies: Breastfeeding infants are often recommended to give vitamin D additives to ensure sufficient intake of this nutrient.

17. Vitamin D and multiple pregnancy:

    • Increased need for vitamin D: Women with multiple pregnancy have an increased need for vitamin D due to the need to provide a sufficient amount of vitamin D for two or more fruits.
    • Careful monitoring: It is necessary to conduct more thorough monitoring of vitamin D in women with multiple pregnancy.

18. Vitamin D and ethnic differences:

    • Darker skin: People with darker skin synthesize less vitamin D under the influence of sunlight.
    • Genetic factors: Genetic factors can affect vitamin D.’s metabolism.
    • Individual needs: Vitamin D needs may vary depending on ethnicity.

19. Vitamin D and the role in the prevention of other diseases:

    • Autoimmune diseases: Studies show that vitamin D can play a role in the prevention of some autoimmune diseases.
    • Cardiovascular diseases: Vitamin D can have a favorable effect on the cardiovascular system.
    • Oncological diseases: Some studies show that vitamin D can play a role in the prevention of some oncological diseases.

20. Future research areas:

    • A personalized approach to vitamin D consumption: Future studies will be aimed at developing a personalized approach to vitamin D during pregnancy, taking into account individual factors and genetic characteristics.
    • Long -term consequences of vitamin D deficiency: Studies of the long -term consequences of vitamin D deficiency during pregnancy for children’s health will continue.
    • The influence of vitamin D on genetic expression: The mechanisms of the influence of vitamin D on genetic expression during pregnancy will be studied.

Continuing research and deepening knowledge about vitamin D, it will be possible to develop more effective strategies to ensure the optimal health of the mother and fetus during pregnancy. Careful monitoring, an individual approach and taking into account environmental factors will play an important role in achieving this goal.