Abstract
Prevention of preeclampsia (PE) remains one of the most significant problems in perinatal medicine. Due to the possible unpredictable course of hypertension in pregnancy, primarily PE and the high complication rate for the mother and fetus/newborn, it is urgent to offer pregnant women in high-risk groups effective methods of preventing the PE development or delaying its appearance. In addition, due to the association of PE with an increased risk of developing cardiovascular diseases (CVD) in later life, effective preeclampsia prevention could also be important in reducing their incidence. Ideal PE prophylaxis should target the pathogenetic changes leading to the development of PE and be safe for the mother and fetus, inexpensive and freely available. Currently, the only recognized method of PE prevention recommended by many institutions around the world is the use of a small dose of acetylsalicylic acid in pregnant women with risk factors. Unfortunately, some cases of PE are diagnosed in women without recognized risk factors and in those in whom prophylaxis with acetylsalicylic acid is not adequate. Hence, new drugs which would target pathogenetic elements in the development of preeclampsia are studied. Vitamin D (Vit D) seems to be a promising agent due to its beneficial effect on placental implantation, the immune system, and angiogenic factors. Studies published so far emphasize the relationship of its deficiency with the development of PE, but the data on the benefits of its supplementation to reduce the risk of PE are inconclusive. In the light of current research, the key issue is determining the protective concentration of Vit D in a pregnant woman. The study aims to present the possibility of using Vit D to prevent PE, emphasizing its impact on the pathogenetic elements of preeclampsia development.
Highlights
Preeclampsia belongs to the group of hypertensive diseases in pregnancy, which affect 8–10% of pregnant women
Results of research conducted by Mumford et al have revealed that vitamin D (Vit D) levels above 75 nmol/L are associated with a higher probability of conception, a reduced risk of pregnancy loss, and a higher rate of live birth [215]
Despite the potential beneficial effect of Vit D on several pathophysiological processes leading to the development of pregnancy complications and promising results of observational studies, most randomized controlled trials (RCTs) and meta-analyses have not demonstrated in a definite and unambiguous way the effect of Vit D supplementation on reducing the incidence of pregnancy complications, including preeclampsia [218,219,220]
Summary
Preeclampsia belongs to the group of hypertensive diseases in pregnancy, which affect 8–10% of pregnant women. PE could be diagnosed in the absence of proteinuria when new-onset hypertension with new onset of any one of the following symptoms: thrombocytopenia (platelet count < 100,000/μL), renal insufficiency (serum creatinine concentration > 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal diseases), impaired liver function (raised concentrations of liver transaminases to twice average concentrations), pulmonary edema, or cerebral or visual problems occur [2] Another form of pregnancy-related hypertension is gestational hypertension or pregnancy-induced hypertension (PIH). Due to the possible unpredictable course of hypertension in pregnancy, primarily PE and the high complication rate for the mother and fetus/newborn, it is highly urgent to offer pregnant women from high-risk groups effective methods of preventing the development of this disease or delaying its appearance. The paper aims to present the possibility of Vit D use in preventing PE, emphasizing its impact on the pathogenetic elements of preeclampsia development
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