ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМП10.25789/YMJ.2020.71.12ymj-2983Research ArticleМЕТОДЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯMETHODS OF DIAGNOSIS AND TREATMENTАудит особенностей метаболизма беременных с железодефицитной анемией и анемией хронических заболеванийAn audit of metabolism features among pregnant women with iron deficiency and anemia of chronic diseasesГасановаБ. М.GasanovaB. M.

Гасанова Бахтыкей Мусалавовна – к.м.н., докторант,

г. Москва

gsbhms69@gmail.comПолинаМ. Л.PolinaM. L.

Полина Мирослава Леонидовна – к.м.н., врач-гинеколог,

г. Москва

polina.ml@mail.ruДугласН. И.DouglasN. I.

Дуглас Наталья Ивановна – д.м.н., зав. кафедрой,

 г. Якутск

ЧотчаеваФ. И.ChotchayevaF. I.

Чотчаева Фатима Исмаиловна – зав. Респ. перинатальным центром,

г. Черкесск

asiyat1967@mail.ruМединститут РУДНRussian FederationМедицинский центр женского здоровьяRussian FederationМединститут СВФУ им. М.К. АммосоваRussian FederationРеспубликанский перинатальный центрRussian Federation202007122025034448Copyright © Гасанова Б.М., Полина М.Л., Дуглас Н.И., Чотчаева Ф.И., 20252025Гасанова Б.М., Полина М.Л., Дуглас Н.И., Чотчаева Ф.И.Gasanova B.M., Polina M.L., Douglas N.I., Chotchayeva F.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/2983

В статье приведены результаты исследования беременных с анемией различного генеза. Установлены отличия развития дефицита железа – истинного и функционального, секвестрация которого в макрофагах связана с хроническим воспалительным или аутоиммунным процессом в организме беременной женщины.

Анемию хронических заболеваний (АХЗ) отличала активность острофазовых реакций воспаления. Плацентарная дисфункция определяла большую перинатальную заболеваемость в группе с АХЗ в сравнении с беременными с железодефицитной анемией за счет значительных метаболических сдвигов. Низкую активность адаптационных механизмов следует рассматривать как следствие хронической гипоксии на фоне особенностей метаболизма при «инфект-анемии» – хронической иммуностимуляции, определяемой вектором продукции цитокинов по Th-1 варианту.

The article presents the results of studies in a sample of pregnant women with anemia of various genesis. Differences in the development of iron deficiency — true and functional — have been established, the sequestration of which in macrophages is associated with a chronic inflammatory or autoimmune process in the body of a pregnant woman.

Anemia of chronic diseases (ACD) was characterized by the activity of acute phase inflammation reactions. Placental dysfunction resulted in large perinatal morbidity in the group with ACD compared to IDA patients due to significant metabolic changes. The low activity of adaptive mechanisms should be considered as a consequence of chronic hypoxia on the background of metabolic features in "infect anemia" - chronic immunostimulation determined by the cytokine production vector according to the Th-1 variant.

