medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-13-64-70medsovet-1988Research ArticleБеременность и родыPregnancy and childbirthПРЕГРАВИДАРНАЯ ПОДГОТОВКАPRECONCEPTION PREPARATIONПустотинаО. А.PustotinaO. A.

д.м.н., профессор, 

Москва

MD, Prof., 

Moscow

Российский университет дружбы народовРоссияRussian University of People’s FriendshipRussian Federation2017081020170136470Copyright © Пустотина О.А., 20172017Пустотина О.А.Pustotina O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1988

В статье представлены основные положения прегравидарной подготовки. Обоснована целесообразность диагностических и  лечебно-профилактических мероприятий при подготовке к беременности, а также роль планирования семьи в  профилактике акушерских и перинатальных осложнений.

The article provides major provisions of the preconception preparation. The practicability of diagnostic and therapeutic and preventive measures at preparation to pregnancy as well as the role of the family planning in prevention of obstetrical and perinatal complications is justified.

прегравидарная подготовкапланирование семьипрофилактика перинатальных осложненийДНТфолиевая кислотаpreconception preparationfamily planningprevention of perinatal complicationsDWNTfolic acidReferencesDean SV, Lassi ZS, Imam AM et al. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod. Health., 2014, 11(Suppl. 3): S1.Dean SV, Lassi ZS, Imam AM et al. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod. Health., 2014, 11(Suppl. 3): S1.Berghella V. Preconceptional care: in book Obstetric Evidence Based Guidelines. 2nd Edition. Ed. by Berghella V. 2012: P1-11.Berghella V. Preconceptional care: in book Obstetric Evidence Based Guidelines. 2nd Edition. Ed. by Berghella V. 2012: P1-11.Прегравидарная подготовка: клинический протокол. [авт. разраб. В.Е. Радзинский и др.]. М.: Редакция журнала StatusPraesens, 2016. 80 с.Прегравидарная подготовка: клинический протокол. [авт. разраб. В.Е. Радзинский и др.]. М.: Редакция журнала StatusPraesens, 2016. 80 с.Радзинский В.Е., Пустотина О.А. Планирование семьи в XXI веке. М.: ГЭОТАР-Медиа, 2015. С. 17.Радзинский В.Е., Пустотина О.А. Планирование семьи в XXI веке. М.: ГЭОТАР-Медиа, 2015. С. 17.De Franco EA, Seske LM, Greenberg JM et al. Influence of interpregnancy interval on neonatal morbidity. Am. J. Obstet. Gynecol., 2015, 212(3): 386.e1–386.e9. [PMID: 25460837]De Franco EA, Seske LM, Greenberg JM et al. Influence of interpregnancy interval on neonatal morbidity. Am. J. Obstet. Gynecol., 2015, 212(3): 386.e1–386.e9. [PMID: 25460837]Chen I, Jhangri GS, Chandra S. Relationship between interpregnancy interval and congenital anomalies. Am. J. Obstet. Gynecol., 2014, 210(6): 564.e1–564.e8. [PMID: 24508646]Chen I, Jhangri GS, Chandra S. Relationship between interpregnancy interval and congenital anomalies. Am. J. Obstet. Gynecol., 2014, 210(6): 564.e1–564.e8. [PMID: 24508646]RCOG: Best practice in postpartum family planning. Best Practice Paper No1. 2015. 13 Р. URL: https://www.rcog.org. uk/en/guidelines-research-services/guidelines/bpp1/.RCOG: Best practice in postpartum family planning. Best Practice Paper No1. 2015. 13 Р. URL: https://www.rcog.org. uk/en/guidelines-research-services/guidelines/bpp1/.Love ER, Bhattacharya S, Smith NC et al. Effect of interpregnancyinterva lon outcomes of pregnancy after miscarriage: Retrospective analysis of hospital episode statistics in Scotland. BMJ, 2010, 341: 3967.Love ER, Bhattacharya S, Smith NC et al. Effect of interpregnancyinterva lon outcomes of pregnancy after miscarriage: Retrospective analysis of hospital episode statistics in Scotland. BMJ, 2010, 341: 3967.CHOICE – итоги первой общеевропейской программы по контрацепции. URL: http:// www.epochtimes.ru/content/ view/38373/7.CHOICE – итоги первой общеевропейской программы по контрацепции. URL: http:// www.epochtimes.ru/content/ view/38373/7.Радзинский В.Е. Акушерская агрессия. М.: Изд-во журнала StatusPraesens, 2011. 688 с.Радзинский В.Е. Акушерская агрессия. М.: Изд-во журнала StatusPraesens, 2011. 