Rekomendacje Polskiego Towarzystwa Ginekologicznego w zakresie stosowania witamin i mikroelementów u kobiet planujących ciążę, ciężarnych i karmiących

>IWT´Ü)OWTIVX´[4SPWOMIKS8S[EV^]WX[E+MRIOSPSKMG^RIKS

[WOÜEH^MI

4VSJHVLEF%KEXE/EVS[MG^&MPMÞWOE

Ā9RM[IVW]XIX1IH]G^R][ÛSH^M 4VSJHVLEF)[E2S[EO1EVO[MX^

Ā9RM[IVW]XIX1IH]G^R][4S^RERMY

4VSJHVLEF8SQEW^3TEPE

Ā9RM[IVW]XIX1IH]G^R][4S^RERMY

4VSJHVLEF4V^IQ]WÜE[3W^YOS[WOM

Ā-RWX]XYX'IRXVYQ>HVS[ME1EXOM4SPOM[ÛSH^M 4VSJHVLEF6]W^EVH4SVÊFE

ĀéPÂWOM9RM[IVW]XIX1IH]G^R]

4VSJHVLEF1EVIO7TEG^]ÞWOM

Ā9RM[IVW]XIX1IH]G^R][4S^RERMY

RE TSWMIH^IRMY [ HRMY  PYXIKS  VSOY W^G^IK´ÜS[S

TV^IEREPM^S[EÜ HSWXÊTRÂ PMXIVEXYVÊ TV^IHQMSXY TSê[MÊGSRÂ

^ETSXV^IFS[ERMYRE[MXEQMR]MQMOVSIPIQIRX][SOVIWMITVI

OSRGITG]NR]Q[TMIV[W^]QMOSPINR]GLXV]QIWXVEGLGMÂõ]SVE^

TSHG^EWPEOXEGNM

7XERS[MWOS TV^IHWXE[ME WXER [MIH^] RE [[ XIQEX RE

H^MIÞTV^ITVS[EH^IRMEEREPM^]>IWT´ÜIOWTIVX´[^EWXV^IKEWS

FMITVE[SHSEOXYEPM^EGNMRMRMINW^IKSWXERS[MWOE[TV^]TEHOY

TSNE[MIRMEWMÊRS[]GLMWXSXR]GLHSRMIWMIÞREYOS[]GL

Wprowadzenie

>ETI[RMIRMI TVE[MHÜS[IKS ^ESTEXV^IRME SVKERM^QY [ RMI-

^FÊHRI WOÜEHRMOM FYHYPGS[I IRIVKIX]G^RI SVE^ [MXEQMR] M QM- OVSIPIQIRX]NIWXW^G^IK´PRMI[EõRI[WXEREGL[^QSõSRIKS^E- TSXV^IFS[ERMERERMIGSWTSH^MI[ERINIWXYOSFMIXTPERYNÂG]GL

GMÂõÊGMÊõEVR]GLSVE^OEVQMÂG]GLTMIVWMÂ&VEOV´[RS[EKMQMÊ- H^]TSW^G^IK´PR]QMWOÜEHRMOEQM^EV´[RSRMIHSF´VNEOMREHQMEV

WXERS[MÄQSõIG^]RRMOSFRMõENÂG]W^ERWIRE^ENêGMI[GMÂõÊMTVE- [MHÜS[]NINHEPW^]VS^[´NEXEOõIQSõIRIKEX][RMI[TÜ]RÂÄRE

VS^[´NOEVQMSRIKSTMIVWMÂH^MIGOE

4VE[MHÜS[E ^V´õRMGS[ERE ^E[MIVENÂGE REXYVEPRI [MXEQM- R]MQMRIVEÜ]HMIXEQSõI^ETI[RMEÄ^ESTEXV^IRMI[RSVQEPR]GL

[EVYROEGLEPI[^VSWX^ETSXV^IFS[ERMETSHG^EWGMÂõ]MPEOXEGNM

QSõIRMIF]Ä[HSWXEXIG^R]WTSW´FXÂHVSKÂTSOV][ER]

;]WSOMIWXÊõIRMETVSKIWXIVSRYMMHÂGI^EX]Q^QMER]^EGLS- H^ÂGI [ SVKERM^QMI OSFMIX] GMÊõEVRIN TS[SHYNÂ SKVERMG^IRMI

FMSHSWXÊTRSêGM[MIPYWOÜEHRMO´[HMIX]ESFIGRSêÄVS^[MNENÂGIN

WMÊGMÂõ]^REG^ÂGS^[MÊOW^E^ETSXV^IFS[ERMIRERMIOX´VI^RMGL

;GLÜERMERMI[MXEQMRMQMOVSIPIQIRX´[SVE^MGLQIXEFSPM^Q^E- PIõR]NIWXV´[RMIõSHSHTS[MIHRMIN^E[EVXSêGMFMEÜOE[HMIGMI

3TX]QEPRETSHEõQEOVSQMOVSIPIQIRX´[M[MXEQMR[SOVI- WMITVIOSRGITG]NR]QTSHG^EWGMÂõ]M[SOVIWMIPEOXEGNMTS^]X][- RMI [TÜ][E RE [I[RÂXV^QEGMG^RI [^VEWXERMI TÜSHY M ^HVS[MI

QEXOM?A

Rekomendacje Polskiego Towarzystwa

Ginekologicznego w zakresie stosowania witamin i mikroelementów u kobiet

planujących ciążę, ciężarnych i karmiących

Recommendations of the Polish Gynecological Society

concerning docosahexaenoic acid supplementation in the prevention

of preterm birth

Zapewnienie zaopatrzenia w niektóre witaminy i mikroele- QIRX]REN[EõRMINW^INIWXTV^IHGMÂõÂSVE^RENINTSG^ÂXOYWXÂH