анемия железодефицитнаяанемия хронических заболеванийперинатальная заболеваемостьоксидативный стрессiron deficiency anemiaanemia of chronic diseasesperinatal outcomesoxidative stressReferencesАпресян С.В. Беременность и роды при экстрагенитальных заболеваниях. под ред. В. Е. Радзинского. 2-е изд., перераб. и доп. / С.В. Апресян. - М.: ГЭОТАР-Медиа, 2015. - 536 с.Apresyan S.V. Pregnancy and childbirth in extragenital diseases, under ed. V.E. Radzinsky. The 2nd ed. / S.V. Apresyan. - M.: GEOTAR-Media, 2015. -536 p.Радзинский В.Е. Беременность ранних сроков. От прегравидарной подготовки к здоровой гестации. 3-е изд., испр. и доп. / В.Е. Радзинский, А.А. Оразмурадов. - М.: Status Praesens, 2018. - 800 с.Radzinsky V.E. Pregnancy of early terms. From pregravid preparation to healthy gestation, 3rd ed. / V.E. Radzinsky, A.A. Orazmuradov. - M.: Status Praesens, 2018. - 800 p.Рукавицын О.А. Актуальные вопросы диагностики и лечения анемии при хронических заболеваниях / О.А. Рукавицын // Клиническая онкогематология. – 2012. – Т. 5, № 4. – С. 296–304.Rukavitsyn O.A. Topical issues of diagnosis and treatment of anemia in chronic diseases / O.A. Rukavitsyn //Clinical haemato-oncology. – 2012. - V.5, №4. - pp.296–304.Abbaspour N. Review on iron and its importance for human health / N. Abbaspour, R. Hurrell, R. Kelishadi //J. Res. Med. Sci. 2014; 19: 164–174.Abbaspour N. Review on iron and its importance for human health / N. Abbaspour, R. Hurrell, R. Kelishadi //J. Res. Med. Sci. 2014; 19: 164–174.Abdel-Raoufabdel-Aziz A.R.Pregnancy outcome and the effect of maternal nutritional status / A.R. Abdel-Raoufabdel-Aziz, D.K. Ali, H.M. Talkhan // J Egypt Soc Parasitol. 2013; 43(1): 125-132.doi: 10.12816/0006372.Abdel-Raoufabdel-Aziz A.R.Pregnancy outcome and the effect of maternal nutritional status / A.R. Abdel-Raoufabdel-Aziz, D.K. Ali, H.M. Talkhan // J Egypt Soc Parasitol. 2013; 43(1): 125-132.doi: 10.12816/0006372.Al-Gubory K.H.The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes / K.H. Al-Gubory, P.A. Fowler, C. Garrel // Int. J. Biochem. Cell. Biol. 2010; 42: 1634–1650. doi: 10.1016/j.biocel.2010.06.001.Al-Gubory K.H.The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes / K.H. Al-Gubory, P.A. Fowler, C. Garrel // Int. J. Biochem. Cell. Biol. 2010; 42: 1634–1650. doi: 10.1016/j.biocel.2010.06.001.Anemia of Inflammation during Human Pregnancy Does Not Affect Newborn Iron Endowment / I. Abioye, S. Park, K. Ripp [et al.]// J Nutr. 2018; 148(3): 427–436. doi: 10.1093/jn/nxx052Anemia of Inflammation during Human Pregnancy Does Not Affect Newborn Iron Endowment / I. Abioye, S. Park, K. Ripp [et al.]// J Nutr. 2018; 148(3): 427–436. doi: 10.1093/jn/nxx052Body iron metabolism and pathophysiology of iron overload / Y. Kohgo, K. Ikuta, T. Ohtake [et al.] / Int. J. Hematol. 2008; 88: 7–15. doi: 10.1007/s12185-008-0120-5.Body iron metabolism and pathophysiology of iron overload / Y. Kohgo, K. Ikuta, T. Ohtake [et al.] / Int. J. Hematol. 2008; 88: 7–15. doi: 10.1007/s12185-008-0120-5.Bresgen N. Oxidative stress and the homeodynamics of iron metabolism / N. Bresgen, P.M. Eckl // Biomolecules. 2015; 5, 808–847. doi: 10.3390/biom5020808.Bresgen N. Oxidative stress and the homeodynamics of iron metabolism / N. Bresgen, P.M. Eckl // Biomolecules. 