688 с.Ciancimino L, Laganà AS, Chiofalo B et al. Would it be too late? A retrospective casecontrol analysis to evaluate maternal-fetal outcomes in advanced maternal age. Arch. Gynecol. Obstet., 2014, 290(6): 1109–1114.Ciancimino L, Laganà AS, Chiofalo B et al. Would it be too late? A retrospective casecontrol analysis to evaluate maternal-fetal outcomes in advanced maternal age. Arch. Gynecol. Obstet., 2014, 290(6): 1109–1114.Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации МЗ РФ (протокол лечения). М., 2016. 72 с.Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации МЗ РФ (протокол лечения). М., 2016. 72 с.Hanson MA, Bardsley A, De-Regil LM, et al. Think Nutrition First. Intern J Gynecol Obstetr, 2015, 131(4): 213-253.Hanson MA, Bardsley A, De-Regil LM, et al. Think Nutrition First. Intern J Gynecol Obstetr, 2015, 131(4): 213-253.Devakumar D, Fall CHD, Sachdev HS et al. Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis. BMC Medicine, 2016, 14: 90.Devakumar D, Fall CHD, Sachdev HS et al. Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis. BMC Medicine, 2016, 14: 90.Gernand AD, Schulze KJ, Stewart CP et al. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat. Rev. Endocrinol., 2016, 12(5): 274-289. [PMID: 27032981]Gernand AD, Schulze KJ, Stewart CP et al. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nat. Rev. Endocrinol., 2016, 12(5): 274-289. [PMID: 27032981]McLean HQ, Fiebelkorn AP, Temte JL et al. Centers for disease control and prevention: Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2013, 62(RR-04): 1–4.McLean HQ, Fiebelkorn AP, Temte JL et al. Centers for disease control and prevention: Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2013, 62(RR-04): 1–4.Best practice in maternal-fetal medicine. FIGO Working Group on Best Practice in Maternal-Fetal Medicine. Int. J. Gynecol. Obstet., 2015, 128: 80-82.Best practice in maternal-fetal medicine. FIGO Working Group on Best Practice in Maternal-Fetal Medicine. Int. J. Gynecol. Obstet., 2015, 128: 80-82.Демикова Н.С., Лапина А.С., Подольная М.А. и др. Динамика частоты врожденных пороков развития в РФ (по данным федеральной базы мониторинга ВПР за 2006–2012 гг.). Российский вестник перинатологии и педиатрии, 2015, 2: 72-77.Демикова Н.С., Лапина А.С., Подольная М.А. и др. Динамика частоты врожденных пороков развития в РФ (по данным федеральной базы мониторинга ВПР за 2006–2012 гг.). Российский вестник перинатологии и педиатрии, 2015, 2: 72-77.Greenberg JA, Bell SJ, Guan Y et al. Folic Acid Supplementaion and Pregnancy: More Than Just Neural Tube Defect Prevention. Rev Obstet Gynecol, 2011, 4(2): 52-59.Greenberg JA, Bell SJ, Guan Y et al. Folic Acid Supplementaion and Pregnancy: More Than Just Neural Tube Defect Prevention. Rev Obstet Gynecol, 2011, 4(2): 52-59.Федеральная служба государственной статистики (Росстат): Российский статистический ежегодник – 2015: Статистический сборник.Федеральная служба государственной статистики (Росстат): Российский статистический ежегодник – 2015: Статистический сборник.De-Regil LM, Pena-Rosas JP, FernandezGaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochr Database Syst Rev, 2015, CD007950.De-Regil LM, Pena-Rosas JP, FernandezGaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochr Database Syst Rev, 2015, CD007950.Van Beynum IM et al. Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registrybased case-control study in the northern Netherlands. Eur Heart J, 2010, 31(4): 464-471.Van Beynum IM et al. Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registrybased case-control study in the northern Netherlands. Eur Heart J, 2010, 31(4): 464-471.Czeizel AE, Puho EH, Langmar Z et al. Possible association of folic acid supplementation during pregnancy with reduction of preterm birth: a population-based study. Eur J Obstet Gynecol Reprod Biol, 2010, 148: 135-140.Czeizel AE, Puho EH, Langmar Z et al. Possible association of folic acid supplementation during pregnancy with reduction of preterm birth: a population-based study. Eur J Obstet Gynecol Reprod Biol, 2010, 148: 135-140.Bukowski R, Malone FD, Porter FT et al. Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study. PLoS Med, 2009, 6: e1000061.Bukowski R, Malone FD, Porter FT et al. Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study. PLoS Med, 2009, 6: e1000061.Timmermans S, Jaddoe VW, Hofman A et al. Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth: the Generation R Study. Br J Nutr, 2009, 102: 777-785.Timmermans S, Jaddoe VW, Hofman A et al. Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth: the Generation R Study. Br J Nutr, 2009, 102: 777-785.Hodgetts VA, Morris RK, Francis A, et al. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of smallfor-gestational age neonates: a population study, systematic review and meta-analysis. BJOG, 2014, DOI: 10.1111/1471-0528.13202.Hodgetts VA, Morris RK, Francis A, et al. Effectiveness of folic acid supplementation in pregnancy on reducing the risk of smallfor-gestational age neonates: a population study, systematic review and meta-analysis. BJOG, 2014, DOI: 10.1111/1471-0528.13202.Smith AD, Smith SM, de Jager CA, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment. A randomized controlled trial. PLoS ONE, 2010, 5: e12244.Smith AD, Smith SM, de Jager CA, et al. Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment. A randomized controlled trial. PLoS ONE, 2010, 5: e12244.Julvez J, Fortuny J, Mendez M, Torrent M, Ribas-Fito N, Sunyer J. Maternal use of folic acid supplements during pregnancy and four-year-old neurodevelopment in a population-based birth cohort. Paediatr Perinat Epidemiol, 2009, 23: 199-206.Julvez J, Fortuny J, Mendez M, Torrent M, Ribas-Fito N, Sunyer J. Maternal use of folic acid supplements during pregnancy and four-year-old neurodevelopment in a population-based birth cohort. Paediatr Perinat Epidemiol, 2009, 23: 199-206.Roth C, Magnus P, Schjolberg S, Stoltenberg C, Suren P, McKeague IW et al. Folic acid supplements in pregnancy and severe language delay in children. JAMA, 2011, 306: 1566-1573.Roth C, Magnus P, Schjolberg S, Stoltenberg C, Suren P, McKeague IW et al. Folic acid supplements in pregnancy and severe language delay in children. JAMA, 2011, 306: 1566-1573.Pietrzik K, Lamers Y, Brämswig S, PrinzLangenohl R. Calculation of red blood cell folate steady state conditions and elimination kinetics after daily supplementation with various folate forms and doses in women in childbearing age. Am J Clin Nutr, 2007, 86: 1414–1419.Pietrzik K, Lamers Y, Brämswig S, PrinzLangenohl R. Calculation of red blood cell folate steady state conditions and elimination kinetics after daily supplementation with various folate forms and doses in women in childbearing age. Am J Clin Nutr, 2007, 86: 1414–1419.Brämswig S, Prinz-Langenohl R, Lamers Y et al. Supplementation with a multivitamin containing 800 µg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women. Int J Vitam Nutr Res, 2009, 79: 61-70.Brämswig S, Prinz-Langenohl R, Lamers Y et al. Supplementation with a multivitamin containing 800 µg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women. Int J Vitam Nutr Res, 2009, 79: 61-70.Czeizel AE, Dudás I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med, 1992, 327: 1832-5.Czeizel AE, Dudás I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med, 1992, 327: 1832-5.Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can, 2006, 28(8): 680.Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can, 2006, 28(8): 680.Wilson RD et al. Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. J. Obstet. Gynaecol. Can., 2015, 37(6): 534-352.Wilson RD et al. Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. J. Obstet. Gynaecol. Can., 2015, 37(6): 534-352.Kim YI. Folate and colorectal cancer: an evidence-based critical review. Mol Nutr Food Re, 2007, 51(3): 267-292.Kim YI. Folate and colorectal cancer: an evidence-based critical review. Mol Nutr Food Re, 2007, 51(3): 267-292.Morris MS, Jacques PF, Rosenberg IH, Selhub J. Circulating unmetabolized folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors. Am J Clin Nutr, 2010, 91: 1733-1744.Morris MS, Jacques PF, Rosenberg IH, Selhub J. Circulating unmetabolized folic acid and 5-methyltetrahydrofolate in relation to anemia, macrocytosis, and cognitive test performance in American seniors. Am J Clin Nutr, 2010, 91: 1733-1744.Linabery AM, Johnson KJ, Ross JA. Childhood cancer incidence trends in association with US folic acid fortification (1986– 2008). Pediatrics, 2012, 129: 1125-1133.Linabery AM, Johnson KJ, Ross JA. Childhood cancer incidence trends in association with US folic acid fortification (1986– 2008). Pediatrics, 2012, 129: 1125-1133.Bekkers MB, Elstgeest LE, Scholtens S et al. Maternal use of folic acid supplements during pregnancy and childhood respiratory health and atopy: the PIAMA birth cohort study. Eur Respir J, 2011.Bekkers MB, Elstgeest LE, Scholtens S et al. Maternal use of folic acid supplements during pregnancy and childhood respiratory health and atopy: the PIAMA birth cohort study. Eur Respir J, 2011.Dunstan JA, West C, McCarthy S et al. The relationship between maternal folate status in pregnancy, cord blood folate levels, and allergic outcomes in early childhood. Allergy, 2011, 67(1): 50-57.Dunstan JA, West C, McCarthy S et al. The relationship between maternal folate status in pregnancy, cord blood folate levels, and allergic outcomes in early childhood. Allergy, 2011, 67(1): 50-57.van der Zee B, de Wert G, Steegers EA et al. Ethical aspects of paternal preconception lifestyle modification. Am J Obstet Gynacol, 2013, 209(1): 11.van der Zee B, de Wert G, Steegers EA et al. Ethical aspects of paternal preconception lifestyle modification. Am J Obstet Gynacol, 2013, 209(1): 11.Maternal-Fetal Evidence Based Guidelines. 2nd Edition. Ed. by Berghella V. 2012. 462 P.Maternal-Fetal Evidence Based Guidelines. 2nd Edition. Ed. by Berghella V. 2012. 462 P.Guideline: Daily iron supplementation in adult women and adolescent girls. Geneva: World Health Organization; 2016.Guideline: Daily iron supplementation in adult women and adolescent girls. Geneva: World Health Organization; 2016.Стуклов Н.И., Козинец Г.И., Леваков С.А. Огурцов П.П. Анемии при гинекологических и онкогинекологических заболеваниях. М.: Медицинское информационное агентство, 2013. 240 с.Стуклов Н.И., Козинец Г.И., Леваков С.А. Огурцов П.П. Анемии при гинекологических и онкогинекологических заболеваниях. М.: Медицинское информационное агентство, 2013. 240 с.International Anemia Consultative Group. Report of the 2001 International Anemia Consultative Group Symposium. Why is iron important and what to do about it: a new perspective. Washington, DC, INACG Secretariat, 2002: 1–50.International Anemia Consultative Group. Report of the 2001 International Anemia Consultative Group Symposium. Why is iron important and what to do about it: a new perspective. Washington, DC, INACG Secretariat, 2002: 1–50.Beard JL. Why iron deficiency is important in infant development. J Nutr, 2008, 138(12): 2534-6.Beard JL. Why iron deficiency is important in infant development. J Nutr, 2008, 138(12): 2534-6.Bresgen N, Eckl PM. Oxidative Stress and the Homeodynamics of Iron Metabolism. Biomolecules, 2015, 5(2): 808–847.Bresgen N, Eckl PM. Oxidative Stress and the Homeodynamics of Iron Metabolism. Biomolecules, 2015, 5(2): 808–847.Innis SM. Metabolic programming of longterm outcomes due to fatty acid nutrition in early life. Matern. Child. Nutr., 2011, 7(Suppl. 2): 112-123.Innis SM. Metabolic programming of longterm outcomes due to fatty acid nutrition in early life. Matern. Child. Nutr., 2011, 7(Suppl. 2): 112-123.Hansen S, Strøm M, Maslova E et al. Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring. J. Allergy Clin. Immunol., 2016.Hansen S, Strøm M, Maslova E et al. Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring. J. Allergy Clin. Immunol., 2016.Лебеденко Е.Ю. Near miss: на грани материнских потерь. Под ред. В.Е. Радзинского. М.: Изд-во журнала StatusPraesens, 2015. 184 с.Лебеденко Е.Ю. Near miss: на грани материнских потерь. Под ред. В.Е. Радзинского. М.: Изд-во журнала StatusPraesens, 2015. 184 с.

The authors declare that there are no conflicts of interest present.