XIõTSXV^IFE^[V´GIRMEY[EKMRESHTS[MIHRMITV^]KSXS[ERMIHS

RMIN M G^ÊWXS OSRX]RYS[ERMI WYTPIQIRXEGNM Eõ HS OSÞGE SOVIWY

PEOXEGNMSVE^RESTX]QEPM^EGNÊHE[IO[^EPIõRSêGMSHEOXYEPRIKS

^ETSXV^IFS[ERME

.EOHSXÂHFVEONIHRSPMXIKS^EPIGERIKSWTSWSFYTSWXÊTS[E- RME^EWEHRSêGMWXSWS[ERMEV´õR]GL[MXEQMRMQMOVSIPIQIRX´[

2MIHSF´V SFMIOX][R]GL óV´HIÜ PMXIVEXYVS[]GL QSKÂG]GL TV^IH- WXE[MÄ YHS[SHRMSRI OSV^]êGM []RMOENÂGI ^I WXSWS[ERME WYTPI- QIRXEGNM Y OSFMIX TPERYNÂG]GL GMÂõÊ GMÊõEVR]GL M OEVQMÂG]GL

TMIVWMÂ[]RMOE^SKVERMG^IÞIX]G^R]GL[TVS[EH^IRMYFEHEÞHS- ê[MEHG^EPR]GLYOSFMIXGMÊõEVR]GL?A

;êV´HWOÜEHRMO´[OX´V]GLTS^]X][R][TÜ][NIHRS^REG^RMI

YHS[SHRMSRS^RENHYNIWMÊO[EWJSPMS[][MIPSRMIREW]GSRIO[EW]

XÜYW^G^S[IõIPE^SNSHM[MXEQMRE(

Kwas foliowy

/[EW JSPMS[] NIWX RMI^FÊHR]Q OSIR^]QIQ QIXEFSPM^QY

O[EW´[ RYOPIMRS[]GL OEXEPM^YNI TVSGIW] OV[MSX[´VG^I HSFV^I

[GLÜERMEWMÊ^NIPMXM[MÂõI^FMEÜOEQMSWSG^E

1SõPM[SêÄ[]WXÂTMIRMESX[EVX]GL[EHSêVSHOS[IKSYOÜEHY

RIV[S[IKS[^VEWXEREWOYXIORMIHSFSVYO[EWYJSPMS[IKS.IWX

SRTMIV[MEWXOMIQ^EPIGER]Q[JSVQMIWXEÜINWYTPIQIRXEGNMHS- YWXRIN[SOVIWMITPERS[ERMEGMÂõ]GSRENQRMINX]KSHRMTV^IH

OSRGITGNÂEõHSG^EWY^EOSÞG^IRMETVSGIWYSVKERSKIRI^]?A

9 GMÊõEVRIN RMIHSF´V O[EWY JSPMS[IKS QSõI WTS[SHS[EÄ

RMIHSOV[MWXSêÄ QIKEPSFPEWX]G^R WTS[SHS[ER  RMITVE[MHÜS- []Q []HÜYõSR]Q HSNV^I[ERMIQ OV[MRIO G^IV[SR]GL [ W^TMOY

OSWXR]QTSPIKENÂG]QRE^[SPRMIRMYTVSGIWYW]RXI^](2%MSFIG- RSêGM[IOV[MSF[SHS[INRMIHSNV^EÜ]GLNÂHV^EWX]GLIV]XVSG]X´[

>ETSXV^IFS[ERMIOSFMIXOEVQMÂG]GLREO[EWJSPMS[]NIWX[]õW^I

RMõTSHG^EWGMÂõ]?A

;TV^]TEHOEGLFVEOYSFIGRSêGMO[EWYJSPMS[IKS[HMIGMI

NYõTSG^XIVIGLQMIWMÂGEGLHSGLSH^MHS[]G^IVTERMENIKS^ETE- sów w organizmie.

>IWT´Ü )OWTIVX´[ 4MIV[SXRIN 4VSJMPEOX]OM ;EH] 'I[] 2IV- [S[IN NYõ SH  V VIOSQIRHYNI WYTPIQIRXS[ERMI TSHG^EW

GMÂõ]QKO[EWYJSPMS[IKSREHSFÊ9OSFMIXTV^]NQYNÂG]GL

VIOSQIRHS[ERÂHE[OÊO[EWYJSPMS[IKSV]^]OS[]WXÂTMIRME[EH

SX[EVX]GLGI[]RIV[S[INSFRMõEWMÊS GSXÜYQEG^]WMÊSFIG- RSêGMÂ[EH392Y[EVYROS[ER]GLMRR]QMRMõRMIHSF´VO[EWYJS- liowego czynnikami.

;TV^]TEHOYWX[MIVH^IRMERMIHSOV[MWXSêGMQIKEPSFPEWX]G^- RINHE[OEO[EWYJSPMS[IKSTS[MRREF]Ä^[MÊOW^SRESVE^[TV^]- TEHOYOSFMIXWXSWYNÂG]GL[G^IêRMINERX]OSRGITGNÊLSVQSREPRÂ

PIOM TV^IGM[TEHEG^OS[I Y TEPÂG]GL TETMIVSW] SX]Ü]GL >[MÊO- W^SRÂHE[OÊO[EWYJSPMS[IKSREPIõ]V´[RMIõWXSWS[EÄYOSFMIX

^LMTIVLSQSG]WXIMRIQMÂREWOYXIOQYXEGNM18,*6FPSOYIR^]- QEX]G^RIKS TSPIKENÂGIKS RE SFRMõSRIN EOX][RSêGM VIHYOXE^]

QIX]PIRSXIXVEL]HVSJSPMERS[IN RE WOYXIO SFIGRSêGM TSPMQSV- JM^QY'8[]WXÊTYNÂGIN^V´õR]QREWMPIRMIQY SW´F

w populacji europejskiej.

