Особенности микронутриентной подготовки к беременности женщин с синдромом поликистозных яичников

Кузнецова И.В., Гаврилова Е.А.

1) НОЧУ ДПО «Высшая медицинская школа», Москва, Россия; 2) Институт клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)» МЗ РФ, Москва, Россия
Цель. Провести систематический анализ литературных данных о методах микронутриентной подготовки к беременности пациенток с синдромом поликистозных яичников (СПКЯ).
Материалы и методы. С целью проведения анализа был осуществлен поиск зарубежных и отечественных публикаций в международной системе цитирования Pubmed, опубликованных за последние 15 лет.
Результаты. Рассмотрены патофизиологические механизмы снижения фертильности при СПКЯ, в том числе связанные с микронутриентной недостаточностью. Приведены данные о пользе применения витаминов, минералов и других биологически активных веществ для повышения фертильности и снижения риска гестационных осложнений у пациенток с СПКЯ. Проанализированы результаты клинических исследований, показавшие эффективность применения мио-инозитола, фолиевой кислоты, антиоксидантов и других биологически активных веществ на этапе прегравидарной подготовки у женщин с СПКЯ. Приведенные данные позволяют обосновать концепцию необходимой микронутриентной поддержки на этапе подготовки к беременности больных СПКЯ.

Ключевые слова

синдром поликистозных яичников
фертильность
бесплодие
биологически активные добавки к пище
микронутриенты
витаминно-минеральные комплексы
прегравидарная подготовка

Список литературы

  1. Борисов В.В. Причины расстройств и перспективы улучшения репродуктивного здоровья населения России. Клиническая лекция. Consilium medicum. 2017; 19(7): 70-5.