2015; 5, 808–847. doi: 10.3390/biom5020808.Broek van den N.R. Factors associated with preterm, early preterm and late preterm birth in Malawi / Broek van den N.R., Jean-Baptiste R., Neilson J.P. // PLoS One, 2014; 9(3), p. e90128. doi: 10.1371/journal.pone.0090128.Broek van den N.R. Factors associated with preterm, early preterm and late preterm birth in Malawi / Broek van den N.R., Jean-Baptiste R., Neilson J.P. // PLoS One, 2014; 9(3), p. e90128. doi: 10.1371/journal.pone.0090128.Duck K.A. Iron uptake and transport across physiological barriers / K.A. Duck, J.R. Connor // Biometals. 2016; 29(4):573-91. doi: 10.1007/s10534-016-9952-2.Duck K.A. Iron uptake and transport across physiological barriers / K.A. Duck, J.R. Connor // Biometals. 2016; 29(4):573-91. doi: 10.1007/s10534-016-9952-2.Effect of dietary iron on fetal growth in pregnant mice / A.C. Hubbard, S. Bandyopadhyay, B.S. Wojczyk [et al.] // Comp Med. 2013; 63(2): 127-135.Effect of dietary iron on fetal growth in pregnant mice / A.C. Hubbard, S. Bandyopadhyay, B.S. Wojczyk [et al.] // Comp Med. 2013; 63(2): 127-135.2018 Global Nutrition Report / Fanzo J., Hawkes C., Udomkesmalee E. [et al.] 2019; 161 p.2018 Global Nutrition Report / Fanzo J., Hawkes C., Udomkesmalee E. [et al.] 2019; 161 p.Fisher A.L. Iron homeostasis during pregnancy / A.L. Fisher, E. Nemeth // Am J Clin Nutr. 2017; 106 (Suppl 6):1567S–1574S. doi: 10.3945/ajcn.117.155812.Fisher A.L. Iron homeostasis during pregnancy / A.L. Fisher, E. Nemeth // Am J Clin Nutr. 2017; 106 (Suppl 6):1567S–1574S. doi: 10.3945/ajcn.117.155812.Free radicals and antioxidants in normal physiological functions and human disease / M. Valko, D. Leibfritz, J. Moncol [et al.] / Int. J. Biochem. Cell Biol. 2007; 39: 44–84. DOI: 10.1016/j.biocel.2006.07.001.Free radicals and antioxidants in normal physiological functions and human disease / M. Valko, D. Leibfritz, J. Moncol [et al.] / Int. J. Biochem. Cell Biol. 2007; 39: 44–84. DOI: 10.1016/j.biocel.2006.07.001.Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE) / DJ. Raiten, FA. Sakr Ashour, AC. Ross [et al.] / J Nutr 2015;145:1039S–108S. doi: 10.3945/jn.114.194571.Inflammation and Nutritional Science for Programs/Policies and Interpretation of Research Evidence (INSPIRE) / DJ. Raiten, FA. Sakr Ashour, AC. Ross [et al.] / J Nutr 2015;145:1039S–108S. doi: 10.3945/jn.114.194571.Influence of maternal anemia during pregnancy on placenta and newborns / M. Lelic, G. Bogdanovic, S. Ramic [et al.] / Med Arch. 2014;68(3):184-7. doi: 10.5455/medarh.2014.68.184-187. DOI: 10.5455/medarh.2014.68.184-187.Influence of maternal anemia during pregnancy on placenta and newborns / M. Lelic, G. Bogdanovic, S. Ramic [et al.] / Med Arch. 2014;68(3):184-7. doi: 10.5455/medarh.2014.68.184-187. DOI: 10.5455/medarh.2014.68.184-187.Iron deficiency in late pregnancy and its associations with birth outcomes in Chinese pregnant women: a retrospective cohort study / X. Yuan, H. Hu, M. Zhang [et al.] / Nutr Metab (Lond). 2019; 16:30. doi: 10.1186/s12986-019-0360-9. eCollection 2019.Iron deficiency in late pregnancy and its associations with birth outcomes in Chinese pregnant women: a retrospective cohort study / X. Yuan, H. Hu, M. Zhang [et al.] / Nutr Metab (Lond). 2019; 16:30. doi: 10.1186/s12986-019-0360-9. eCollection 2019.Laflamme E.M. Maternal hemoglobin concentration and pregnancy outcome: a study of the effects of elevation in El Alto, Bolivia / E.M. Laflamme // McGill J Med. 2012; 11(1): 47.Laflamme E.M. Maternal hemoglobin concentration and pregnancy outcome: a study of the effects of elevation in El Alto, Bolivia / E.M. Laflamme // McGill J Med. 2012; 11(1): 47.Lewandowska M. Serum Microelements in Early Pregnancy and their Risk of Large-for-Gestational Age Birth Weight / M. Lewandowska, J. Lubiński // Nutrients. 