2MIHSF´VO[EWYJSPMS[IKSREWOYXIORMIHSWXEXIG^RINTSHE- õ]PYFRMITVE[MHÜS[IKSQIXEFSPM^QYQSõITS[SHS[EÄRMIX]P- OS[^VSWXV]^]OE[EHSX[EVX]GL392PIG^XEOõI[EHWIVGEM[EH

^ETSVS[]GLYOÜEHYQSG^S[IKSSVE^[^VSWXV]^]OE[]WXÂTMIRME

TSVSRMIÞ^EOV^ITMG]

>HVYKMIN^EêWXVSR]WXSWS[ERMI[]WSOMGLHE[IOO[EWYJS- PMS[IKS QSõI TS[SHS[EÄ [^VSWX V]^]OE YW^OSH^IRME [G^IWRIN

GMÂõ]STV´G^XIKSWYTPIQIRXEGNEO[EWIQJSPMS[]QNIWXTV^IGM[- [WOE^ERE Y SW´F [ WXEVW^]Q [MIOY M [ GLSVSFEGL RS[SX[SVS- []GL^I[^KPÊHYRENIKSH^MEÜERMITVSPMJIVEG]NRI

>EPIGERIHE[OS[ERMISOVIWTVIOSRGITG]NR]GMÂõE[G^IWRE

HSHVYKMIKSXV]QIWXVYQKHSFE

2MIHSOV[MWXSêÄ QIKEPSFPEWX]G^RE LMTIVLSQSG]WXIMRIQME

QK[]õW^IHE[OMTSHOSRXVSPÂWXÊõIRMEJSPMER´[[WYVS[MG]

;MIPSRMIREW]GSRIO[EW]XÜYW^G^S[I

Ā49*% TSPMYRWEXYVEXIHJEXX]EGMHW

;MIPSRMIREW]GSRIO[EW]XÜYW^G^S[IWÂWOÜEHRMOEQMFYHYP- GS[]QM HPE FÜSR JSWJSPMTMHS[]GL WXERS[MÂG   O[EW´[

XÜYW^G^S[]GL^E[EVX]GL[JSWJSPMTMHEGLYOÜEHYRIV[S[IKSMWMEX- O´[OM SOE ;GLSH^Â [ WOÜEH SWÜSRIO QMIPMRS[]GL RIV[´[ SF- [SHS[]GLFÜSRW]RETX]G^R]GLMRIYVSXVERWQMXIV´[PMTMHS[]GL

WOÜEHRMO´[VIGITXSVS[ING^ÊêGMWMEXO´[OM4VE[MHÜS[E^E[EVXSêÄ

[MIPSRMIREW]GSR]GLO[EW´[XÜYW^G^S[]GL[HMIGMIMMGLHSWXÊT- RSêÄHPETÜSHY[TÜ][ERETVE[MHÜS[]VS^[´NWMEXO´[OMSOE[GLS- H^ÂG[WOÜEHNINJSXSVIGITXSV´[SVE^OSQ´VIORIV[S[]GL[TÜ]- [E RE TIVGITGNÊ [VEõIÞ [^VSOS[]GL M MGL ^EQMERÊ RE MQTYPW]

RIV[S[I>ETI[RMIRMISVKERM^QS[MTVE[MHÜS[IKS^ESTEXV^IRME

TSHG^EWGMÂõ][TÜ][ERE[]HÜYõIRMIG^EWYXV[ERMEGMÂõ][^VSWX

QEW] YVSH^IRMS[IN RS[SVSHOE FI^ [^VSWXY V]^]OE QEOVSWSQMM

SVE^WTEHIOV]^]OE[]WXÂTMIRMETSVSHYTV^IH[G^IWRIKS?A

7XSWS[ERMIO[EW´[SQIKE^QRMINW^EV]^]OS[]WXÂTMIRMEGY- OV^]G] X]TY - GLSVSF] REHGMêRMIRMS[IN [ [MIOY HSVSWÜ]Q SVE^

EPIVKMM?A

.IHR]Q ^ REN[EõRMINW^]GL WOÜEHRMO´[ HMIX] [ G^EWMI GMÂõ]

MPEOXEGNM^KVYT]O[EW´[SQIKENIWX(,%O[EWHSOS^ELIOWE- IRS[] OX´VIKSREXYVEPR]QóV´HÜIQWÂXÜYWXIV]F]QSVWOMIS[S- ce morza i algi morskie.

>ETI[RMIRMITVE[MHÜS[IN^E[EVXSêGM[HMIGMIMHSWXÊTRSêGM

(,%HPESVKERM^QYTSHG^EWGMÂõ]MPEOXEGNMQSõI[TÜ]RÂÄV´[- RMIõREVS^[´NTW]GLSQSXSV]G^R]H^MIGOESWXVSêÄ[MH^IRMESVE^

SFRMõIRMIV]^]OE[]WXÂTMIRMEHITVIWNMTSTSVSHS[INYQEXOM?A

&MSVÂG TSH Y[EKÊ OSV^]êGM []RMOENÂGI ^ H^MEÜERME (,% RE

SVKERM^QQEXOMMH^MIGOEOSFMIX][GMÂõ]TS[MRR][TV^]TEHOY

RMWOMIKSWTSõ]GMEV]FMFVEOYMRR]GLóV´HIÜ(,%TEGNIRXOMTS[MR- R]TV^]NQS[EÄGSRENQRMINQK(,%GSH^MIRRMI;TV^]TEHOY

[]WSOMIKSV]^]OE[]WXÂTMIRMETSVSHYTV^IH[G^IWRIKSTVSTSRY- NIWMÊTV^]NQS[ERMIRE[IXQK(,%H^MIRRMI>I[^KPÊHYRE

[TÜ][(,%REHEPW^]VS^[´NH^MIGOE^EPIGEWMÊXEOõITV^]NQS[E- nie DHA podczas laktacji w celu zapewnienia optymalnego jego WXÊõIRME[QPIOY2MI[]OE^ERSõEHR]GLWOYXO´[YFSG^R]GLHPE