  2. Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil. Steril. 2020; 113(2): 305-22. https://dx.doi.org/10.1016/j.fertnstert.2019.10.014.
  3. Bozdag G., Mumusoglu S., Zengin D., Karabulut E., Yildiz B.O. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum. Reprod. 2016; 31(12): 2841-55. https://dx.doi.org/10.1093/humrep/dew218.
  4. Goodman N.F., Cobin R.H., Futterweit W., Glueck J.S., Legro R.S., Carmina E.; American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society (AES). American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome – Part 1 Endocr. Pract. 2015; 21(11): 1291-300. https://dx.doi.org/10.4158/EP15748.DSC.
  5. El Hayek S., Bitar L., Hamdar L.H., Mirza F.G., Daoud G. Polycystic ovarian syndrome: an updated overview. Front Physiol 2016; 7: 124.
  6. Kazemi M., McBreairty L.E., Zello G.A., Pierson R.A., Gordon J.J., Serrao S.B. et al. A pulse-based diet and the therapeutic lifestyle changes diet in combination with health counseling and exercise improve health-related quality of life in women with polycystic ovary syndrome: Secondary analysis of a randomized controlled trial. J. Psychosom. Obstet. Gynaecol. 2020; 41(2): 144-53. https://dx.doi.org/10.1080/0167482X.2019.1666820.
  7. Bednarska S., Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: what’s new? Adv. Clin. Exp. Med. 2017; 26(2): 359-67.https://dx.doi.org/10.17219/acem/59380.
  8. Rosenfield R.L., Ehrmann D.A. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr. Rev. 2016; 37(5): 467-520. https://dx.doi.org/10.1210/er.2015-1104.
  9. Lin A.W., Lujan M.E. Comparison of dietary intake and physical activity between women with and without polycystic ovary syndrome: A review. Adv. Nutr. 2014; 5(5): 486-96. https://dx.doi.org/10.3945/an.113.005561.
  10. Barr S., Hart K., Reeves S., Sharp K., Jeanes Y.M. Habitual dietary intake, eating pattern and physical activity of women with polycystic ovary syndrome. Eur. J. Clin. Nutr. 2011; 65(10): 1126-32. https://dx.doi.org/10.1038/ejcn.2011.81.
  11. Kazemi M., Jarrett B., Vanden Brink H., Lin A., Hoeger K., Spandorfer S., Lujan M. Associations between diet quality and ovarian dysmorphology in premenopausal women are mediated by obesity and metabolic aberrations (OR36-03-19). Curr. Dev. Nutr. 2019; 3(Suppl. 1): nzz035.OR36-03-19. https://dx.doi.org/10.1093/cdn/nzz035.OR36-03-19.
  12. Moran L.J., Ranasinha S., Zoungas S., McNaughton S.A., Brown W.J., Teede H.J. The contribution of diet, physical activity and sedentary behavior to body mass index in women with and without polycystic ovary syndrome. Hum. Reprod. 2013; 28: 2276-83. https://dx.doi.org/10.1093/humrep/det256.
  13. Tsai Y.H., Wang T.W., Wei H.J., Hsu C.Y., Ho H.J., Chen W.H. et al. Dietary intake, glucose metabolism and sex hormones in women with polycystic ovary syndrome (PCOS) compared with women with non-PCOS-related infertility. Br. J. Nutr. 2013; 109(12): 2190-8. https://dx.doi.org/10.1017/S0007114512004369.
  14. Sirmans S.M., Weidman-Evans E., Everton V., Thompson D. Polycystic ovary syndrome and chronic inflammation: pharmaco-therapeutic implications. Ann. Pharmacother. 2012; 46(3): 403-18. https://dx.doi.org/10.1345/aph.1Q514.
  15. Wehr E., Pieber T.R., Obermayer-Pietsch B. Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency in polycystic ovary syndrome women: a pilot study. J. Endocrinol. Invest. 2011; 34(10): 757-63. https://dx.doi.org/10.3275/7748.
  16. Sadeghi A., Djafarian K., Mohammadi H., Shab-Bidar S. Effect of omega-3 fatty acids supplementation on insulin resistance in women with polycystic ovary syndrome: meta-analysis of randomized controlled trials. Diabetes Metab. Syndr. 2017; 11(2): 157-62.
  17. Rahmani E., Jamilian M., Samimi M., Zarezade Mehrizi M., Aghadavod E., Akbari E. et al. The effects of coenzyme Q10 supplementation on gene expression related to insulin, lipid and inflammation in patients with polycystic ovary syndrome. Gynecol. Endocrinol. 2018; 34(3): 217-22. https://dx.doi.org/10.1080/09513590.2017.1381680.
  18. Yu P.L., Pu H.F., Chen S.Y., Wang S.W., Wang P.S. Effects of catechin, epicatechin and epigallocatechin gallate on testosterone production in rat leydig cells. J. Cell. Biochem. 2010; 110(2): 333-42. https://dx.doi.org/10.1002/jcb.22541.
  19. Wojciechowska A., Osowski A., Jóźwik M., Górecki R., Rynkiewicz A., Wojtkiewicz J. Inositols’ importance in the improvement of the endocrine–metabolic profile in PCOS. Int. J. Mol. Sci. 2019; 20(22): 5787. https://dx.doi.org/10.3390/ijms20225787.
  20. Facchinetti F., Orrù B., Grandi G., Unfer V. Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): A meta-analysis of randomized clinical trials. Gynecol. Endocrinol. 2019; 35(3): 198-206. https://dx.doi.org/10.1080/09513590.2018.1540578.
  21. Bibbins-Domingo K., Grossman D.C., Curry S.J., Davidson K.W., Epling J.W. Jr, García F.A.R. et al. Force USPST. Folic acid supplementation for the prevention of neural tube defects: US preventive services task force recommendation statement. JAMA. 2017; 317(2): 183-9. https://dx.doi.org/10.1001/jama.2016.19438.
  22. Farahi N., Zolotor A. Recommendations for preconception counseling and care. Am. Fam. Physician. 2013; 88(8): 499-506.
  23. Gaskins A.J., Mumford S.L., Chavarro J.E., Zhang C., Pollack A.Z., Wactawski-Wende J. et al. The impact of dietary folate intake on reproductive function in premenopausal women: a prospective cohort study. PLoS One. 2012; 7(9): e46276. https://dx.doi.org/10.1371/journal.pone.0046276.
  24. Cueto H.T., Riis A.H., Hatch E.E., Wise L.A., Rothman K.J., Sørensen H.T., Mikkelsen E.M. Folic acid supplementation and fecundability: a Danish prospective cohort study. Eur. J. Clin. Nutr. 2016; 70(1): 66-71. https://dx.doi.org/10.1038/ejcn.2015.94.
  25. Божедомов В.А., Торопцева М.В., Ушаков И.В., Спориш Е.А., Ловыгина Н.А., Липатова Н.А. Активные формы кислорода и репродуктивная функция мужчин: фундаментальные и клинические аспекты (обзор литературы). Андрология и генитальная хирургия. 2011; 12(3): 10-6.

  26. Нашивочникова Н.А., Крупин В.Н., Селиванова С.А. Антиоксидантная терапия бесплодного брака. Урология. 2015; 3: 71-4.