2020; 12(3): 866. doi: 10.3390/nu12030866Lewandowska M. Serum Microelements in Early Pregnancy and their Risk of Large-for-Gestational Age Birth Weight / M. Lewandowska, J. Lubiński // Nutrients. 2020; 12(3): 866. doi: 10.3390/nu12030866Lysosomal proteolysis is the primary degradation pathway for cytosolic ferritin and cytosolic ferritin degradation is necessary for iron exit / Y. Zhang, M. Mikhael, D. Xu [et al.] // Antioxid. Redox Signal. 2010; 13: 999–1009. doi: 10.1089/ars.2010.3129.Lysosomal proteolysis is the primary degradation pathway for cytosolic ferritin and cytosolic ferritin degradation is necessary for iron exit / Y. Zhang, M. Mikhael, D. Xu [et al.] // Antioxid. Redox Signal. 2010; 13: 999–1009. doi: 10.1089/ars.2010.3129.Maternal anaemia and preterm birth: a prospective cohort study / Q. Zhang, C.V. Ananth, Z. Li [et al.] // Int. J. Epidemiol. 2009; 38: 1380– 1389. doi: 10.1093/ije/dyp243.Maternal anaemia and preterm birth: a prospective cohort study / Q. Zhang, C.V. Ananth, Z. Li [et al.] // Int. J. Epidemiol. 2009; 38: 1380– 1389. doi: 10.1093/ije/dyp243.Maternal anemia during pregnancy and infant low birth weight: a systematic review and meta-analysis / S. Rahmati, A. Delpishe, M. Azami [et al.] // Int. J. Reprod. Biomed. (Yazd.). 2017; 15: 125–134.Maternal anemia during pregnancy and infant low birth weight: a systematic review and meta-analysis / S. Rahmati, A. Delpishe, M. Azami [et al.] // Int. J. Reprod. Biomed. (Yazd.). 2017; 15: 125–134.Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis / M.F. Young , B.M. Oaks, S. Tandon [et al.] / Ann N Y Acad Sci. 2019;1450(1):47-68. doi: 10.1111/nyas.14093Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta-analysis / M.F. Young , B.M. Oaks, S. Tandon [et al.] / Ann N Y Acad Sci. 2019;1450(1):47-68. doi: 10.1111/nyas.14093Milman N. Iron and pregnancy–a delicate balance / N. Milman // Ann. Hematol 85. 2006; 559–565. DOI: 10.1007/s00277-006-0108-2Milman N. Iron and pregnancy–a delicate balance / N. Milman // Ann. Hematol 85. 2006; 559–565. DOI: 10.1007/s00277-006-0108-2Northrop-Clewes C.A. Interpreting indicators of iron status during an acute phase response–lessons from malaria and human immunodeficiency virus / C.A. Northrop-Clewes // Ann Clin Biochem. 2008; 45:18–32. doi: 10.1258/acb.2007.007167Northrop-Clewes C.A. Interpreting indicators of iron status during an acute phase response–lessons from malaria and human immunodeficiency virus / C.A. Northrop-Clewes // Ann Clin Biochem. 2008; 45:18–32. doi: 10.1258/acb.2007.007167Oxidative Profile and δ-Aminolevulinate Dehydratase Activity in Healthy Pregnant Women with Iron Supplementation / De Lucca L, Fabiane R, Letícia BJ. [et al.] / Int J Environ Res Public Health. 2016; 13(5): 463. doi: 10.3390/ijerph13050463Oxidative Profile and δ-Aminolevulinate Dehydratase Activity in Healthy Pregnant Women with Iron Supplementation / De Lucca L, Fabiane R, Letícia BJ. [et al.] / Int J Environ Res Public Health. 