OSFMIX]GMÊõEVRINMTÜSHYRE[IXTV^]WTSõ][ER]GLHE[OEGL[]õ- W^]GL?A

6]^]OS^ERMIG^]W^G^IRMEQIXEPEQMGMÊõOMQMHMSOW]REQMSVE^

TSPMGLPSVS[ER]QM FMJIR]PEQM 4'&  OX´VI QSKÂ F]Ä W^OSHPM[I

HPETÜSHYNIWX[]IPMQMRS[ERIKH](,%TSGLSH^M^FI^TMIG^R]GL

óV´HIÜMNIWXOSRXVSPS[ER]&I^TMIG^R]QóV´HÜIQNIWX(,%Y^]WOM- [ER]^QEÜ]GLV]FSVE^^EPKVSH^ENY7GLM^SGL]XVMYQWTLSHS[E- R]GL[W^XYG^R]GL[EVYROEGL?A

;MIPSRMIREW]GSRI O[EW] XÜYW^G^S[I [TÜ][ENÂ V´[RMIõ

SGLVSRRMIREYOÜEHOVÂõIRMETV^I^LEQS[ERMITVSGIW´[^ETEP- R]GL[FPEW^OEGLQMEõHõ]GS[]GLSFRMõERMIWXÊõIRMEXV´NKPMGIV]- H´[MJVEOGNM0(0PMTMH´[WXERS[MÂSFVSRÊTV^IHTVSGIWIQYXPI- RMERMEXOEROS[IKSFÊHÂGNIHRSG^IêRMIWYFWXVEXIQHSTVSHYOGNM

prostaglandyn, prekursorów mediatorów odpowiedzi immunolo- KMG^RINEOX][EXSV´[EKVIKEGNMTÜ]XIOMWYFWXERGNMREG^]RMSEOX][- R]GL?A7XERS[MWOS)YVSTIER*SSH7EJIX]%YXLSVMX]TSX[MIVH^E

OSRMIG^RSêÄ ^ETI[RMIRME SHTS[MIHRMIN H]WXV]FYGNM O[EWY (,%

TÜSHS[MMRS[SVSHOS[MGIPIQ^ETI[RMIRMETVE[MHÜS[IKSVS^[S- NYTS^RE[G^IKSMSWXVSêGM[MH^IRME?A

;SFIG RE[]O´[ õ][MIRMS[]GL SKVERMG^ENÂG]GL ^REG^RMI

QSõPM[SêGM ^ETI[RMIRME HSWXEXIG^RIN MPSêGM (,% [ TSõ][MIRMY

VIOSQIRHYNIWMÊNIKSWYTPIQIRXEGNÊTV^]RENQRMINSHX]KSHRME

GMÂõ] OMIH] MRXIRW][RMI VS^[MNE WMÊ SêVSHOS[] YOÜEH RIV[S[]

TÜSHY?A

(SFS[I^ETSXV^IFS[ERMIRERMIREW]GSRIO[EW]XÜYW^G^S[I

TSHG^EWGMÂõ]SVE^OEVQMÂG]GLOSFMIX[]RSWMSHQK(,%

E[EVYROEGL^REG^RIKSRMIHSFSVYQK

ôIPE^S

9OSFMIXGMÊõEVR]GLTSHG^EWVYX]RS[]GLFEHEÞYOÜEHYG^IV- [SRSOV[MROS[IKSG^ÊWXSWX[MIVH^EWMÊRMIHSOV[MWXSêÄRMIHSFS- VS[ SFWIV[YNI WMÊ V´[RMIõ X^[ JM^NSPSKMG^R RMIHSOV[MWXSêÄ

^[MÂ^ERÂ ^I WTEHOMIQ LIQEXSOV]XY %RIQME []RMOENÂGE ^ RMI- HSFSVYõIPE^EQSõITS[SHS[EÄSFRMõIRMIXSPIVERGNMRE[]WMÜIO

JM^]G^R]YG^YGMI^QÊG^IRMEEYOSFMIXGMÊõEVR]GL^[MÊOW^EÄV]-

^]OSTSVSHYTV^IH[G^IWRIKS2MIHSOV[MWXSêÄQEXOMTSHG^EWOEV- QMIRMETMIVWMÂEX]QWEQ]QSFRMõIRMI^E[EVXSêGMõIPE^E[TSOEV- QMIQSõITSHRSWMÄV]^]OS[]WXÂTMIRMERMIHSOV[MWXSêGMYH^MIGOE

EXEOõISKVERMG^IRMEVS^[SNYTW]GLSQSXSV]G^RIKS?A

+VYTEQM ^EKVSõIRME RMIHSOV[MWXSêGMÂ WÂ SWSF] FÊHÂGI RE

HMIGMI[IKEÞWOMINPYF[IKIXEVMEÞWOMIN^^EFYV^IRMEQM[GLÜERME- RME SVE^ OSFMIX] SFJMGMI QMIWMÂG^OYNÂGI GMÊõEVRI G^] OEVQMÂGI

TMIVWMÂ?A

7YTPIQIRXEGNE^[MÂ^OEQMõIPE^E[JSVQMIHSYWXRINTS[MR- REF]ÄTVS[EH^SREYOSFMIX^RMIHSOV[MWXSêGMÂTV^IHTPERS[ERÂ

GMÂõÂEREWXÊTRMI[ÜÂG^ERETSRS[RMITSYOSÞG^IRMYX]KSHRME

GMÂõ]^I[^KPÊHYRE[^VSWXV]^]OERMIOSV^]WXRIKSH^MEÜERME[]- WSOMGLWXÊõIÞõIPE^E[TÜ]RMITÊGLIV^]OS[]QREVS^[MNENÂG]WMÊ

^EVSHIOTS[SHYNÂG][^VSWXV]^]OETS[WXERME[EHVS^[SNS[]GL

?A

2MIHSOV[MWXSêÄ^RMIHSFSVYõIPE^EHIJMRMYNIWMÊNEOSWXÊõIRMI

LIQSKPSFMR]TSRMõINQK 

(^MIRRE^E[EVXSêÄõIPE^E[HMIGMITS[MRREYOSFMIXRMIGMÊ- õEVR]GL[]RSWMÄGSRENQRMINQK[^VEWXEÄHSQKTSH- G^EWGMÂõ]SVE^F]ÄRETS^MSQMIQK[G^EWMIPEOXEGNM