  27. Fares S., Sethom M.M., Khouaja-Mokrani C., Jabnoun S., Feki M., Kaabachi N. Vitamin A, E, and D deficiencies in tunisian very low birth weight neonates: prevalence and risk factors. Pediatr. Neonatol. 2014; 55(3): 196-201. https://dx.doi.org/10.1016/j.pedneo.2013.09.006.
  28. Baumgartner M.R. Vitamin-responsive disorders: cobalamin, folate, biotin, vitamins B1 and E. Handb. Clin. Neurol. 2013; 113: 1799-810. https://dx.doi.org/10.1016/B978-0-444-59565-2.00049-6.
  29. Moores J. Vitamin C: a wound healing perspective. Br. J. Community Nurs. 2013; Suppl.6: S8-11. https://dx.doi.org/10.12968/bjcn.2013.18.sup12.s6.
  30. Gürgen S.G., Erdoğan D., Elmas C., Kaplanoğlu G.T., Ozer C. Chemoprotective effect of ascorbic acid, α-tocopherol, and selenium on cyclophosphamide-induced toxicity in the rat ovarium. Nutrition. 2013; 29(5): 777-84. https://dx.doi.org/10.1016/j.nut.2012.11.004.
  31. Zal F., Mostafavi-Pour Z., Amini F., Heidari A. Effect of vitamin E and C supplements on lipid peroxidation and GSH-dependent antioxidant enzyme status in the blood of women consuming oral contraceptives. Contraception. 2012; 86(1): 62-6.
  32. Rahmani E., Samimi M., Ebrahimi F.A., Foroozanfard F., Ahmadi S., Rahimi M. et al. The effects of omega-3 fatty acids and vitamin E co-supplementation on gene expression of lipoprotein(a) and oxidized low-density lipoprotein, lipid profiles and biomarkers of oxidative stress in patients with polycystic ovary syndrome. Mol. Cell. Endocrinol. 2017; 439: 247-55. https://dx.doi.org/10.1016/j.mce.2016.09.008.
  33. Mohammad Hosseinzadeh F., Hosseinzadeh-Attar M.J., Yekaninejad M.S., Rashidi B. Effects of selenium supplementation on glucose homeostasis and free androgen index in women with polycystic ovary syndrome: a randomized, double blinded, placebo controlled clinical trial. J. Trace Elem. Med. Biol. 2016; 34: 56-61. https://dx.doi.org/10.1016/j.jtemb.2016.01.002.
  34. Razavi M., Jamilian M., Kashan Z.F., Heidar Z., Mohseni M., Ghandi Y., Bagherian T., Asemi Z. Selenium supplementation and the effects on reproductive outcomes, biomarkers of inflammation, and oxidative stress in women with polycystic ovary syndrome. Horm. Metab Res 2016; 48(3): 185-90. https://dx.doi.org/10.1055/s-0035-1559604.
  35. Imaeda N., Kuriki K., Fujiwara N., Goto C., Tokudome Y., Tokudome S. Usual dietary intakes of selected trace elements (Zn, Cu, Mn, I, Se, Cr, and Mo) and biotin revealed by a survey of four-season 7-consecutive day weighed dietary records in middle-aged Japanese dietitians. J. Nutr. Sci. Vitaminol. (Tokyo). 2013; 59(4): 281-8. https://dx.doi.org/10.3177/jnsv.59.281.
  36. Ramakrishnan K., Shenbagarathai R., Kavitha K., Thirumalaikolundusubramanian P., Rathinasabapati R. Selenium levels in persons with HIV/tuberculosis in India, Madurai City. Clin. Lab. 2012; 58(1-2): 165-8.
  37. Akinloye O., Adebayo T.O., Oguntibeju O.O., Oparinde D.P., Ogunyemi E.O. Effects of contraceptives on serum trace elements, calcium and phosphorus levels. West Indian Med. J. 2011; 60(3): 308-15.
  38. Takacs P., Jaramillo S., Zhang Y., Datar R., Williams A., Olczyk J. et al. The effects of PPARδ agonist and zinc on ovariectomized rats’ vagina. Female Pelvic Med. Reconstr. Surg. 2013; 19(3): 126-31. https://dx.doi.org/10.1097/SPV.0b013e31828746e9.
  39. Berenson A.B., Rahman M. Effect of hormonal contraceptives on vitamin B12 level and the association of the latter with bone mineral density. Contraception. 2012; 86(5): 481-7. https://dx.doi.org/10.1016/j.contraception.2012.02.015.
  40. Shen J., Lai C.Q., Mattei J., Ordovas J.M., Tucker K.L. Association of vitamin B-6 status with inflammation, oxidative stress, and chronic inflammatory conditions: the Boston Puerto Rican Health Study. Am. J. Clin. Nutr. 2010; 91(2): 337-42. https://dx.doi.org/10.3945/ajcn.2009.28571.
  41. Grober U., Schmidt J., Kisters K. Magnesium in prevention and therapy. Nutrients. 2015; 7(9): 8199-226. https://dx.doi.org/10.3390/nu7095388.
  42. Morais J.B.S., Severo J.S., de Alencar G.R.R., de Oliveira A.R.S., Cruz K.J.C., Marreiro D.D.N. et al. Effect of magnesium supplementation on insulin resistance in humans: a systematic review. Nutrition 2017; 38: 54-60. https://dx.doi.org/10.1016/j.nut.2017.01.009.
  43. Dupont J.J., Farquhar W.B., Townsend R.R., Edwards D.G. Ascorbic acid or L-arginine improves cutaneous microvascular function in chronic kidney disease. J. Appl. Physiol. 2011; 111(6): 1561-7. https://dx.doi.org/10.1152/japplphysiol.00419.2011.
  44. Takasaki A., Tamura H., Miwa I., Taketani T., Shimamura K., Sugino N. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertil. Steril. 2010; 93(6): 1851-8. https://dx.doi.org/10.1016/j.fertnstert.2008.12.062.
  45. White R.E., Gerrity R., Barman S.A., Han G. Estrogen and oxidative stress: A novel mechanism that may increase the risk for cardiovascular disease in women. Steroids. 2010; 75(11): 788-93. https://dx.doi.org/10.1016/j.steroids.2009.12.007.
  46. Жуков О.Б., Евдокимов В.В., Жуков А.А., Шугушева Л.Х., Брагина Е.Е. Новая стратегия профессионального медицинского сопровождения супружеской пары при бесплодии. Андрология и генитальная хирургия. 2013; 2: 70-4.

