docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2023-22-5-34-39docru-158Research ArticleНА СТЫКЕ ДИСЦИПЛИНCROSS-DISCIPLINARY APPROACHЧем опасен психологический стресс для беременных и как снизить его влияние на течение беременности и перинатальные исходыWhat is the Danger of Psychological Stress for Pregnant Women and How to Reduce its Impact on the Course of Pregnancy and Perinatal Outcomeshttps://orcid.org/0000-0001-6785-6063ЗефироваТ. П.ZefirovaT. P.

Татьяна Петровна Зефирова, д. м. н., профессор

кафедра акушерства и гинекологии

420012; ул. Бутлерова, д. 36; Казань

420012; 36 Butlerov Str.; Kazan

tzefirova@gmail.comhttps://orcid.org/0000-0002-7599-7998МухаметоваР. Р.MukhametovaR. R.

Рената Рузалевна Мухаметова, врач — акушер-гинеколог, ассистент

кафедра акушерства и гинекологии

420008; ул. Кремлевская, д. 18, корп. 1; Казань

420015; 51, Bolshaya Krasnaya Str.; Kazan

rena-super2@rambler.ruКазанская государственная медицинская академия — филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияKazan State Medical AcademyRussian FederationФГАОУ ВО «Казанский (Приволжский) федеральный университет»РоссияKazan (Volga region) Federal UniversityRussian Federation202317022025225ГИНЕКОЛОГИЯ3439Copyright © Зефирова Т.П., Мухаметова Р.Р., 20252025Зефирова Т.П., Мухаметова Р.Р.Zefirova T.P., Mukhametova R.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/158   Цель статьи

   Цель статьи: оценить влияние психологического стресса на течение и исходы беременности, а также рассмотреть возможности использования витаминно-минеральных комплексов с целью компенсации негативного действия стресса на организм беременной женщины.

   Основные положения

   Основные положения. Большинство беременных женщин испытывают влияние разнообразных стрессорных факторов, и около 30 % из них на разных этапах гестации отмечают клинические проявления психологического стресса. В статье обозначены наиболее уязвимые категории женщин, рассмотрены проявления психологического стресса до и во время беременности, данные о влиянии стресса на исходы беременности и развитие плода и новорожденного. Уделено внимание современным представлениям о патогенезе повреждающего действия психологического стресса на различные системы организма. Сделан акцент на роли акушера-гинеколога в своевременном выявлении женщин с признаками психологического стресса, организации немедикаментозной помощи и рациональной фармакологической поддержки. Обсуждены патогенетически обоснованные возможности использования витаминно-минеральных комплексов для компенсации негативных эффектов психологического стресса на этапе преконцепции и во время беременности.

   Заключение

   Заключение. Стресс до и во время беременности отражается на потомстве в долгосрочной перспективе, нарушая его физическое состояние, негативно отражаясь на функциях центральной нервной системы. В современной акушерской практике актуальными будут врачебная настороженность, своевременное консультирование со специалистами и полноценное использование всех возможностей немедикаментозной и фармакологической поддержки, направленных на преодоление тревоги и стресса на каждом этапе гестации.

   Aim

   Aim: assess the impact of psycho-emotional stress on the course of pregnancy at various times, as well as consider the possibility of reducing it with the help of vitamin-mineral complexes.

   Key Points

   Key Points. Pregnant women, like all others, are influenced by a variety of stress factors, and about 30 % of them at different stages of gestation realize clinical manifestations of psychological stress. The article considers issue related to the causes of psychological stress before and during pregnancy, identifies the most vulnerable categories of women. Data on the influence of psychological stress on pregnancy outcomes and postnatal development are presented. Attention is paid to modern ideas about the pathogenesis of the damaging effect of psychological stress on various body systems, including the microbiome. Emphasis is placed on the role of an obstetrician-gynecologist as an attending physician in the timely identification of women with signs of psychological stress, in the organization of non-drug care and rational pharmacological support. Pathogenetically justified possibilities of using vitamin and mineral complexes to compensate for the negative effects of psychological stress at the preconception stage and during pregnancy were discussed.