>KSHRMI^VIOSQIRHEGNEQM'('[WOE^ERINIWX[TVS[EH^I- RMIYOSFMIXGMÊõEVR]GL^RMIHSOV[MWXSêGMÂWYTPIQIRXEGNMHSYWX- RINTVITEVEXEQMõIPE^ETSYOSÞG^IRMYX]KSHRMEGMÂõ][HE[GI

SH  QK H^MIRRMI M ^[MÊOW^IRMI HE[OM HSFS[IN HS  QK

[ TV^]TEHOY TSX[MIVH^IRME V´õRIKS WXSTRME RMIHSOV[MWXSêGM

^RMIHSFSVYõIPE^E

;PIG^IRMYRMIHSOV[MWXSêGMTVITEVEXEQMHSYWXR]QMTSHOVI- êPEWMÊOSRMIG^RSêÄY^YTIÜRMERMERMIHSFSVYõIPE^ERMWOMQMNIKS

HE[OEQMTV^I^HÜYõW^]SOVIWG^EWYKH]õH]WXV]FYGNE^[MÂ^ERE

NIWX^^E[EVXSêGMÂFMEÜIORSêRMOS[]GLOX´VIWÂ[WT´PRIHPENS- R´[ QIXEPM TV^INêGMS[]GL 2E TVE[MHÜS[] QIXEFSPM^Q õIPE^E

[TÜ][EV´[RMIõSFIGRSêÄQEKRI^YSVE^[MXEQMR]&?A

-WXRMIN V´õRI TVITEVEX] õIPE^E OX´V]GL HSWXÊTRSêÄ FMSPS- KMG^RENIWX^V´õRMGS[EREG^ÊWXS^EPIõRESHT,WSOYõSÜÂHOS[I- go i diety.

7YTPIQIRXEGNE õIPE^IQ STV´G^ TSTVE[] TEVEQIXV´[ G^IV- [SRSOV[MROS[]GLQSõITS[SHS[EÄ[^VSWXQEW]GMEÜERS[SVSH- O´[FI^[^VSWXYV]^]OEQEOVSWSQMM

7YTPIQIRXEGNEõIPE^ETS[MRREF]ÄTVS[EH^SREYOSFMIXTPE- RYNÂG]GL GMÂõÊ Y OX´V]GL QSõRE TV^I[MH][EÄ RMIHSF´V õIPE^E

[T´óRMINW^]QG^EWMISVE^[GMÂõ]SMPIMWXRMINÂG^]RRMOMV]^]OE

[]WXÂTMIRME RMIHSOV[MWXSêGM 6IOSQIRHS[ERE HE[OE XS QMRM- QYQQKTV^IHGMÂõÂMQKTSHG^EWGMÂõ]TSHG^EWPEOXE- GNMHE[OEQSõIF]Ä^VIHYOS[EREHSQK

; PIG^IRMY NYõ MWXRMINÂGIN RMIHSOV[MWXSêGM REPIõ] WXSWS[EÄ

[]õW^ISHTVSJMPEOX]G^R]GLHE[OMPYFMRNIOGNIHSQMÊêRMS[I

Jod

4SPWOENIWXOVENIQSêVIHRMQV]^]OY[]WXÂTMIRMERMIHSFSVY

jodu w diecie, co jest powodem wprowadzenia profilaktycznego NSHS[ERMEWSPMOYGLIRRIN4SHG^EWGMÂõ][^VEWXE^ETSXV^IFS[E- RMIRENSHGSQMÊH^]MRR]QMWTS[SHS[ERINIWX[^VSWXIQEOX][- RSêGMHINSH]RE^YXVEXÂNSHYTV^I^RIVOMSVE^^ETSXV^IFS[ERMIQ

TÜSHY>EPIGERIG^ÊWXSGMÊõEVR]QSKVERMG^IRMIWTSõ]GMEWSPMOY- GLIRRINQSõIV´[RMIõREWMPEÄNIKSRMIHSF´V?A

3FRMõSRE TSHEõ NSHY QSõI F]Ä TV^]G^]RÂ TS[WXERME [SPE

XEVG^]GS[IKSYGMÊõEVRINM[^VSWXYV]^]OERMIHSVS^[SNYYQ]WÜS- [IKSYH^MIGM?A2EWOYXIORMIHSFSVYHSGLSH^MHS^EFYV^IÞ

QMIPMRM^EGNM[Ü´OMIRRIV[S[]GLYW^OSH^IRMESêVSHOS[IKSYOÜE- HYRIV[S[IKSRMIHSWÜYGLYMKÜYGLSX]RS[SVSHO´[2MIHSG^]R- RSêÄXEVG^]G]YGMÊõEVRIN^[MÂ^ERE^RMIHSFSVIQNSHYTS[SHYNI

[^VSWXV]^]OETSVSRMIÞTSVSH´[TV^IH[G^IWR]GLRMIHSG^]RRS- êGMXEVG^]G]YTÜSHYMRS[SVSHOE?A

;^VSWX ^ETSXV^IFS[ERME RE NSH WX[MIVH^E WMÊ NYõ [ TMIV[- W^]QXV]QIWXV^IGMÂõ]HSSOSÜSQMOVSKVEQ´[REHSFÊ>E- TSXV^IFS[ERMIRENSHNIWXV´[RMIõ^[MÊOW^SRITSHG^EWOEVQMIRME

