Magne6 in edema
Preventive application of Magne-B6 in pregnant women with arterial hypertension and obesity, suffering from miscarriage
N.G. Kosheleva, E.W. Nicologorskaya.
Research Institute of Obstetrics andgynecology them. BEFORE. Otta SZO RAMS (Director - Academician of the Russian Academy of Medical Sciences, Honored Scientist, Professor EK Ailamazyan), Center for Preventing and Treating Miscarriage (Headed by Candidate of Medical Sciences TA Pluzhnikova), St. Petersburg
In many countries of the world over the past decadethe incidence of obesity increased 2 or more times. According to WHO, 30% of the world's population had excess weight by the end of the 20th century . In Western Europe, 25% of women and 20% of men are overweight or obese. In the US, these figures reach 60% and 27% respectively. In Russia at present, 30% of the working-age population have an overweight and 25% have obesity .
The situation is significantly complicated if a womanarterial hypertension is detected. In Russia, it affects about 30% of the population and only 8% receive effective treatment. Diseases of the cardiovascular system occupy the main place in the structure of extragenital pathology of pregnant women and are still one of the leading causes of maternal and perinatal mortality [9,12].
Excess body weight has long been considered one of the main risk factors for the development of hypertension and pregnancy complications, among which the threat of interruption and gestosis take a leading place.
According to the Center for Prevention and Treatment(hereinafter referred to as the Center), among women with a habitual miscarriage of pregnancy in an anamnesis, persons with excess body weight are 11%, with obesity - 9%.
Previous studies have shown thatthe content of magnesium in the blood of women with obesity is lowered. In addition, pregnant women with obesity often have a hypokinetic type of circulation, in which hypomagnesemia also appears [2,3]. In addition, St. Petersburg is a city in the soil and water of which the content of calcium and magnesium is lowered.
Goals and objectives of work
The objective of the study was to evaluate the effectiveness of long-term use of small doses of Magne-B6 for the prevention of gestosis in women with arterial hypertension and obesity, suffering from habitual miscarriage.
Magne-V6 firm "Sanofi-Aventis" - a preparation containing magnesium in the form of dehydrated lactate and pyridoxine (vitamin B6 ). Combined preparation favorably combines the multifaceted action of magnesium ions and pyridoxine. The drug is widely used in obstetric practice [1,2,3,7].
The features of the course of pregnancy andbirths, as well as outcomes for the fetus and the newborn in 64 women who were observed at the Center, who had hypertension and vegetovascular dystonia in the hypertensive type of which the pregnancy ended in 2009. All patients underwent complex treatment of the threat of abortion taking into account the etiopathogenesis of this pathology and the resulting complications of pregnancy.
Group I comprised 32 women who used Magne-B from 12 to 38-39 weeks of pregnancy6 on 1-2 ampoules a day, which was included in complex therapy of the main pathology. Group II also consisted of 32 women who did not receive Magne-B6 during pregnancy, which were selectedin pairs to the patients of group I in full accordance with age, parity, somatic incidence and similar obstetric-gynecological anamnesis according to the principles of evidence-based medicine . Portability of Magne-B6 was good, no side effects were observed. The group did not include persons younger than 17 and older than 40, suffering from a history of diabetes mellitus, gastrointestinal tract diseases and severe extragenital pathology.
Results of the study and discussion
The age of pregnant women ranged from 20 to 39 years and inthe mean was 28 ± 0.64 years in both groups. GB of the 1st degree was observed in 18.8 ± 6.9% of women, VSD by hypertonic type - in 81.2 ± 6.9% in each group. The majority of women had obesity of the 1st degree (65.6 ± 8.4%), the rest had an excess of body weight (34.4 ± 8.4%). In both groups the thyroid gland diseases (37.5 ± 8.6%), the kidney and upper respiratory tract diseases were observed in 15.6 ± 6.4% of women with the greatest frequency among somatic pathology, the antiphospholipid syndrome was detected in 9,4 ± 5.2% of women.
Among gynecological diseases more oftenthe insufficiency of the luteal phase of the menstrual cycle - in 59,4 ± 8,7%, chronic inflammatory diseases of the genitals - in 25,0 ± 7,7%, hyperandrogenemia - in 21,9 ± 7,3%, infertility II in the anamnesis - in 18,8 ± 6,9%, violation of the menstrual cycle - in 12,5 ± 5,9%. Hyperprolactinaemia, uterine myoma and adenomyosis met with an equal frequency of 9.4 ± 5.2%, malformations of the uterus - in 6.3 ± 4.3%.
A total of 32 women in each group had 98pregnancies in the anamnesis. On average, there were 3.1 pregnancies per woman. 30,6 ± 4,7% of pregnancies ended in spontaneous miscarriages, 31,6 ± 4,7% - undeveloped pregnancy, 3,1 ± 1,0% - premature birth. 33.7 ± 4.8% of pregnancies were artificially interrupted and 3.9 ± 2.0% were ectopic. 68.8 ± 4.7% of women suffered from habitual miscarriage.