   Conclusion

   Conclusion. Stress before and during pregnancy affects the offspring in the long term, disrupting their physical condition, negatively affecting the functions of the central nervous system. In modern obstetric practice, medical alertness, timely consultation with specialists and the full use of all the possibilities of non-drug and pharmacological support aimed at overcoming anxiety and stress at each stage of gestation will be relevant.

психологический стрессбеременностьперинатальные осложненияанемиявитаминно-минеральные комплексыpsychological stresspregnancyperinatal complicationsanemiavitamin and mineral complexesСтатья подготовлена при поддержке АО «Нижфарм» (группа компаний STADA). Мнение авторов может не совпадать с мнением компанииThe study was supported by Nizhpharm JSC (group of companies STADA); the opinion of the authors may not coincide with the opinion of the companyReferencesTsigos C., Kyrou I., Kassi E. et al. Stress : endocrine physiology and pathophysiology. review. In: Endotext. South Dartmouth; 2000.Tsigos C., Kyrou I., Kassi E. et al. Stress : endocrine physiology and pathophysiology. review. In: Endotext. South Dartmouth; 2000.Кубасов Р.В., Барачевский Ю.Е., Лупачев В.В. Функциональные изменения гипофизарно-гонадного и тиреоидного эндокринных звеньев в ответ на стрессовые факторы. Фундаментальные исследования. 2014;(10-5):1010–1014.Kubasov R.B., Barachevsky Yu.E., Lupachev V.V. Functional changes in pituitary-gonadal and thyroid endocrine parts in response to stress factors. Fundamental researches. 2014;(10-5):1010–1014. (in Russian).Loomans E.M., van Dijk A.E., Vrijkotte T.G.M. et al. Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. Eur. J. Public Health. 2013;23(3):485–491. DOI: 10.1093/eurpub/cks097Loomans E.M., van Dijk A.E., Vrijkotte T.G.M. et al. Psychosocial stress during pregnancy is related to adverse birth outcomes: results from a large multi-ethnic community-based birth cohort. Eur. J. Public Health. 2013;23(3):485–491. DOI: 10.1093/eurpub/cks097Tomfohr-Madsen L.M., Racine N., Giesbrecht G.F. et al. Depression and anxiety in pregnancy during COVID-19 : a rapid review and meta-analysis. Psychiatry Res. 2021;300:113912. DOI: 10.1016/j.psychres.2021.113912Tomfohr-Madsen L.M., Racine N., Giesbrecht G.F. et al. Depression and anxiety in pregnancy during COVID-19 : a rapid review and meta-analysis. Psychiatry Res. 2021;300:113912. DOI: 10.1016/j.psychres.2021.113912Gao L., Qu J., Wang A.Y. et al. Anxiety, depression and social support in pregnant women with a history of recurrent miscarriage: a cross-sectional study. J. Reprod. Infant. Psychol. 2020;38(5):497–508. DOI: 10.1080/02646838.2019.1652730Gao L., Qu J., Wang A.Y. et al. Anxiety, depression and social support in pregnant women with a history of recurrent miscarriage: a cross-sectional study. J. Reprod. Infant. Psychol. 2020;38(5):497–508. DOI: 10.1080/02646838.2019.1652730Wang W., Wen L., Zhang Y. et al. Maternal prenatal stress and its effects on primary pregnancy outcomes in twin pregnancies. J. Psychosom. Obstet. Gynaecol. 2020;41(3):198–204. DOI: 10.1080/0167482X.2019.1611776Wang W., Wen L., Zhang Y. et al. Maternal prenatal stress and its effects on primary pregnancy outcomes in twin pregnancies. J. Psychosom. Obstet. Gynaecol. 