TMIVWM >E[EVXSêÄ NSHY [ TSOEVQMI QEXOM NIWX Y^EPIõRMSRE SH

^E[EVXSêGMNSHY[HMIGMIMTYPM^ETEWS[INY[EPRMERIN[XEVG^]G]

?A

;IHÜYK VIOSQIRHEGNM ;,3 HSFS[E HE[OE WYTPIQIRXEG]N- RENSHYYOSFMIXGMÊõEVR]GLMOEVQMÂG]GLTS[MRRE[]RSWMÄSOSÜS

QMOVSKVEQ´[REHSFÊ?A

7YTPIQIRXEGNEEOXYEPRMI^EPIGEREHSFS[EHE[OENSHYHPE

OSFMIXTPERYNÂG]GLGMÂõÊGMÊõEVR]GLMOEVQMÂG]GLTMIVWMÂ[]RSWM

QMOVSKVEQ´[REHSFÊ

Witamina D

3HRMIHE[RE^[VEGEWMÊY[EKÊREVSPÊ[MXEQMR]([SVKERM-

^QMIG^ÜS[MIOE;TÜ][ESREREVIKYPEGNÊWXÊõIRME[ETRMEMJSW- JSVY [ SWSG^Y YXV^]Q][ERMI TVE[MHÜS[IN KÊWXSêGM QMRIVEPRIN

OSêGM LEQS[ERMI REHQMIVRIN TVSPMJIVEGNM M WX]QYPS[ERMI V´õRM- GS[ERMEOSQ´VIO[YOÜEH^MIOV[MSX[´VG^]QSVE^QSHYPS[ERMI

JYROGNM YOÜEHY SHTSVRSêGMS[IKS (^MEÜERMI ERX]TVSPMJIVEG]NRI

witaminy D w ustroju polega na regulacji procesów transkrypcji [TSREHKIREGLSFRMõEH^MÊOMXIQYV]^]OS^EGLSVS[ERMERE

RMIOX´VIRS[SX[SV][X]QNIPMXEKVYFIKSMWYXOE;MXEQMRE(QE

V´[RMIõH^MEÜERMIMQQYRSQSHYPYNÂGITV^I^EOX][EGNÊKIR´[OS- HYNÂG]GL TITX]H] TV^IGM[FEOXIV]NRI TV^IGM[^ETEPRI LEQYNÂGI

TVSHYOGNÊG]XSOMR;MXEQMRE(NIWXV´[RMIõ^EPIGEREYOSFMIX

^^EFYV^IRMEQMS[YPEGNM?A

;EõR]QóV´HÜIQ[MXEQMR](HPEG^ÜS[MIOENIWXNINW]RXI^E

TV^I^ WO´VÊ OX´VE ^EGLSH^M H^MÊOM IOWTS^]GNM RE TVSQMIRMI WÜS- RIG^RI EPI [ 4SPWGI NIWX XS QSõPM[I X]POS [ SOVIWMI SH QEVGE

HS[V^IêRMEM[]QEKEGSRENQRMINT´ÜKSH^MRRINIOWTS^]GNMFI^

Yõ][ERMEOVIQ´[^JMPXVEQM9:>ERMIG^]W^G^IRMITS[MIXV^ESVE^

TVSGIWWXEV^IRMEWMÊWO´V]V´[RMIõ^QRMINW^ENÂQSõPM[SêGMW]RXI-

^]TV^I^WO´VRIN?A

2MIHSF´V[MXEQMR](QSõIF]ÄTV^]G^]RÂ^EFYV^IÞKSWTS- HEVOM QMRIVEPRS[ETRMS[IN M JSWJSVS[IN TVS[EH^ÂG]GL HS SWXI- STIRMMEREWXÊTRMISWXISTSVS^];[EVYROEGLLMTSOEPGIQMM[NI- PMXEGLHSGLSH^MHS^[MÊOW^IRME[GLÜERMERME[ETRMEE[RIVOEGL

HS[^VSWXYNIKSVIEFWSVFGNM4SX[MIVH^SRSV´[RMIõõIWYTPIQIR- XEGNE[MXEQMRÂ(SFRMõEV]^]OS[]WXÂTMIRME FEGXIVMEPZEKMRSWMW

OSVIPYNÂGIN^RMIOX´V]QMTS[MOÜERMEQMGMÂõ]?A

+VYTÊ^EKVSõIRMERMIHSFSVIQ[MXEQMR](WXERS[MÂOSFMIX]

GMÊõEVRIMOEVQMÂGITMIVWMÂFÊHÂGKVYTÂREVEõIRMERE[^QSõSRÂ

YXVEXÊ[ETRME^OSêGM

(^MIRRE HE[OE ^EPIGERE Y OSFMIX GMÊõEVR]GL M OEVQMÂG]GL

^ RMIHSFSVIQ [MXEQMR] ( [ HMIGMI PYF SKVERMG^IRMIQ W]RXI^]

TV^I^WO´VÊREHSFÊ[]RSWMÜEHSX]GLG^EW-9NIHREOõI

RS[I HSRMIWMIRME WYKIVYN ^EWEHRSêÄ WYTPIQIRXEGNM []õW^]QM

HE[OEQM[]RSW^ÂG]QMHS-9REHSFÊ

2EN[]õW^EFI^TMIG^REHSFS[EHE[OEPIG^RMG^EXS-9

>EPIGIRME[MXEQMRE(TS[MRREF]ÄWXSWS[EREYOSFMIXTPE- RYNÂG]GLGMÂõÊGMÊõEVR]GLSVE^[SOVIWMIPEOXEGNM[HE[GI

-9REHSFÊ

Magnez

1EKRI^VIKYPYNÂGTV^I[SHRMGX[SRIV[S[SQMÊêRMS[ITSH- []õW^E TV´K TSFYHPM[SêGM SFRMõENÂG OYVG^PM[SêÄ QMÊêRM KÜEH- OMGLMTSTV^IG^RMITVÂõOS[ER]GL6S^OYVG^QMÊêRM´[OMKÜEHOMIN