All observed women were prepared forpregnancy in the Center. When bacteriological examination of pregnant women in the cervical channel, U. Urealyticum was detected in 21.9 ± 7.3%, in half of cases in association with a conditionally pathogenic microflora. C.trachomatis were isolated in 3,1 ± 3,1% of women, M. hominis - in 3,1 ± 3,1% in association with bacteria. Among the conditionally pathogenic microflora, Streptococs of B group were most often isolated: in 18.8 ± 6.9% of women, Enterococc and Candida alb. with the same frequency in 15,6 ± 6,4%, E. colli - in 12,5 ± 5,9%, Gardnerella vaginalis - in 9,4 ± 5,2%.
The table shows that the threat of termination of pregnancy occurred in more than half of the pregnant women in the group of women who took Magne-B6. and in the prevailing majority of persons among those,who did not take this drug. Despite the fact that in I group the edema was in half of pregnant women, gestosis of mild degree developed only in 9,4 ± 5,2%, whereas in group II edema was observed less often, and gestosis of mild degree appeared 3 times more often than in I group. In this case, women who received Magne-B6. edema appeared after 30 weeks of pregnancy,and those who did not take the drug - much earlier, half of them after 22 weeks. It is very important that in childbirth gestosis moderate and severe developed 3 times less often in women who during pregnancy received magnesium with vitamin B6. compared with those who did not take it.
Pyelonephritis of pregnant women appeared 6 times less often in group I. These women did not have fetal hypoxia in childbirth (Table).
The frequency and nature of complications of pregnancy and childbirth in women who took Magne-B6 (I group) and did not take it (group II)</ b>
Note: * - the reliability of the differences between the data of Groups I and II, where p <0.05.
Given the high drug load thatexperienced pregnant women in modern conditions, it is extremely important to reduce by 4 times the frequency of antihypertensive drugs (dopegit, clonidine, etc.) in pregnancy in group I, compared with group II.
The frequency of other complications in labor in both groups was not significantly different (Table). However, the cesarean section due to gestosis was done in the I group in 2 out of 7, and in the II group - in 7 out of 12 women.
The weight of the body of full-term children in group I was higher,than in the II group, and amounted to 3551.7 ± 57.4 and 3144.3 ± 62.6 grams, respectively (p <0.001). Fetal hypotrophy in the I group was noted in 6.9 ± 4.7% of women, in group II - in 15.6 ± 6.4%. In the first group of females in the first group, the Apgar score for newborns was 7 points for 4 people (12.5 ± 5.9%), 1 score for 26 (81.3 ± 6.9%), 9 points - (6,3 ± 4,3%), and in 5 minutes 8 points - in 21 people (65,6 ± 8,4%) and 9 points - in 11 people (34,4 ± 8,4% ). In women in group II, the Apgar score for newborns was 7 points for 10 people (31.3 ± 8.2%) for 1 minute, 8 for 22 people (68.8 ± 8.2%), and after 5 minutes 7 points - 5 people (15.6 ± 6.4%), 8 points - 20 people (62.5 ± 8.6%) and 9 points - 7 people (21.9 ± 7.3% )
Premature birth was in three women(9.4 ± 5.2%) in Group I (one in 36/37 weeks, two in 35 weeks) and five (15.6 ± 6.4%) in Group II in 36/37 weeks, in four - in 35 weeks and in one - in 30 weeks of pregnancy). The body weight of premature infants in the I and II groups was 1933 ± 375.3 and 2030 ± 197.7 grams, respectively.
Thus, our study showed that the constant use of small doses of Magne-B6 (1-2 ampoules) in pregnant women with arterialhypertension and obesity was highly effective. Thus, the frequency of gestosis during pregnancy and childbirth decreased by 3 times. This is very important, since severe gestosis, suffered by a woman in the gestational period, is the reason for the development of not only severe complications in childbirth, but also hypertension and glomerulonephritis in the future. Of great importance is the decrease in the frequency of application of antihypertensive agents by 3 times during pregnancy.
The result obtained by us, apparently, is explained by the properties and features of magnesium and pyridoxine.
Magnesium is a vital element. Actively participating in metabolism, it activates more than 300 enzymatic reactions. Its deficiency leads to the appearance of various diseases [1,6]. The reduced content of magnesium in water and diet leads to an increase in the frequency of hypertensive disease in the population. In patients with essential hypertension, a decrease in magnesium in erythrocytes was observed. A low concentration of extracellular magnesium leads to vasospasms. The intracellular magnesium content of patients with arterial hypertension is in feedback with the value of arterial pressure . Chronic hypomagnesemia, with essential hypertension, is accompanied by high activity of reninoplasm, increased excretion of urine in the aldosterone .
Magnesium is a natural regulator of vasculartone. Under the influence of magnesium deficiency, the basal tone of the smooth muscles of the vessels increases, the reactivity of the vessels increases with respect to endogenous pressor substances and vasodilatation is inadequate [1,6]. In pregnant women with arterial hypertension, already in the early stages of pregnancy, the magnesium level in the saliva was significantly less than in normotensive women .