2020;41(3):198–204. DOI: 10.1080/0167482X.2019.1611776Ramiro-Cortijo D., Soto-Balbuena C., Rodríguez-Muñoz M.F. Early association factors for depression symptoms in pregnancy: a comparison between spanish women spontaneously gestation and with assisted reproduction techniques. J. Clin. Med. 2021;10(23):5672. doi: 10.3390/jcm10235672Ramiro-Cortijo D., Soto-Balbuena C., Rodríguez-Muñoz M.F. Early association factors for depression symptoms in pregnancy: a comparison between spanish women spontaneously gestation and with assisted reproduction techniques. J. Clin. Med. 2021;10(23):5672. doi: 10.3390/jcm10235672Kemppinen L., Mattila M., Ekholm E. et al. Gestational anemia and maternal antenatal and postpartum psychological distress in a prospective. FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth. 2022;22(1):704. DOI: 10.1186/s12884-022-05032-zKemppinen L., Mattila M., Ekholm E. et al. Gestational anemia and maternal antenatal and postpartum psychological distress in a prospective. FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth. 2022;22(1):704. DOI: 10.1186/s12884-022-05032-zKwak D.W., Kim S., Lee S.Y. et al. Maternal Anemia during the First Trimester and Its Association with Psychological Health. Nutrients. 2022;14(17):3505. DOI: 10.3390/nu14173505Kwak D.W., Kim S., Lee S.Y. et al. Maternal Anemia during the First Trimester and Its Association with Psychological Health. Nutrients. 2022;14(17):3505. DOI: 10.3390/nu14173505Andrawus M., Sharvit L., Atzmon G. Epigenetics and pregnancy: conditional snapshot or rolling event. Int. J. Mol. Sci. 2022;23(20):12698. DOI: 10.3390/ijms232012698Andrawus M., Sharvit L., Atzmon G. Epigenetics and pregnancy: conditional snapshot or rolling event. Int. J. Mol. Sci. 2022;23(20):12698. DOI: 10.3390/ijms232012698Keenan K., Hipwell A.E., Class Q.A., Mbayiwa K. Extending the developmental origins of disease model: impact of preconception stress exposure on offspring neurodevelopment. Dev. Psychobiol. 2018;60(7):753–764. DOI: 10.1002/dev.21773Keenan K., Hipwell A.E., Class Q.A., Mbayiwa K. Extending the developmental origins of disease model: impact of preconception stress exposure on offspring neurodevelopment. Dev. Psychobiol. 2018;60(7):753–764. DOI: 10.1002/dev.21773Răchită A., Strete G.E., Suciu L.M. et al. psychological stress perceived by pregnant women in the last trimester of pregnancy. Int. J. Environ. Res. Public Health. 2022;19(14):8315. DOI: 10.3390/ijerph19148315Răchită A., Strete G.E., Suciu L.M. et al. psychological stress perceived by pregnant women in the last trimester of pregnancy. Int. J. Environ. Res. Public Health. 2022;19(14):8315. DOI: 10.3390/ijerph19148315O'Donnell K.J., Bugge Jensen A., Freeman L. et al. Maternal prenatal anxiety and downregulation of placental 11β-HSD2. Psychoneuroendocrinology. 2012;37(6):818–826. DOI: 10.1016/j.psyneuen.2011.09.014O'Donnell K.J., Bugge Jensen A., Freeman L. et al. Maternal prenatal anxiety and downregulation of placental 11β-HSD2. Psychoneuroendocrinology. 2012;37(6):818–826. DOI: 10.1016/j.psyneuen.2011.09.014Kassotaki I., Valsamakis G., Mastorakos G., Grammatopoulos D.K. Placental CRH as a signal of pregnancy adversity and impact on fetal neurodevelopment. Front. Endocrinol. (Lausanne). 