[ REG^]RMEGL OV[MSRSêR]GL TS[SHYNI MGL VS^W^IV^IRMI [^VSWX

SFNÊXSêGMÜSõ]WOEREG^]RMS[IKSEREWXÊTRMISFRMõIRMIGMêRMIRME

XÊXRMG^IKS;^VSWXWXÊõIRMEQEKRI^YWOYXOYNISFRMõIRMIQTVSKY

HVKE[OS[IKS QMÊêRM 1EKRI^ [TÜ][E V´[RMIõ RE TVE[MHÜS[Â

KSWTSHEVOÊQMRIVEPRÂOSêGMHENÂG^[MÊOW^IRMIMGLKÊWXSêGMQM- RIVEPRIN2MIHSF´VQEKRI^YQSõITS[SHS[EÄ^EFYV^IRMETV^I- [SHRMGX[ERIV[S[SQMÊêRMS[IKSSVE^[^VSWXTV^ITYW^G^EPRSêGM

FÜSROSQ´VOS[]GLHPENSR´[WSHYM[ETRMEHENÂG[^VSWXMGLWXÊ- õIRME[I[RÂXV^OSQ´VOM^[MÊOW^EÄOYVG^PM[SêÄQMÊêRMMV]^]OS

[]WXÂTMIRMEREHGMêRMIRME?A

3FNE[IQ RMIHSFSVY QEKRI^Y WÂ FSPIWRI WOYVG^I QMÊêRM

;WXEREGLSFRMõSRIKSWXÊõIRMEQEKRI^Y[IOV[MPYFSFNE[EGL

OPMRMG^R]GLNIKSRMIHSFSVY^EPIGEWMÊWYTPIQIRXEGNÊ?A

(SFS[I^ETSXV^IFS[ERMISVKERM^QY[]RSWMSOSÜSQKRE

OKQEW]GMEÜE[^VEWXENÂGRE[IXH[YOVSXRMITSHG^EWGMÂõ]MPEO- tacji.

Stosowane dawki doustnej suplementacji magnezu w za- PIõRSêGMSH[WOE^EÞ[ELENÂWMÊSHHSQKQEKRI^YRE

HSFÊ?A

; TSWYQS[ERMY WX[MIVH^MÄ REPIõ] õI ^KSHRMI ^ ^EWEHEQM

)&1FI^WTSVRINIWXWYTPIQIRXS[ERMITSHG^EWGMÂõ]O[EWIQJS- PMS[]QNSHIQM[MXEQMRÂ([SFIGTSX[MIVH^SRIKSHYõIKSV]^]- OE[]WXÊTS[ERMERMIHSFSVY[TSTYPEGNMTS^SWXEÜI^EêWOÜEHRMOM

NEOõIPE^S(,%QEKRI^MMRRI[^EPIõRSêGMSHWXSTRMEMWXRMINÂGI- KSRMIHSFSVYPYFNIKSWTIG]JMG^RIKSV]^]OE

>KSHRMI ^ ^EPIGIRMEQM 9RMM )YVSTINWOMIN OEõH] EOX][R]

WOÜEHRMO [GLSH^ÂG] [ WOÜEH SOVIêPSRIKS TVITEVEXY TS[MRMIR

[][SÜ][EÄWTSH^MI[ER]IJIOX^EPIGERINIWXWXSWS[ERMIHE[IO

[]õW^]GLSHRENRMõW^]GL^ETSFMIKE[G^]GLSVE^RENRMõW^]GLHE- [IO XIVETIYX]G^R]GL (E[OM [MXEQMR M QMOVSIPIQIRX´[ HSWXS- WS[ERITS[MRR]F]ÄHSRSVQEPRINHMIX]OX´VEV´[RMIõHSWXEVG^E

TI[R]GLHE[IO[MXEQMRQMOVSIPIQIRX´[EF]RMIHSW^ÜSHSTV^I- OVSG^IRMEHE[IOFI^TMIG^R]GL

>IWT´ÜIOWTIVX´[48+HÂõ]HS^ETI[RMIRMERMI^EPIõRSêGM

M SFMIOX][M^QY [I [W^]WXOMGL W[SMGL H^MEÜERMEGL IHYOEG]N

R]GL 'IPIQ H^MEÜEÞ IOWTIVX´[ 48+ OX´VI HSTVS[EH^MÜ] HS

TS[WXERME RMRMINW^IKS STVEGS[ERME RMI NIWX TVSQS[ERMI TS

TMIVERMIPYF^EPIGERMI[W^G^IK´PR]WTSW´FTVSHYOX´[LERHPS

[]GLYWÜYKERMWTV^ÊXYQIH]G^RIKSOX´V]GLSTMW]^REPE^Ü]WMÊ

w artykule.

&MSVÂG TSH Y[EKÊ TS[]õW^I REPIõ] WX[MIVH^MÄ õI õEHIR

^G^ÜSRO´[TERIPYIOWTIVX´[RMI^KÜEW^EOSRJPMOXYMRXIVIW´[

[^[MÂ^OY^TS[WXERMIQRMRMINW^IKSSTVEGS[ERME

7XERS[MWOS TV^IHWXE[ME WXER [MIH^] RE [[ XIQEX RE

H^MIÞTV^ITVS[EH^IRMEEREPM^]>IWT´ÜIOWTIVX´[^EWXV^IKEWS

FMITVE[SHSEOXYEPM^EGNMRMRMINW^IKSWXERS[MWOE[TV^]TEHOY

TSNE[MIRMEWMÊRS[]GLMWXSXR]GLHSRMIWMIÞREYOS[]GL

Piśmiennictwo

1. Shah PS, Ohlsson A. Effects of prenatal multi micronutrients supplementation on pregnancy outcomes a meta analysis. CMAJ. 2009, 180, 12-20.