Neuromuscular excitability is significantdepends on the transmembrane electrical potential. Magnesium blocks slow calcium channels and stabilizes cell membranes. Magnesium-containing enzymes and magnesium ions provide the implementation and maintenance of a variety of energy processes in the body. The participation of magnesium in lipid metabolism is very significant. Activation of fatty acids can not occur without magnesium ions. It participates in the regulation of the balance of high-low-density lipoprotein fractions and triglycerides [6,13]. Magnesium participates in the regulation of nervous excitation systems at the level of the brain and subcortical formations, without it synthesis of neuromediators is impossible [1,6]. Being a cofactor of a number of enzymes, magnesium plays a significant role in ensuring the normal functioning of endothelial cells, and has a pronounced effect on the blood coagulation system . Magnesium - a universal regulator of physiological and biochemical processes in the body with a complex effect on the cardiovascular system. A very successful combination of magnesium with pyridoxine, which is a "fixer" of magnesium in the cell and enhances its effect. In addition, pyridoxine itself serves as a cofactor of several dozen enzymes and actively participates in nitrogen metabolism . Long-term use of small doses of Magne-B6 had a positive effect on the fetus. Hypoxia of the fetus during labor in persons using Magne-B6 was not, whereas in women who did not takeThis medication was a complication in every eighth woman giving birth. The beneficial effect of magnesium on the fetoplacental complex and fetus is known [2,13]. This is largely due to the participation of magnesium in cellular and molecular processes, in particular in the transfer of the hormonal signal in the cell from the plasma membrane to the core, which is impossible without magnesium . It is possible that the favorable effect of Magne-B6 the fetoplacental complex was obtained fromdecrease in this group 6 times gestational pyelonephritis. According to our data, despite the asymptomatic course that often occurs during pregnancy, the frequency of microbial colonization of the placenta in these women is high.
Thus, long-term use of small doses of Magne-B6 during pregnancy is a method of preventing gestosis and improves the fetal condition in women with arterial hypertension and obesity.
The use of small doses of Magne-B6 on 1-2 ampoules a day in a constant mode at womenwith arterial hypertension and obesity from 12 to 38-39 weeks of pregnancy reduces the frequency of gestosis in pregnancy and childbirth 3 times, the frequency of pyelonephritis - 6 times and the frequency of fetal hypoxia in childbirth. In addition, the frequency of the use of antihypertensive agents during pregnancy is reduced by 4 times.
1. O. Gromova. Magnesium and pyridoxine: knowledge bases: New technologies for diagnosis and correction of magnesium deficiency: UNESCO training programs. M. RSC Micronutrients Institute, UNESCO, 2006; 176.
2. Kosheleva N.G. The use of magnesium preparations in obstetrics and gynecology. Akush and Gin 2004; 2: 62-65.
3. Nikologorskaya E.V. Central hemodynamics and vegetative regulation in women with a habitual miscarriage of a pregnancy in the anamnesis: Author's abstract. dis ... .kand. honey. sciences. SPb 2006; 24.
4. Obesity: etiology, pathogenesis, clinical aspects. A guide for doctors. Ed. I.I. Dedova, G.A. Melnichenko. M. Medical Information Agency LLC 2006; 452.
5. Pestrikova T.Yu. Yurasova EA Prenatal diagnosis and preventive treatment with Magne V6 pregnant women at risk for gestosis. Akush and Gin 2006; 4: 55-58.
6. Rebrov V.G. Gromova OA Vitamins and microelements. M. "ALEV" 2003; 670s.
7. Tkacheva ON Gromova OA Mishina N.K. Klemenov A.N. Macro and microelementary status during pregnancy. Magnesium deficiency and its correction in hypertension in pregnant women. M. MedPrakt Publishing House 2007; 132.
8. Fletcher R. Fletcher S. Wagner E. Clinical Epidemiology. Basics of Evidence-Based Medicine: Per. with English. M. Media Sphere 1998; 352.
9. Shekhtman M.M. Manual on extragenital pathology in pregnant women. - M. "Triad" 2003; 816.
10. Carrera F. Proverbio T. Marin R. Proverbio F. Ca-ATPase of human myometrium plasma membranes. Physiol. Res 2000; 49 (3): 331-338.
11. Dawson E.B. Evans D.R. Kelly R. et al. Blood cell lead, calcium, and magnesium levels associated with pregnancy-induced hypertension and preeclampsia. Biol Trace Elem Res 2000; 74 (2): 107-16.
12. Guidelines Committee 2003: European Society of Hypertension - European Society of Cardiology guidelines for the management of arterial hypertension. J. Hypertens 2003, 21: 1011-1053.
13. Itoh Kazue, Kawazaki Terakazu, Nakamura Motoomi. The effects of nigh oral magnesium supplementation on the blood pressure, serum lipids and related variables in apparently healthy Japanesse subjects. Br. J. Nutr.1997; 78: 737-750.
14. Seidell, J.S. The future epidemic of obesity. In: Progress in obesity research. 8th International congress on obesity. B. Guy - Grand, G. Ailhand, eds. London: John Libbly and Company Lid 1999; 661-668
15. Suter P.M. The effects of potassium, magnesium, salcium and fiber on risk of stroke. Nutr-Rew 1999; 57 (3): 84-88.
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Document Date: December 2010