  47. Huger M., Nouri K., Imhof M., Egarter C., Ott J. The impact of a standardized micronutrient supplementation on PCOS-typical parameters: a randomized controlled trial. Arch. Gynecol. Obstet. 2019; 300(2): 455-60. https://dx.doi.org/10.1007/s00404-019-05194-w.
  48. Regidor P.A., Schindler A.E., Lesoine B., Druckman R. Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Horm. Mol. Biol. Clin. Investig. 2018; 34(2). https://dx.doi.org/10.1515/hmbci-2017-0067.
  49. Esmaeilzadeh S., Gholinezhad-Chari M., Ghadimi R. The effect of metformin treatment on the serum levels of homocysteine, folic acid, and vitamin B12 in patients with polycystic ovary syndrome. J. Hum. Reprod. Sci. 2017; 10(2): 95-101. https://dx.doi.org/10.4103/jhrs.JHRS_74_16.
  50. Bahmani F., Karamali M., Shakeri H., Asemi Z. The effects of folate supplementation on inflammatory factors and biomarkers of oxidative stress in overweight and obese women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled clinical trial. Clin. Endocrinol. (Oxford). 2014; 81(4): 582-7. https://dx.doi.org/10.1111/cen.12451.
  51. Asemi Z., Karamali M., Esmaillzadeh A. Metabolic response to folate supplementation in overweight women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial. Mol. Nutr. Food Res. 2014; 58(7): 1465-73. https://dx.doi.org/10.1002/mnfr.201400033.

Поступила 08.05.2020

Принята в печать 29.05.20

Об авторах / Для корреспонденции

Кузнецова Ирина Всеволодовна, профессор, д.м.н., руководитель направления гинекологической эндокринологии НОЧУ ДПО ВМШ. Тел.: +7 (495) 212-23-56.
E-mail: ms.smith.ivk@gmail.com. 105318, Россия, Москва, ул. Малая Семеновская, д. 3А, стр. 2.
Гаврилова Екатерина Андреевна, аспирант кафедры акушерства и гинекологии ИКМ им. Н.В. Склифосовского ФГАОУ ВО «ПМГМУ им. И.М. Сеченова» МЗ РФ (Сеченовский Университет). Тел.: +7 (499) 248-66-07. E-mail: gavrilova263@yandex.ru.
119435, Россия, Москва, ул. Еланского, д. 2, стр. 1.

Для цитирования: Кузнецова И.В., Гаврилова Е.А. Особенности микронутриентной подготовки к беременности женщин с синдромом поликистозных яичников.
Акушерство и гинекология. 2020; 6: 116-122
https://dx.doi.org/10.18565/aig.2020.6.116-122

Также по теме

Продолжая использовать наш сайт, вы даете согласие на обработку файлов cookie, которые обеспечивают правильную работу сайта.