2021;12:714214. DOI: 10.3389/fendo.2021.714214Kassotaki I., Valsamakis G., Mastorakos G., Grammatopoulos D.K. Placental CRH as a signal of pregnancy adversity and impact on fetal neurodevelopment. Front. Endocrinol. (Lausanne). 2021;12:714214. DOI: 10.3389/fendo.2021.714214Konstantakou P., Mastorakos G., Vrachnis N. et al. Dysregulation of 11beta-hydroxysteroid dehydrogenases: implications during pregnancy and beyond. J. Matern. Fetal Neonatal. Med. 2017;30(3):284–293. DOI: 10.3109/14767058.2016.1171308Konstantakou P., Mastorakos G., Vrachnis N. et al. Dysregulation of 11beta-hydroxysteroid dehydrogenases: implications during pregnancy and beyond. J. Matern. Fetal Neonatal. Med. 2017;30(3):284–293. DOI: 10.3109/14767058.2016.1171308Jašarević E., Howard C.D., Morrison K. et al. The maternal vaginal microbiome partially mediates the effects of prenatal stress on offspring gut and hypothalamus. Nat. Neurosci. 2018;21(8):1061–1071. DOI: 10.1038/s41593-018-0182-5Jašarević E., Howard C.D., Morrison K. et al. The maternal vaginal microbiome partially mediates the effects of prenatal stress on offspring gut and hypothalamus. Nat. Neurosci. 2018;21(8):1061–1071. DOI: 10.1038/s41593-018-0182-5Yeramilli V., Cheddadi R., Shah J. et al. A review of the impact of maternal prenatal stress on offspring microbiota and metabolites. Metabolites. 2023;13(4):535. DOI: 10.3390/metabo13040535Yeramilli V., Cheddadi R., Shah J. et al. A review of the impact of maternal prenatal stress on offspring microbiota and metabolites. Metabolites. 2023;13(4):535. DOI: 10.3390/metabo13040535Zaboski B.A., Storch E.A. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31–37. DOI: 10.2217/fnl-2017-0030Zaboski B.A., Storch E.A. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31–37. DOI: 10.2217/fnl-2017-0030Abildgaard A., Elfving B., Hokland M. et al. Probiotic treatment reduces depressive-like behaviour in rats independently of diet. Psychoneuroendocrinology. 2017;79:40–48. DOI: 10.1016/j.psyneuen.2017.02.014Abildgaard A., Elfving B., Hokland M. et al. Probiotic treatment reduces depressive-like behaviour in rats independently of diet. Psychoneuroendocrinology. 2017;79:40–48. DOI: 10.1016/j.psyneuen.2017.02.014Li J., Wang J., Wang M. et al. Bifidobacterium: a probiotic for the prevention and treatment of depression. Front. Microbiol. 2023;14:1174800. DOI: 10.3389/fmicb.2023.1174800Li J., Wang J., Wang M. et al. Bifidobacterium: a probiotic for the prevention and treatment of depression. Front. Microbiol. 2023;14:1174800. DOI: 10.3389/fmicb.2023.1174800Brawner K.M., Yeramilli V.A., Kennedy B.A. et al. Prenatal stress increases IgA coating of offspring microbiota and exacerbates necrotizing enterocolitis-like injury in a sex-dependent manner. Brain Behav. Immun. 2020;89:291–299. DOI: 10.1016/j.bbi.2020.07.008Brawner K.M., Yeramilli V.A., Kennedy B.A. et al. Prenatal stress increases IgA coating of offspring microbiota and exacerbates necrotizing enterocolitis-like injury in a sex-dependent manner. Brain Behav. Immun. 2020;89:291–299. DOI: 10.1016/j.bbi.2020.07.008Cheddadi R., Narendra Khandekar N., Yeramilli N., Colin M. The impact of maternal stress on the development of necrotizing enterocolitis: a comprehensive review. Semin. Pediatr. Surg. 2023;32(3):151324. DOI: 10.1016/j.sempedsurg.2023.151324Cheddadi R., Narendra Khandekar N., Yeramilli N., Colin M. The impact of maternal stress on the development of necrotizing enterocolitis: a comprehensive review. Semin. Pediatr. Surg. 2023;32(3):151324. DOI: 10.1016/j.sempedsurg.2023.151324Walsh K., McCormack C.A., Webster R. et al. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc. Natl. Acad. Sci. USA. 2019;116(48):23996–24005. DOI: 10.1073/pnas.1905890116Walsh K., McCormack C.A., Webster R. et al. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc. Natl. Acad. Sci. USA. 2019;116(48):23996–24005. DOI: 10.1073/pnas.1905890116Bierer L.M., Bader H.N., Daskalakis N.P. et al. Intergenerational effects of maternal holocaust exposure on FKBP5 methylation. Am. J. Psychiatry. 2020;177(8):744–753. DOI: 10.1176/appi.ajp.2019.19060618Bierer L.M., Bader H.N., Daskalakis N.P. et al. Intergenerational effects of maternal holocaust exposure on FKBP5 methylation. Am. J. Psychiatry. 2020;177(8):744–753. DOI: 10.1176/appi.ajp.2019.19060618Zaidan H., Leshem M., Gaisler-Salomon I. Prereproductive stress to female rats alters corticotropin releasing factor type 1 expression in ova and behavior and brain corticotropin releasing factor type 1 expression in offspring. Biol. Psychiatry. 2013;74(9):680–687. DOI: 10.1016/j.biopsych.2013.04.014Zaidan H., Leshem M., Gaisler-Salomon I. Prereproductive stress to female rats alters corticotropin releasing factor type 1 expression in ova and behavior and brain corticotropin releasing factor type 1 expression in offspring. Biol. Psychiatry. 2013;74(9):680–687. DOI: 10.1016/j.biopsych.2013.04.014Moog N.K., Buss C., Entringer S. et al. Maternal exposure to childhood trauma is associated during pregnancy with placental-fetal stress physiology. Biol. Psychiatry. 2016;79(10):831–839. DOI: 10.1016/j.biopsych.2015.08.032Moog N.K., Buss C., Entringer S. et al. Maternal exposure to childhood trauma is associated during pregnancy with placental-fetal stress physiology. Biol. Psychiatry. 2016;79(10):831–839. DOI: 10.1016/j.biopsych.2015.08.032Bush N.R., Noroña-Zhou A., Coccia M., Rudd K.L. Intergenerational transmission of stress: multi-domain stressors from maternal childhood and pregnancy predict children's mental health in a racially and socioeconomically diverse, multi-site cohort. Soc. Psychiatry Psychiatr Epidemiol. 2023. DOI: 10.1007/s00127-022-02401-zBush N.R., Noroña-Zhou A., Coccia M., Rudd K.L. Intergenerational transmission of stress: multi-domain stressors from maternal childhood and pregnancy predict children's mental health in a racially and socioeconomically diverse, multi-site cohort. Soc. Psychiatry Psychiatr Epidemiol. 2023. DOI: 10.1007/s00127-022-02401-zChan J.C., Nugent B.M., Bale T.L. Parental advisory: maternal and paternal stress can impact offspring neurodevelopment. Biol. Psychiatry. 2018;83(10):886–894. DOI: 10.1016/j.biopsych.2017.10.005Chan J.C., Nugent B.M., Bale T.L. Parental advisory: maternal and paternal stress can impact offspring neurodevelopment. Biol. Psychiatry. 2018;83(10):886–894. DOI: 10.1016/j.biopsych.2017.10.005Chan J.C., Morgan C.P., Leu N.A. et al. Reproductive tract extracellular vesicles are sufficient to transmit intergenerational stress and program neurodevelopment. Nat. Commun. 2020;11(1):1499. DOI: 10.1038/s41467-020-15305-wChan J.C., Morgan C.P., Leu N.A. et al. Reproductive tract extracellular vesicles are sufficient to transmit intergenerational stress and program neurodevelopment. Nat. Commun. 