2. Stanowisko Zespołu Ekspertów Polskiego Towarzystwa Ginekologicznego w zakresie suplementacji witamin i mikroelementów podczas ciąży. Ginekol Pol. 2011, 82, 550-553.

3. Nilsen RM; Mastoiakovo P; Gunnes M. Folic acid supplementation and interpregnancy interval.

Pediatr Perinat Epidemiol. 2014, 10, 111.

4. Wang M, Wang ZP, Gaol J, [et al.]. Maternal body mass index and the association betveen filok acid supplements and neutral tube defects. Acta Pediatr. 2013, 102, 908-913.

5. Rekomendacje Zespołu Ekspertów Polskiego Towarzystwa Ginekologicznego w zakresie stosowania kwasów omega-3 w położnictwie. Ginekol Pol. 2010, 81, 467-469.

6. Carlson SE, Colombo J, Gajewski BJ, [et al.]. DHA supplementation and pregnancy outcomes.

Am J Clin Nutr. 2013, 97, 808-815.

7. Kamiński K, Wietrak E, Popiel M. Rola kwasu dokozaheksaenowego (DHA) w ciąży. Jaką dawkę stosować? Gin Pol Med Project. 2011, 3, 1-16.

8. Jaclyn M, Coletta MD, Stacey J, [et al.]. Omega-3 Fatty Acids and Pregnancy. Rev Obstet Gynecol. 2010, 3, 163–171.

9. Smuts CM, Huang M, Mundy D, [et al.]. A Randomized Trial of Docosahexaenoic Acid Supplementation During the Third Trimester of Pregnancy. Obstet Gynecol. 2003, 101, 469- 479.

10. Szajewska W, Horvath A, Koletzko B. Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measured at birth: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2006, 83, 1337-1344.

11. Anandan C, Nurmatov U, Sheikh A. Omega-3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009, 64, 840-848.

12. Salvig JD, Lamont RF. Evidence regarding an effect of marine n-3 fatty acids on preterm birth: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2011, 90, 825-838.

13. Horvath A, Koletzko B, Szajewska H, [et al.]. Effect of supplementation of women in high-risk pregnancies with long-chain polyunsaturated fatty acids on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials. Br J Nutr. 2007, 98, 253-259.

14. Salvig JD, Lamont RF. Evidence regarding an effect of marine n-3 fatty acids on preterm birth: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2011, 90, 825-838.

15. Cogswell ME, Parvanta I, Ickes L, [et al.]. Iron supplementation during pregnancy, anemia and birth weight: a randomized controlled trial. Am J Clin Nutr. 2003, 78, 773-781.

16. Hider RC, Kong X. Iron – efect of overload and defficiency. Met Ions Live Sci. 2013, 13, 229- 294.

17. Chander SG, Lekha S, Pradip KS. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med. 2008, 10, 283-286.

18. Pearce EN. Effects of iodine deficiency in pregnancy. J Trace Elem Med Biol. 2012, 26, 131- 133.

19. Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol. 2012, 26, 108-117.

20. WHO Secretariat, Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old:

conclusions and recommendations of the Technical Consultation. Public Health Nutr. 2007, 10, 1606-1611.

21. Morreale de Escobar G, Obregon MJ, Escobar del Rey F. Iodine deficiency and brain development in the first half of pregnancy. Public Health Nutrition. 2007, 10, 1554-1570.

22. Polskie zalecenia dotyczące profilaktyki niedoborów witaminy D- 2009. Pol Merk Lek. 2010, 28, 130-133.

23. Czech-Kowalska J, Wietrak E, Popiel M. Znaczenie witaminy D w okresie ciąży i laktacji. Gin Pol Med Project. 2011, 1, 48-61.

24. Grundmann M, von Versen-Höynck F. Vitamin D – roles in women’s reproductive health. Reprod Biol Endocrinol. 2011, 9, 146.

25. Zeisel SH. Is maternal diet supplementation beneficial? Optimal development of infant depends on mother’s diet. Am J Clin Nutr. 2009, 89, 685-687.

26. Alwan NA, Greenwood DC, Simpson NAB, [et al.]. The relationship between dietary supplement use in late pregnancy and birth outcomes: a cohort study in British women. BJOG. 2010, 117, 821–829.

27. Committee Opinion n0 573. Magnesium sulfate use in obstetrics. Amer College of Ob& Gyn Com. Obstet Gynecol. 2013, 122, 727-728.

W a r u n k i p r e n u m e r a t y

Uprzejmie informujemy, i˝ cz∏onkowie Polskiego Towarzystwa Ginekologicznego b´dà otrzymywali Ginekologie Polskà po wczeÊniejszym op∏aceniu sk∏adki cz∏onkowskiej w odpowiednim Oddziale PTG.

Wysy∏ka Ginekologii Polskiej do cz∏onków PTG jest dokonywana na podstawie list dostarczonych z poszczególnych oddzia∏ów PTG do Redakcji „Ginekologii Polskiej”.

Uprzejmie prosimy wszystkich zainteresowanych o zaktualizowanie danych adresowych w swoich Oddzia∏ach PTG.

Koszt rocznej prenumeraty (krajowa i zagraniczna) dla osób nie b´dàcych cz∏onkami PTG i instytucji na 2012 rok wynosi 180,00 PLN. +VAT.

Zamówienie wraz z kserokopià dowodu wp∏aty prosimy przesy∏aç na adres:

Redakcja „Ginekologii Polskiej”

Ma∏gorzata Skowroƒska 60-535 Poznaƒ, ul. Polna 33

tel. 061 84-19-265; fax.: 061 84-19-465

e-mail: redakcjagp@gpsk.am.poznan.pl; ginpol@onet.eu www.ginekolpol.com

Wp∏at nale˝y dokonywaç na konto:

ING Bank Âlàski – nr konta: 14 1050 1953 1000 0023 1354 3718

Instrukcja dla autorów w j´zyku polskim i angielskim znajduje si´

na stronie: www.ginekolpol.com

R e d a k c j a

2014