2016; 13(5): 463. doi: 10.3390/ijerph13050463Sangkhae V. Placental iron transport: The mechanism and regulatory circuits / V. Sangkhae, E. Nemeth // Free Radic Biol Med. 2019;133:254- 261. doi: 10.1016/j.freeradbiomed.2018.07.001.Sangkhae V. Placental iron transport: The mechanism and regulatory circuits / V. Sangkhae, E. Nemeth // Free Radic Biol Med. 2019;133:254- 261. doi: 10.1016/j.freeradbiomed.2018.07.001.Prenatal Iron Supplementation Reduces Maternal Anemia, Iron Deficiency, and Iron Deficiency Anemia in a Randomized Clinical Trial in Rural China, but Iron Deficiency Remains Widespread in Mothers and Neonates / GGXu. Zhao, Z. Min, J. Yaping [et al.] // J Nutr. 2015; 145(8): 1916–1923. doi: 10.3945/jn.114.208678Prenatal Iron Supplementation Reduces Maternal Anemia, Iron Deficiency, and Iron Deficiency Anemia in a Randomized Clinical Trial in Rural China, but Iron Deficiency Remains Widespread in Mothers and Neonates / GGXu. Zhao, Z. Min, J. Yaping [et al.] // J Nutr. 2015; 145(8): 1916–1923. doi: 10.3945/jn.114.208678Risk for preterm delivery and low birthweight are independently increased by severity of maternal anemia / HL. Kidanto, I. Mogren, G. Lindmark [et al.] / S Afr Med J. 2009; 99:98–102.Risk for preterm delivery and low birthweight are independently increased by severity of maternal anemia / HL. Kidanto, I. Mogren, G. Lindmark [et al.] / S Afr Med J. 2009; 99:98–102.Schmidt P.J. Regulation of iron metabolism by hepcidin under conditions of inflammation / P.J. Schmidt // J. Biol. Chem. 2015; 290: 18975– 18983. doi: 10.1074/jbc.R115.650150.Schmidt P.J. Regulation of iron metabolism by hepcidin under conditions of inflammation / P.J. Schmidt // J. Biol. Chem. 2015; 290: 18975– 18983. doi: 10.1074/jbc.R115.650150.Scholl T.O. Maternal iron status: Relation to fetal growth, length of gestation, and iron endowment of the neonate / T.O. Scholl // Nutrition Reviews. 2011; 69(1):S23–S29. doi: 10.1111/j.1753-4887.2011.00429.x.Scholl T.O. Maternal iron status: Relation to fetal growth, length of gestation, and iron endowment of the neonate / T.O. Scholl // Nutrition Reviews. 2011; 69(1):S23–S29. doi: 10.1111/j.1753-4887.2011.00429.x.The effects of oxidative stress on female reproduction: A review / A. Agarwal, A. Aponte-Mellado, BJ. Premkumar [et al.] // Reprod. Biol. Endocrinol. 2012; 10: 49–80. doi: 10.1186/1477-7827-10-49The effects of oxidative stress on female reproduction: A review / A. Agarwal, A. Aponte-Mellado, BJ. Premkumar [et al.] // Reprod. Biol. Endocrinol. 2012; 10: 49–80. doi: 10.1186/1477-7827-10-49The global prevalence of anaemia in 2011. Geneva: World Health Organization. Accessed August 28, 2017.The global prevalence of anaemia in 2011. Geneva: World Health Organization. Accessed August 28, 2017.The relationship between third trimester maternal hemoglobin and birth weight/ length; results from the tertiary center in Turkey / Y. Yildiz, E. Ozgü, SB. Unlu [et al.] // J Matern Fetal Neonatal Med. 2014;27(7):729-32. doi: 10.3109/14767058.2013.837445The relationship between third trimester maternal hemoglobin and birth weight/ length; results from the tertiary center in Turkey / Y. Yildiz, E. Ozgü, SB. Unlu [et al.] // J Matern Fetal Neonatal Med. 2014;27(7):729-32. doi: 10.3109/14767058.2013.837445Theil E.C. Ferritin protein nanocages - the story / E.C. Theil, C. Elizabeth // Nanotechnol. Percept. 2012; 8: 7–16. doi: 10.4024/n03th12a. ntp.08.01.Theil E.C. Ferritin protein nanocages - the story / E.C. Theil, C. Elizabeth // Nanotechnol. Percept. 2012; 8: 7–16. doi: 10.4024/n03th12a. ntp.08.01.UK guidelines on the management of iron deficiency in pregnancy / S. Pavord, B. Myers, S. Robinson [et al.] / Br J Haematol. 2012;156:588– 600. doi: 10.1111/j.1365-2141.2011.09012.x.UK guidelines on the management of iron deficiency in pregnancy / S. Pavord, B. Myers, S. Robinson [et al.] / Br J Haematol. 2012;156:588– 600. doi: 10.1111/j.1365-2141.2011.09012.x.

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