2020;11(1):1499. DOI: 10.1038/s41467-020-15305-wHipwell A.E., Fu H., Tung I. et al. Preconception stress exposure from childhood to adolescence and birth outcomes: the impact of stress type, severity and consistency. Front. Reprod. Health. 2023;4:1007788. DOI: 10.3389/frph.2022.1007788Hipwell A.E., Fu H., Tung I. et al. Preconception stress exposure from childhood to adolescence and birth outcomes: the impact of stress type, severity and consistency. Front. Reprod. Health. 2023;4:1007788. DOI: 10.3389/frph.2022.1007788Amici F., Röder S., Kiess W. et al. Maternal stress, child behavior and the promotive role of older siblings. BMC Public Health. 2022;22(1):863. DOI: 10.1186/s12889-022-13261-2Amici F., Röder S., Kiess W. et al. Maternal stress, child behavior and the promotive role of older siblings. BMC Public Health. 2022;22(1):863. DOI: 10.1186/s12889-022-13261-2Gu J., Guan H.-B. Maternal psychological stress during pregnancy and risk of congenital heart disease in offspring : A systematic review and meta-analysis. J. Affect. Disord. 2021;291:32–38. DOI: 10.1016/j.jad.2021.05.002Gu J., Guan H.-B. Maternal psychological stress during pregnancy and risk of congenital heart disease in offspring : A systematic review and meta-analysis. J. Affect. Disord. 2021;291:32–38. DOI: 10.1016/j.jad.2021.05.002Serpeloni F., Radtke K., de Assis S.G. et al. Grandmaternal stress during pregnancy and DNA methylation of the third generation: an epigenome-wide association study. Transl. Psychiatry. 2017;7(8):e1202. DOI: 10.1038/tp.2017.153Serpeloni F., Radtke K., de Assis S.G. et al. Grandmaternal stress during pregnancy and DNA methylation of the third generation: an epigenome-wide association study. Transl. Psychiatry. 2017;7(8):e1202. DOI: 10.1038/tp.2017.153Lopes N.A., Ambeskovic M., King S.E. et al. Environmental enrichment promotes transgenerational programming of uterine inflammatory and stress markers comparable to gestational chronic variable stress. Int. J. Mol. Sci. 2023;24(4):3734. DOI: 10.3390/ijms24043734Lopes N.A., Ambeskovic M., King S.E. et al. Environmental enrichment promotes transgenerational programming of uterine inflammatory and stress markers comparable to gestational chronic variable stress. Int. J. Mol. Sci. 2023;24(4):3734. DOI: 10.3390/ijms24043734Кельмансон И.А. Материнско-фетальная привязанность как естественный феномен беременности и формирования материнства. Педиатрия. Consilium Medicum. 2023;1:12–18. DOI: 10.26442/26586630.2023.1.202127Kelmanson I.A. Maternal-fetal attachment as a natural phenomenon of pregnancy and maternity development : a review. Pediatrics. Consilium Medicum. 2023;1:12–18. (in Russian). DOI: 10.26442/26586630.2023.1.202127Rossen L., Hutchinson D., Wilson J., Burns L. Predictors of postnatal mother–infant bonding: the role of antenatal bonding, maternal substance use and mental health. Arch. Womens Ment. Health. 2016;19(4):609–622. DOI 10.1007/s00737-016-0602-zRossen L., Hutchinson D., Wilson J., Burns L. Predictors of postnatal mother–infant bonding: the role of antenatal bonding, maternal substance use and mental health. Arch. Womens Ment. Health. 2016;19(4):609–622. DOI 10.1007/s00737-016-0602-zSingla D.R., Meltzer-Brody S.E., Silver R.K. et al. Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial. Trials. 