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‘5 (106) <strong>с</strong>ентябрь 2017 г.<br />
ПРАКТИЧЕСКАЯ МЕ<strong>Д</strong>ИЦИНА 21<br />
мл, не<strong>с</strong>мотря на дотацию [50]. Избежать этого можно было<br />
бы большими дозами <strong>с</strong> ранних <strong>с</strong>роков беременно<strong>с</strong>ти или <strong>с</strong><br />
этапа прегравидарной подготовки, и в дальнейшем применение<br />
4000 МЕ подтвердило это предположение. Практиче<strong>с</strong>ки<br />
в<strong>с</strong>ем женщинам при взятии на учет по беременно<strong>с</strong>ти<br />
рекомендует<strong>с</strong>я принимать препараты кальция непременно<br />
<strong>с</strong> витамином D. Необходимо отметить важно<strong>с</strong>ть приема<br />
витамина D, уча<strong>с</strong>твующего в регулировании размножения<br />
клеток, обменных проце<strong>с</strong><strong>с</strong>ов и в <strong>с</strong>интезе ряда гормонов<br />
при планировании и во время беременно<strong>с</strong>ти. <strong>Д</strong>озы витамина<br />
D для беременных зави<strong>с</strong>ят от многих факторов, которые<br />
определит врач по<strong>с</strong>ле <strong>с</strong>оответ<strong>с</strong>твующей оценки обе<strong>с</strong>печенно<strong>с</strong>ти<br />
и некоторых фенотипиче<strong>с</strong>ких и генотипиче<strong>с</strong>ких о<strong>с</strong>обенно<strong>с</strong>тей<br />
женщины.<br />
Таким образом, витамин D имеет очень широкие пер<strong>с</strong>пективы<br />
для оптимизации <strong>с</strong>о<strong>с</strong>тояния здоровья женщин и<br />
детей. Профилактика дефицита витамина D у беременных<br />
и до<strong>с</strong>тижение адекватного уровня кальция в дет<strong>с</strong>тве позволят<br />
не только предотвратить рахит, но и уменьшить<br />
ри<strong>с</strong>к о<strong>с</strong>теопороза, а также других длительно текущих латентных<br />
болезненных проце<strong>с</strong><strong>с</strong>ов, которые были <strong>с</strong>вязаны <strong>с</strong><br />
дефицитом витамина D во время беременно<strong>с</strong>ти. Это может<br />
быть одной из наиболее важных профилактиче<strong>с</strong>ких программ<br />
здравоохранения. Из-за от<strong>с</strong>ут<strong>с</strong>твия кон<strong>с</strong>ен<strong>с</strong>у<strong>с</strong>а в<br />
литературе необходимы дальнейшие и<strong>с</strong><strong>с</strong>ледования для<br />
уточнения дозы витамина D, которой будет до<strong>с</strong>таточно для<br />
улучшения материн<strong>с</strong>кого и перинатального здоровья.<br />
Обобщая имеющие<strong>с</strong>я данные, можно предположить,<br />
что женщины, имеющие ри<strong>с</strong>к преэкламп<strong>с</strong>ии,<br />
ге<strong>с</strong>тационного <strong>с</strong>ахарного диабета, преждевременных<br />
родов, привычного невынашивания, плацентарной<br />
недо<strong>с</strong>таточно<strong>с</strong>ти и ВУИ, должны принимать<br />
на этапе прегравидарной подготовки и <strong>с</strong> ранних<br />
<strong>с</strong>роков беременно<strong>с</strong>ти не менее 4000 МЕ витамина<br />
D. <strong>Д</strong>ля здоровых женщин <strong>с</strong> уровнем витамина D 25-<br />
30 нг/мл возможно и<strong>с</strong>пользование 2000 МЕ, более<br />
30 нг/мл — рекомендуемые в на<strong>с</strong>тоящее время —<br />
1000 МЕ.<br />
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ПРИМЕНЕНИЕ ВИТАМИНА D В КЛИНИЧЕСКОЙ ПРАКТИКЕ