2021;22(1):186. DOI: 10.1186/s13063-021-05075-1Singla D.R., Meltzer-Brody S.E., Silver R.K. et al. Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial. Trials. 2021;22(1):186. DOI: 10.1186/s13063-021-05075-1Sánchez-Polán M., Franco E., Silva-José C., Gil-Ares J. Exercise during pregnancy and prenatal depression : a systematic review and meta-analysis. Front. Physiol. 2021;12:640024. DOI: 10.3389/fphys.2021.640024Sánchez-Polán M., Franco E., Silva-José C., Gil-Ares J. Exercise during pregnancy and prenatal depression : a systematic review and meta-analysis. Front. Physiol. 2021;12:640024. DOI: 10.3389/fphys.2021.640024Pasha H., Faramarzi M., Chehrazi M. et al. Role of social capital and self-efficacy as determinants of stress in pregnancy. Tzu. Chi. Med. J. 2021;33(3):301–306. DOI: 10.4103/tcmj.tcmj_156_20Pasha H., Faramarzi M., Chehrazi M. et al. Role of social capital and self-efficacy as determinants of stress in pregnancy. Tzu. Chi. Med. J. 2021;33(3):301–306. DOI: 10.4103/tcmj.tcmj_156_20Young L.M., Pipingas A., White D.J. et al. A systematic review and meta-analysis of b vitamin supplementation on depressive symptoms, anxiety, and stress: effects on healthy and 'at-risk' individuals. Nutrients. 2019;11(9):2232. DOI: 10.3390/nu11092232Young L.M., Pipingas A., White D.J. et al. A systematic review and meta-analysis of b vitamin supplementation on depressive symptoms, anxiety, and stress: effects on healthy and 'at-risk' individuals. Nutrients. 2019;11(9):2232. DOI: 10.3390/nu11092232Du J., Zhu M., Bao H. et al. The role of nutrients in protecting mitochondrial function and neurotransmitter signaling: implications for the treatment of depression, PTSD, and suicidal behaviors. Crit. Rev. Food Sci. Nutr. 2016;56(15):2560–2578. DOI: 10.1080/10408398.2013.876960Du J., Zhu M., Bao H. et al. The role of nutrients in protecting mitochondrial function and neurotransmitter signaling: implications for the treatment of depression, PTSD, and suicidal behaviors. Crit. Rev. Food Sci. Nutr. 2016;56(15):2560–2578. DOI: 10.1080/10408398.2013.876960Godswill A.G., Somtochukwu I.V., Ikechukwu A.O., Kate E.C. Health benefits of micronutrients (vitamins and minerals) and their associated deficiency diseases : a systematic review. Int. J. Food Sci. 2020;3(1):1–32. doi: 10.47604/ijf.1024Godswill A.G., Somtochukwu I.V., Ikechukwu A.O., Kate E.C. Health benefits of micronutrients (vitamins and minerals) and their associated deficiency diseases : a systematic review. Int. J. Food Sci. 2020;3(1):1–32. doi: 10.47604/ijf.1024Oh C., Keats E.C., Bhutta Z.A. Vitamin and Mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries : a systematic review and meta-analysis. Nutrients. 2020;12(2):491. DOI: 10.3390/nu12020491Oh C., Keats E.C., Bhutta Z.A. Vitamin and Mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries : a systematic review and meta-analysis. Nutrients. 2020;12(2):491. DOI: 10.3390/nu12020491Серов В.Н. Информационное письмо Российского общества акушеров-гинекологов. РМЖ. Мать и дитя. 2019;2(2):84–88. DOI: 10.32364/2618-8430-2019-2-2-84-88Serov V.N. Information letter of the Russian Society of Obstetricians and Gynecologists. Russian Journal of Woman and Child Health. 2019;2(2):84–88. (in Russian). DOI: 10.32364/2618-8430-2019-2-2-84-88

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